How do you know when you're enabling an elderly loved one to slide by the easy way as opposed to actually helping them out with something they need?

It's never an easy choice and the answer may differ on any given day.

I watched my mom struggle with painful arthritis in every joint. She'd had two hip replacements and her knees rubbed bone against bone with every step. Sometimes, watching her struggle with her walker tore at my heart so much, I could hardly help but insist that she let me get her into the wheelchair.

Yet, we both knew that if she didn't move she'd get worse.

Arthritis can freeze the joints so that movement gradually becomes almost impossible. This is one of many examples of "use it or lose it." Knowing this, I tried to rein in my tendency to be overly helpful. I attempted to encourage Mom to do what she could, while still being available to help when she needed me to.

Here are some other situations where caregivers can find themselves toeing the line between assisting and enabling a love one:

The parent who wants (but doesn't necessarily need) everything done for him or her

Some old people refuse help from their younger family members, while others would like to retire from life and let – no, expect – their relatives to be available at all times, to satisfy their every whim.

How do you handle parents like this?

You press them to do what they can for themselves, while reassuring them that you are available for specific chores and emergencies. You might also consider making an extra effort to visit your parents regularly; not for any other reason than just to see how they are doing. This may serve to reinforce the idea that they needn't demand your attention to get it.

This philosophy fits into the "ignore bad behavior and reward good behavior" school of thought.

What about addictive behavior?

Millions of baby boomers struggle to cope with an elder's addictive behavior, which could involve anything from cigarettes, alcohol and drugs to eating unhealthy foods.

What is the place of an adult child in such a situation? Enable the addiction, or refuse to take part?

While some may say there is only one right answer – you take away the harmful substance, or at least don't help them obtain their drug of choice – I can't say that I'd always agree.

Many caregivers are torn between their elder's need for cigarettes and the knowledge that said cigarettes are bad for their loved ones.

My feeling is that unless there is a way to humanely help an addicted person quit smoking, for many caregivers there's not much choice but to accept that their elder will smoke, at least in their own homes – with or without the caregiver's help.

One potentially helpful device that is available these days is the electronic cigarette, or the e-cigarette. This device is an electronic inhaler that vaporizes a liquid solution of nicotine into an aerosol mist. The inhaler resembles a cigarette and the physical act of inhaling simulates the act of tobacco smoking.

While this device may not help smokers to quit the habit as advertised, it may provide a safer way for a shaky, forgetful elder to "smoke" more safely—without flame or risk of fire. Some readers have said that the e-cigarette has given them a middle ground when it came to convincing their elders to give up conventional cigarettes.

Alcohol is another issue. Alcohol abuse in the elderly population is a serious problem.

For an alcohol-addicted elder who is even slightly willing, obtaining help through medical treatment and/or Alcoholics Anonymous would be ideal. You can also try an intervention with the help of professional addiction therapists.

However, the reality is that many elders are too far into their end-of-life journey to give up their addictive behavior. Thus, the humane approach may be to allow them to keep their long-held source of comfort. Watering down their alcohol—if you can gain access to it—may help them drink less.

If they can't or won't quit drinking, keeping them as safe as possible may be your only realistic choice. You – and they – know that they are damaging their health and risking falls. But short of locking them up, for some there is no other way.

Only you can make the decision whether to cooperate, ignore or flat out refuse to be a part of your parent's addiction. There will be consequences either way.

Much depends on their age and physical condition. When it comes to illegal amounts of pain killers and other drugs, you cannot help them continue that kind of addiction. You should get them medical help for withdrawal and try not to judge them; but don't risk your own future in an effort to obtain illegal substances for them.

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Encouraging independence is good for self esteem

When it comes to walking the line between helping and enabling—as with most situations involving human beings—easy solutions rarely present themselves.

Nearly every caregiver will regularly face the dilemma of determining whether they are helping or hurting their vulnerable loved ones by providing a particular service, or access to some substance.

However, even the most vulnerable elders may have areas where they can help themselves.

My first elder, Joe, liked to walk the ten blocks or so to our downtown area on a nice day. His destination was a bar that had been a big part of his life when he'd been a working man. He'd then take a cab home when he was good and ready.

When I offered to give Joe a lift, he'd decline saying the walk was good for him. I knew it was, physically and psychologically. However, a deaf old man wobbling his way over sometimes slippery sidewalks is pretty scary business. Many a time, I'd practically hold my breath until I'd see the cab drop him off at his home.

Yet this was Joe's choice.

He was happy for me to get his groceries. He was happy for me to take him on errands. But his bar run was his.

Frankly, this was good for me, too, because I didn't have to feel guilty if he was even more wobbly when he arrived home. We agreed that I would mind my own business when he chose to take those journeys.

If there is some way your loved one can experience a little independence, then that should be encouraged. Good days may require less help from a caregiver, whereas bad days may require significantly more.

Helping versus enabling is just one more moving target that makes caregivers second-guess themselves.

Above all, try not to do doubt yourself. You will never be perfect in your decision-making process.

Rather, make a decision based on the best information you have at the time and move forward.