This photo was taken the last time I remember seeing Grandma Sylvia smile. Alzheimer’s had already set in – she came to our engagement party in a hired ambulance and wasn’t sure why she was there. For the five years thereafter we only saw her in bed, where she withered away until her death. Sylvia suspected she was going to get Alzheimer’s. She saw what happened to her own mother (though it wasn’t diagnosed as Alzheimer’s back then), bought long term health insurance, downsized early and gave her children specific instructions to always keep her at home. I watched with respect as my mother-in-law Marilyn and her brother Jerry did their best to honor Sylvia’s wishes as she slipped further and further away. It was an example of pure love and commitment. Caring for Sylvia required an extended team of family members, caregivers, and even the doormen of her building who would help lift her out of bed into her wheelchair to go outside when that was still possible.

Looking back, I am ashamed that my husband and I weren’t more helpful. Now that I am a mother, I see how I could have done more. My mother-in-law assured me today that like her mother Sylvia she has planned for her own future. Frankly it doesn’t seem possible that a woman as talented, joyful, funny and loving as Marilyn could become a person in a bed who doesn’t recognize her grandchildren. But the frightening and sad truth is that it is possible. And while I am grateful that she has the resources to pay for her long-term care, I don’t want to lose her or anyone in our family the way we lost Sylvia.