Adult children are less likely to assist an aging stepparent, studies show. A growing “step gap” in senior care worries experts.The encounter happened years ago, but Beverly K. Brandt remembers it vividly.She was leaving her office at Arizona State University, where she taught design history, to run an errand for her ailing stepfather. He had moved into a retirement community nearby after his wife, Dr. Brandt’s mother, died of cancer.As his caregiver, Dr. Brandt spoke with him daily and visited twice a week. She coordinated medical appointments, prescriptions, requests for facility staff — the endless responsibilities of maintaining a man in his 90s.Maybe she looked especially frazzled that day, she said, because a longtime colleague drew her aside with a startling question.“Beverly, why are you doing this?” he said. “He’s not a blood relative. He’s just a stepfather. You don’t have any obligations.”“I was dumbfounded,” Dr. Brandt, 72, recalled. “I still can’t understand it.”She was 5 when her father died. Three years later, she said, her mother married Mark Littler, an accounting executive and a “wonderful” parent.“He’d come home from a grueling job, change out of his good clothes, then carry me around the living room on his back,” she recalled. Later, he introduced her to the symphony and the theater, funded her graduate education and mentored her as she entered the academic world.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Researchers are only beginning to understand why some people embrace retirement while others won’t even consider it.Beth Bergmans liked working as a project manager for an online university based in Minnesota. “We are offering opportunities for people to advance in life — that brought some satisfaction,” she said. “And the people I work with are awesome.”Ms. Bergmans, 63, planned to stay on the job for two years, until she qualified for Medicare. But in recent months, something had shifted, subtly. In her fast-paced workplace, she began to find it harder to recall the details of recent meetings, to retrieve words and to filter out distractions. She took short breaks at her desk to recharge.“You find ways to adapt,” she said. “You use Post-it notes and whiteboards, and you spend more time prepping before a meeting.” Nobody complained or even seemed to notice, but Ms. Bergmans worried.“People don’t really talk about this, the fear that you’re starting to slip professionally,” she said. “The last thing I want is to crash and burn at the end because I didn’t recognize that it was time to stop.”So a couple of weeks ago, Ms. Bergmans told her manager that she would retire at the end of the year.Sometimes it works this way: People engaged in and proud of their careers, intending to continue past typical retirement ages, encounter internal or external difficulties and step aside, even if no one is urging them to resign or retire.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Many Americans plan to donate their organs for transplants or their bodies for medical science. Few realize that there’s a growing need for their brains, too.About a month ago, Judith Hansen popped awake in the predawn hours, thinking about her father’s brain.Her father, Morrie Markoff, was an unusual man. At 110, he was thought to be the oldest in the United States. His brain was unusual, too, even after he recovered from a stroke at 99.Although he left school after the eighth grade to work, Mr. Markoff became a successful businessman. Later in life, his curiosity and creativity led him to the arts, including photography and sculpture fashioned from scrap metal.He was a healthy centenarian when he exhibited his work at a gallery in Los Angeles, where he lived. At 103, he published a memoir called “Keep Breathing.” He blogged regularly, pored over The Los Angeles Times daily, discussed articles in Scientific American and followed the national news on CNN and “60 Minutes.”Now he was nearing death, enrolled in home hospice care. “In the middle of the night, I thought, ‘Dad’s brain is so great,’” said Ms. Hansen, 82, a retired librarian in Seattle. “I went online and looked up ‘brain donation.’”Her search led to a National Institutes of Health web page explaining that its NeuroBioBank, established in 2013, collected post-mortem human brain tissue to advance neurological research.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

At an assisted living facility in New York State, a small crowd had gathered at the dining room entrance at lunchtime, waiting for the doors to open. As a researcher observed, one woman, growing tired and frustrated, asked the man in front of her to move; he didn’t appear to hear.“Come on, let’s get going!” she shouted — and pushed her walker into him.In Salisbury, Md., a woman awoke in the darkness to find another resident in her bedroom in an assisted living complex. Her daughter, Rebecca Addy-Twaits, suspected that her 87-year-old mother, who had dementia and could become confused, was hallucinating about the encounter.But the man, who lived down the hall, returned half a dozen times, sometimes during Ms. Addy-Twaits’s visits. He never menaced or harmed her mother, but “she’s entitled to her privacy,” Ms. Addy-Twaits said. She reported the incidents to administrators.In long-term care facilities, residents sometimes yell at or threaten one other, lob insults, invade fellow residents’ personal or living space, rummage through others’ possessions and take them. They can swat or kick or push.Or worse. Eilon Caspi, a gerontologist at the University of Connecticut, has searched news coverage and coroners’ reports and identified 105 resident deaths in long-term care facilities over 30 years that resulted from incidents involving other residents.The actual number is higher, he said, because such deaths don’t always receive news media attention or are not reported in detail to the authorities.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Medicare Advantage plans say it reduces waste and inappropriate care. Critics say it often restricts coverage unnecessarily.Slowly but steadily, Marlene Nathanson was recovering. She had suffered a stroke in November 2022 at her home in Minneapolis and spent a week in a hospital; afterward, when she arrived at Episcopal Homes in St. Paul for rehabilitation, she couldn’t walk. Weakness in her right arm and hand left her unable to feed herself, and her speech remained somewhat garbled.But over three weeks of physical, occupational and speech therapy, “she was making good progress,” her husband, Iric Nathanson, said. “Her therapists were very encouraging.” Ms. Nathanson, then 85, had begun to get around using a walker. Her arm was growing stronger and her speech had nearly returned to normal.Then, on a Wednesday afternoon, one of her therapists told the Nathansons that their Medicare Advantage plan had refused a request to cover further treatment. “She has to leave our facility by Friday,” the therapist said, apologetically.Mr. Nathanson, then 82, felt anxious and angry. He didn’t see how he could arrange for home care aides and equipment in 48 hours. Besides, he said, “it didn’t seem right that the therapists and professionals couldn’t determine the course of her care” and had to yield to an insurance company’s dictates. “But apparently it happens a lot.”It does. Traditional Medicare rarely requires so-called prior authorization for services. But virtually all Medicare Advantage plans invoke it before agreeing to cover certain services, particularly those carrying high price tags, such as chemotherapy, hospital stays, nursing home care and home health.“Most people come across this at some point if they stay in a Medicare Advantage plan,” said Jeannie Fuglesten Biniek, associate director of the program on Medicare policy at KFF, the nonprofit health policy research organization. After years of steep growth, more than half of Medicare beneficiaries are now enrolled in Advantage plans, which are administered by private insurance companies.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Trained negotiators can help families struggling with vexing elder-care issues.The four adult children were in agreement.Their father, William Curry, a retired electrical engineer and business executive, was sinking deeper into dementia. They had found a memory care facility about a mile from their parents’ house in Chelmsford, Mass., where they thought Mr. Curry would do better.But their mother, Melissa, who was 83 when her family began urging her to make this change in 2016, remained determined to continue caring for her 81-year-old husband at home, despite the increasing toll on her own health. When her children raised the issue of a move, “she wouldn’t discuss it,” said her daughter, Shannon Curry, 56. “She’d clam up. Sometimes she’d cry.”Yet Melissa Curry’s memory was faltering, too. She would forget to give her husband his medications, or get the doses wrong. The family worried about falls and fires. Even after they persuaded her to accept a hired aide several days a week, the couple was still alone most of the day as well as overnight.As the weeks passed, “we were really at an impasse,” Ms. Curry said. “Do you override your mother?”Enter the mediator. Through a friend, Ms. Curry learned about Elder Decisions, a company offering “elder adult family mediation.” Her parents and siblings all agreed to give it a try. Crystal Thorpe, the company’s principal and founder, and a co-mediator, Rikk Larsen, interviewed family members by phone, then scheduled a session around the parents’ dining room table.Often associated with business disputes or divorce and custody cases, trained mediators can also help families struggling with an array of vexing elder-care issues: appropriate living arrangements, care responsibilities, communication and information sharing, and health and financial decisions.When families seek mediation, they “want to do what is best, but have different perspectives on what ‘best’ might mean,” Ms. Thorpe explained.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Homeownership is not the boon to older Americans that it once was.When it came to housing, Susan Apel and Keith Irwin thought they had planned adroitly for later life. They bought a four-bedroom house on two acres in Lebanon, N.H., 24 years ago, and “we made sure to pay off the mortgage before we retired,” said Ms. Apel, 71.That way, the home equity they had built up — they estimate their house is now worth about $700,000 — would allow them to sell and downsize into smaller, more manageable quarters when they needed them.That time has arrived. Ms. Apel, a retired law professor, is having trouble climbing stairs. Mr. Irwin, 71, previously an account manager for a local business, is wearying of yard work and snow shoveling, and finding workers to do those chores instead has become difficult.“We’re seeing the writing on the wall,” Ms. Apel said. They have started shopping for “a nice two-bedroom condo with a little den, all on one floor.”But they can’t find one. Local developers are putting up four-level townhouses with even more stairs. The few suitable one-floor homes available get instantly snapped up. City dwellers fleeing Covid helped pump up housing prices: One unit the couple saw recently cost $950,000 and needed work, Ms. Apel reported. Even “tiny shoeboxes” are selling for $600,000.“We were very grateful to live in this lovely place and to have paid off our house,” Ms. Apel said. “It never occurred to us that it didn’t give us the ability to move out of it.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The pandemic played a role in increased consumption, but alcohol use among people 65 and older was climbing even before 2020.The phone awakened Doug Nordman at 3 a.m. A surgeon was calling from a hospital in Grand Junction, Colo., where Mr. Nordman’s father had arrived at the emergency room, incoherent and in pain, and then lost consciousness.At first, the staff had thought he was suffering a heart attack, but a CT scan found that part of his small intestine had been perforated. A surgical team repaired the hole, saving his life, but the surgeon had some questions.“Was your father an alcoholic?” he asked. The doctors had found Dean Nordman malnourished, his peritoneal cavity “awash with alcohol.”The younger Mr. Nordman, a military personal finance author living in Oahu, Hawaii, explained that his 77-year-old dad had long been a classic social drinker: a Scotch and water with his wife before dinner, which got topped off during dinner, then another after dinner, and perhaps a nightcap.Having three to four drinks daily exceeds current dietary guidelines, which define moderate consumption as two drinks a day for men and one for women, or less. But “that was the normal drinking culture of the time,” said Doug Nordman, now 63.At the time of his hospitalization, though, Dean Nordman, a retired electrical engineer, was widowed, living alone and developing symptoms of dementia. He got lost while driving, struggled with household chores and complained of a “slipping memory.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Federal law requires states to go after the assets, usually homes, of people who died after receiving benefits for long-term care.The letter came from the state department of human services in July 2021. It expressed condolences for the loss of the recipient’s mother, who had died a few weeks earlier at 88.Then it explained that the deceased had incurred a Medicaid debt of more than $77,000 and provided instructions on how to repay the money. “I was stunned,” said the woman’s 62-year-old daughter.At first, she thought the letter might be some sort of scam. It wasn’t.She asked not to be identified, because the case is unresolved and she doesn’t want to jeopardize her chances of getting the bill reduced. The New York Times has reviewed documentation substantiating her account.The daughter moved into the family’s Midwestern home years earlier, when her widowed mother, who had vascular dementia, began to need assistance.Her mother was well insured, with Medicare, a private supplemental “Medigap” policy and long-term care insurance. The only reason she enrolled in Medicaid was that she had signed up for a state program that allowed her daughter to receive modest payments for caregiving.But that triggered additional monthly charges through a Medicaid managed care organization, and now the state wants that money back.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

New criteria could lead to a dementia diagnosis on the basis of a simple blood test, even in the absence of obvious symptoms. Determining whether someone has Alzheimer’s disease usually requires an extended diagnostic process. A doctor takes a patient’s medical history, discusses symptoms, administers verbal and visual cognitive tests.The patient may undergo a PET scan, an M.R.I. or a spinal tap — tests that detect the presence of two proteins in the brain, amyloid plaques and tau tangles, both associated with Alzheimer’s.All of that could change dramatically if new criteria proposed by an Alzheimer’s Association working group are widely adopted.Its final recommendations, expected later this year, will accelerate a shift that is already underway: from defining the disease by symptoms and behavior to defining it purely biologically — with biomarkers, substances in the body that indicate disease.The draft guidelines, Revised Criteria for Diagnosis and Staging of Alzheimer’s Disease, call for a simpler approach. That could mean a blood test to indicate the presence of amyloid. Such tests are already available in some clinics and doctors’ offices.“Someone who has biomarker evidence of amyloid in the brain has the disease, whether they’re symptomatic or not,” said Dr. Clifford R. Jack Jr., the chair of the working group and an Alzheimer’s researcher at the Mayo Clinic.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.