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In late life, increasing medical and cognitive problems are harbingers of the inevitable.
How does a family set goals for its oldest generation's last months or years?
Linda Casavecchia made her mother give up driving three years ago, and it's still a sore subject. Her bed is in the living room, and there's a commode in the dining room - like so many Philadelphia houses, hers doesn't have a bathroom on the first floor.
Her mother turns off the air conditioner on hot days. Linda Casavecchia, 57, who lives a few blocks away, comes every day to empty the commode, straighten up, and talk.
There was a brief, disastrous marriage to a man who made her heart flutter, then abandoned her.
When possible, she said, it's much better to tour facilities - together - before a broken hip or stroke forces the issue.
The decision is dauntingly complex, forcing families to grapple with their ability to provide care in the home or pay for help.
"You're just torn." Meanwhile her mother, who is wary of strangers and did not want her name used, said she's happy where she is.
She feels young and says there's nothing wrong with her mind, though she has dementia. "I can do whatever the hell I want." More than 13 million older adults were living alone in 2015, including 46 percent of all women 75 and older.