Nurse Ann noticed that the house was clean and orderly. A tray in front of the TV had the remains of a ham sandwich and glass of ice tea.

Ann, a community nurse, made an afternoon home visit with Susan and her father. After the death of her mother, Susan had growing concerns about her father living alone. “I worry about my father all the time. He is becoming more forgetful and he has trouble seeing. Mom used to take care of him. I am not sleeping and I am irritable around him. Yesterday I shouted at him because he wouldn’t let me help him with his laundry. I felt terrible! I am at my wits’ end! My brothers and sisters do not want to put dad in a nursing home but they are not willing to help out. As usual, they have left me with all the responsibility. I work part time and have two small children to care for.” Susan’s father, Sam, sat quietly with tears filling his eyes. He was well nourished and well-groomed but would not make eye contact. Nurse Ann noticed that the house was clean and orderly. A tray in front of the TV had the remains of a ham sandwich and glass of ice tea. Mail was piled up, unopened on a small table near the front door. There was only one car in the driveway and the yard was in need of attention.