A. It is always better to take a proactive approach to planning instead of waiting until an actual crisis occurs.

You identified two conditions that need to be assessed by a physician: her forgetfulness (a thinking problem) and why her legs are becoming weaker (a physical problem). It is important for a physician to identify the actual cause in order for your mother to receive the proper care.

Serious memory loss and confusion are not a part of the normal aging process. Forgetfulness becomes a more serious matter when it begins to interfere with normal daily routines. If this is the case, the physician should be seen as soon as possible for a thorough medical workup.

There are many conditions that cause memory loss: medication overuse/underuse; serious depression; poor nutrition; thyroid problems; head injury; severe dehydration among others. Often memory improves when the condition causing the problem is treated. Even if the diagnosis is Alzheimer's disease or a related illness, much can be done to treat the patient and help the family. The first step is to make an appointment with her physician and explain the reason for the visit. You want to ask the right questions and seek medical advice.

The Alzheimer's Association has a training program called "Partnering with Your Doctor: A Guide for Persons with Memory Problems and Their Care Partner." The program is designed to enable caregivers to work with the physician to get the best care, identifying the questions to ask the physician, and learning how to prepare for the physician's visit. The training is available at most of the 81 chapters throughout the United States.

Your mother may be too forgetful to let the physician know about her memory challenges or to even follow through with what the physician recommends. So it would be best to have someone to go with her to make sure that correct information is shared with the physician, prescribed tests are completed and that follow-up actions are taken.

If this is not possible, and since she is eligible, there are Medicaid programs that would pay for a person to accompany her to the medical visit, and follow up to make sure medical tests and appointments are completed.

If there are chronic medical conditions, then increased living supervision would be the desired intervention. There are care homes, assisted living homes, and in-home services available at various levels according to need.

The Alzheimer's Association is here to help you get through this maze of options and community resources for your mother, such as Nursing Home Without Walls, Case Management, and Public Health Nursing. For a current listing of names and agencies, or to speak directly to one of our professional staff, please call the Alzheimer's Association at (800) 272-3900 and ask for the Aloha Chapter.

Q. I have been taking care of my wheelchair-bound mother and mentally handicapped brother for the past eight years full time. Though they have income through Social Security and pension, it is barely enough for three of us. I don't have enough for my own medical and have been without medical insurance for many years. I have no income of my own. They have, in fact, become my sole support in a odd opposite sort of way.

My question is this. I have heard that there may be financial assistance and even food-stamp assistance given to caregivers. I would like to know if this true, and if so, how does it work?

A. If you have less than $2,000 in assets and no income, you personally may be eligible for assistance through the Department of Human Services. This would include food stamps and medical coverage. It is not because you are a caregiver, but rather because you are financially needy. Your mother's Social Security and pension are hers and for her care, and the same holds true for your brother; therefore their benefits are not counted as your income.

Certain caregivers may get a small hourly payment for a few hours a week from the state if the person they are caring for is already on Medicaid, but it does not sound like that is the case with your mother.

The best thing to do would be to get advice from a case manager, such as those at Ohana Care at Honolulu Gerontology Program (543-8468), which would look at the whole family situation and help you apply for anything you might qualify for, including services to help you in your caregiving.

A. There is no simple answer. Nelson can go to the General Assistance Office with the state to see if he qualifies for food stamps or welfare. He would have to meet asset limits.

Caregivers can be paid through the state Department of Human Services' chore services program; however, it has a waitlist of one to three years.

If his brother qualifies for Medicaid's developmentally disabled waiver, he may be able to get help there, and Nelson could qualify as a caregiver.

If the family owns their home, they may be able to do a reverse mortgage, which would bring the greatest relief. If they are renting and are not currently in affordable housing, they might want to waitlist for an affordable unit.

Nelson may also want to consider a public clinic for his health care.

Q. Since the flood in Manoa, our grandmother seems very down, depressed and worried. What can we do?

A. The family should take grandmother to her doctor for a medical workup and possible referral for counseling. The factors affecting her depression should be explored. ...

These questions should be explored with her by a professional who has dealt with disaster victims.

A. If her home or possessions have been damaged or destroyed, she is experiencing feelings of loss and (maybe) is going through a grieving process. If she has not experienced personal loss, she may be exhibiting excessive anxiety and fear triggered by hearing about the losses of others. In either case, make an appointment for her to see a geriatrician (a doctor specializing in treating the elderly) who can make an assessment of her condition and advise you accordingly. Medication, counseling, or both may be recommended.

In communicating with her, be sure to acknowledge how she is feeling ("Grandma, I know you feel sad ... "), instead of trying to talk her out of it with logic. You might even talk about the future and assure her that you will keep her and her belongings safe.

A. Clinical depression can be very common in the elderly, particularly after a traumatic experience. They may have problems with sleeping, appetite, anxiety or irritability. She should be evaluated by a physician for depression. Many of the medications we use for depression now have little side effects and are well tolerated.

Q. My mother lives on Kaua'i with my brother. They have a nice home, and until recently, she has been able to stay alone during the day. Unfortunately, she broke her hip about a month ago and was in Wilcox Hospital for one week, then moved to Garden Isle Health Care facility (also in Wilcox Hospital) for rehab. She has been released from Garden Isle Health Care and is still not able to walk. This presents a problem for my brother during the day. He has to work. Is there any assistance that would be available during the day until she fully recovers and is able to get around? Thank you.

A. There are several options the family can consider, depending on their economic ability to pay:

• Day healthcare. The family can apply for Medicaid if there is financial need and they need help to pay for the day healthcare. This is similar to daycare but for high needs adults.

• Hiring a home nurse aide or appropriate level for what they need for their mom. Rates vary with level of care.

• Care home or adult foster home — again depending on the level of care.

The family should contact the Kaua'i Office on Aging — (808) 241-6400 for available service providers and services. Or go back to the social worker at Garden Isle Health Care for options.