Episode Details

Leaving the Room
Separation Anxiety, the Caregiver's Own Life, and What a Fiduciary Actually Does
Contents
The Essay
1. Two People in One Room 3
2. A Letter from 1994 3
3. What Separation Anxiety Actually Is 3
4. Leaving Well 4
5. The Bench 5
6. The Caregiver Is the Second Patient 6
7. Two Households 6
8. Medicare Already Agrees with You 7
9. What a Fiduciary Does in This Season 7
10. ALIVE, for Two 8
The Essay
1. Two People in One Room
There is a particular moment that nearly every family caregiver knows. You are standing at the front door with your keys in your hand, and the person you love asks, for the third time in ten minutes, where you are going and when you will be back. You answer patiently, and then you answer again. Then you face the real question, which is whether you are allowed to walk out the door at all.
This piece is about that moment. It covers three things: the practical side of separation anxiety in a loved one living with Alzheimer's or another dementia, or in a family member who is physically dependent; the caregiver's own health and why stepping away is an act of responsibility rather than selfishness; and what a true fiduciary wealth advisor and manager does when a family enters this season. It is not medical advice. Diagnosis, medication and behavior plans belong to the physician. This is about planning, logistics and permission.
Let me concede the obvious at the outset. Leaving is hard, the guilt is real, and on some days you genuinely cannot go. Nothing here pretends otherwise. What this piece argues is narrower and, I think, much harder to dispute: a caregiver who never leaves eventually cannot help anyone.
2. A Letter from 1994
On November 5, 1994, Ronald Reagan wrote a letter by hand to the American people telling them he had Alzheimer's disease. Most people remember its closing, about beginning the journey that would lead him into the sunset of his life. Fewer remember two sentences a little earlier: "Unfortunately, as Alzheimer's Disease progresses, the family often bears a heavy burden. I only wish there was some way I could spare Nancy from this painful experience."
Consider what that means. The man receiving the diagnosis, a man who had carried the weight of the presidency, spent part of that letter worrying about the person who would take care of him. He understood before most of the country did that Alzheimer's has two patients.
Nancy Reagan cared for him for the better part of ten years, until his death in June 2004. In 2002 she described it to Mike Wallace of 60 Minutes as "the long, long goodbye." She also said this: "When you come right down to it, you're in it alone, and there's nothing that anybody can do for you. So it's lonely." This was a woman with more resources than almost any caregiver in America: staff, security, money and friends in high places. She was lonely anyway. If the disease could isolate her, you should assume it can isolate you, and plan accordingly.
3. What Separation Anxiety Actually Is
Start with the scale, because it matters. The Alzheimer's Association's 2026 Facts and Figures report estimates that 7.4 million Americans age 65 and older are living with Alzheimer's dementia. More than 12 million family members and other unpaid caregivers provided an estimated 19.6 billion hours of care in 2025, and the Association values that unpaid work at $446.3 billion.
$446.3 billion.
The same report projects paid health and long-term care for people living with dementia at $409 billion in 2026. Set those two figures side by side and the conclusion is hard to escape: the largest dementia care provider in the United States is not Medicare, not Medicaid and not the nursing home industry. It is the family, working without a paycheck.
Now to the behavior itself. Caregivers call it shadowing. The person follows you from room to room, ask