Introduction

The days of Purim are days of joy, and the fulfillment of the holiday’s mitzvot – reading the megillah, mishloach manot, matanot le’evyonim, and the mitzvah feast (together with the reading of Parshat Zachor on the Shabbat before Purim, and Taanit Esther) – can awaken pleasant memories and emotions and generally can uplift the spirits of those with dementia. Alongside this, the tumult and noise that are involved in some of the events of Purim can disturb them and make them uncomfortable, a matter that applies to all patients in general. In this paper we will deal with the fulfilment of the mizvot of the Purim days for a person with dementia, a patient and their caretakers and the possibility of integrating them into the family and the community. As a general principle, in some of the medical conditions delineated further on, the patient is exempt from fulfilling mitzvot, yet there is also room to allow them to fulfill these mitzvot if it would benefit them. When one is obligated in mitzvot or when it is observed that fulfilling mitzvot benefits him even if he is exempt – the family and the community members are responsible for creating the appropriate conditions for fulfilling the mitzvot of the day.

Halachic Principles

1. A person with dementia who understands what Purim is and is aware of the mitzvot of the day (even if they require a reminder) – is obligated in all mitzvot of the day as well as hearing Parshat Zachor on the Shabbat before Purim. When they are totally unaware of the significance of the day or the mitzvot – they are exempt from the mitzvot of the day¹.

2. If fulfilling these mitzvot involves great difficulty or suffering for the person with dementia or patient with complex disease, he is exempt².

3. Even when a person with dementia or complex disease is exempt from mitzvot, they may spiritually and mentally benefit from participating in the experience of reading the megillah (in synagogue or at home), the holiday feast with family, etc. Therefore, it is proper to integrate them wherever possible – however one should not overburden them and should act in their interests based on their current state³.

4. One who takes care of a person with dementia or a patient who requires constant supervision is considered “currently engaged in a mitzvah” (osek bamitzvah). When they are the sole caretaker, they are exempt from other mitzvot; and even when they are not directly taking care of the patient, if the sickness is life-threatening, they are exempt from other mitzvot, and this rule applies as well when there is a reasonable concern that fulfilling the mitzvah will negatively impact the patient’s care. If there is more than one caretaker, the caretaker must excuse himself from taking care of the patient and fulfill the mitzvah⁴.

Parshat Zachor

5. A person with dementia who is aware that there is a mitzvah to hear Parshat Zachor  should listen to the reading in synagogue. If it is difficult for him to come to synagogue or stay there for an extended period, he can read (or someone can read for him) out of a Chumash in his home⁵.

Taanit Esther

6. Taanit Esther is an ancient and important custom that all Jews follow, yet it is not an obligation, and therefore a person with dementia is exempt from fasting. It is proper for a caretaker to begin the fast and if he feels that the fast is becoming difficult for him with his work, he may break the fast⁶.

The Joy of Purim

7. There is a mitzvah to be joyous on Purim, as is written “to make them days of feasting and joy”⁷. Included within the mitzvah of joy is caring for the joy of those who have difficulty being happy and are preoccupied with their worries. Therefore, it is the obligation of the friends, neighbors, and congregation members to pay attention to the needs of the sick and their family, who are busy all year and on Purim taking care of their relatives, providing them with joy, and assisting them in all their needs⁸.

Reading the Megillah

8. A person with dementia who is aware that there is an obligation to recite the megillah, even if one must remind him, is obligated to hear the megillah. It is proper to include him in the megillah reading in the synagogue. If he is acting in a manner that disgraces himself or his family, or if the matter could disturb those who are praying, the congregation has an obligation to find an appropriate way to integrate them into the congregation at synagogue. If the disturbance is great, it is better that they do not come to synagogue⁹.

9. Despite this, it is proper to assess – together with the dementia patient or without him – if the recital at synagogue is appropriate for him and if it is perhaps better to hear the reading in a shortened format due to the commotion around the recital and its length, or a personal reading tailored to his needs¹⁰.

10. A person with dementia who is obligated to hear the megillah and is unable to go to the recital with a minyan – should hear the recital at home. Ideally a man should recite for a man, and a woman can hear recital from a man or a woman. When it is necessary for the recital to be performed by a woman, a man can fulfill his obligation with this reading¹¹.

11. When one is reciting the megillah exclusively for a person with dementia and there is a doubt if he is obligated in hearing it – they should read it without making a blessing¹².

12. One may stop the recital of the megillah in the middle in order to perform the needs of the dementia patient. One should abstain from speaking during the break, yet one should not point this out to the dementia patient. Even if the break is long and even if they spoke in the interim, one should return to the location where they stopped and there is no need to start over at the beginning of the megillah¹³.

13. A person with dementia is permitted to eat before reading the megillah, both at night and during the day. Regarding a caretaker who is waiting to hear the megillah but needs to eat, they should eat fruits or a small portion of food but should not fix a meal¹⁴.

14. The ideal time for reading the megillah is from the appearance of three stars at nightfall (tzeit hakochavim). Regarding a person with dementia who needs to hear the megillah early, such as in a case where one would need to wait a long time for someone to recite it for them after tzeit hakochavim or if according to their normal schedule they would go to sleep earlier – one may recite it for him starting from 1 and a quarter hour before sunset (plag minchah). (For the year 5784, plag minchah of Purim in Israel is at 15:36). In a year where the megillah recital is after Shabbat (such as this year – 5784), one cannot read the megillah early before Shabbat ends. A caretaker that cannot hear the megillah because they are taking care of their relative can fulfill their obligation with this reading (see article 4 as well)¹⁵.

15. If there is no possibility of reading from a kosher megillah scroll – for a person with dementia, one can hear the megillah on the phone or through Zoom, even though they do not fulfill their obligation through this reading¹⁶.

16. Regarding a person with dementia who regularly reads the megillah who is still of sound mind and wishes to recite it for the congregation, however there is a reasonable concern that he will make a mistake, it is best to convince him not to read (and of course that one should talk to him before Purim and not embarrass him in front of the congregation). If he is suffering greatly, and on condition that this is a small burden for the congregation, it is proper to allow him to read all or part of the megillah¹⁷.

17. For a person with dementia who is aware of the mitzvah of mishloach manot and matanot le’evyonim – it is a mitzvah to assist them in fulfilling these mitzvot. When another person manages their financial affairs, the allocated amount for these gifts should be as much as the dementia patient would have given when he was healthy, however it should be according to his capabilities nowadays as well¹⁸.

18. It is proper to give mishloach manot to a person with dementia as well and provide joy to him through this, as well as matanot le’evyonim if he is a poor person; but if his cognitive state is declining – one should give mishloach manot and matanot le’evyonim to another person as well¹⁹.

The Purim Feast

19. Regarding a person with dementia who can participate in the family Purim feast – it is best that he be a participant and it is proper to set the feast at a time that fits with his schedule. If he is not able to participate in this feast, he fulfills his obligation with any meal at any time of the day (not at night)²⁰.

20. One who has difficulty drinking wine is not obligated to drink wine at the feast. A person with dementia should avoid drinking wine for medical reasons²¹.

A Person Sick with Complex Disease

21. A patient in the hospital or with supportive treatment at home who is unable to go to synagogue – can fulfill the mitzvot of Purim in the place where they are situated. Megillat Esther should be read from a kosher scroll and Parshat Zachor can be read from a Chumash. When necessary and when there is no other possibility, one may hear the reading through the phone or on Zoom²². One should allow the patient the conditions to fulfill the most basic obligations of the rest of the mitzvot – the Purim feast, mishloach manot, and matanot le’evyonim – and even beyond this if it would be beneficial for them.

22. A patient who is treated with painkillers that impair their alertness, and a patient who is very weak from their disease and the medical care does not need to be woken up in order to fulfill the mitzvot²³.  If he is unable to be awake for a sustained period necessary to hear the megillah, they are not obligated in the mitzvah. If the assessment is that fulfilling the mitzvah will provide him comfort and the suffering from lowering the dosage of the painkillers is minimal – one may wake him²⁴.

1.  See what we have written in the document ‘Obligations of a Dementia Patient on Fast Days and in Mourning Rites of the Three Weeks’, https://bit.ly/3Y2lE9q, endnote 3. Our conclusion there is that a person who with dementia who is able to understand their actions – is obligated to fulfill the mitzvah like a mentally competent individual; however, when they do not understand their actions or are not aware of the mitzvah act they are performing – they are exempt. The precise definition is dependent on various factors, primarily the person’s condition and their level of competency as well as the capabilities required to fulfill each mitzvah. When one is unable to make logical decision regarding expenses (a situation that at times presents early in the disease’s course), they are not obligation in the mitzvah of matanot le’evyonim, see footnote 18 later on.
2. See ibid., endnote 4. Rabbi Ovadiah Yosef (Chazon Ovadiah Responsa, article 4) writes that when fulfilling a mitzvah will lead to sickness one is exempt, and this is also the written by Rabbi Yaakov Ariel: “a sick person who is unable to fulfill a positive commandment without great distress and suffering, according to the eyes of my teacher, is exempt from fulfilling the mitzvah (BaOhalah Shel Torah Responsa, volume 2, article 92), and we will hopefully expand on this if God wills.
3. This is what we have written in the document ‘The Holiday Season for a Person with Dementia’, https://bit.ly/3Y2lE9q, and this is the opinion of Rabbi Yitzchok Zilberstein (Torah Lessons for Doctors, volume 3, article 208, page 483) regarding reading the megillah – that there is a benefit to hearing the reading so that words of Torah should flow into their ears and heart.
4. The Shulchan Aruch (640:3; all references here to the Shulchan Aruch, Beit Yosef and Rema as well as the commentaries on site are from Orach Chaim unless otherwise noted) rules that one who serves a sick person is exempt from a Sukkah since they are engaged in a mitzvah, and when the sick person does not need them – they are obligated (the Shulchan Aruch writes this under the title of “there are those who say”, however it is possible that everyone agrees regarding this. This is also written by the Kaf HaChaim, ibid., subarticle 17). However, regarding a patient with a life-threatening illness, one should be lenient even when they do not require their services (Mishneh Brura, ibid, subarticle 11; Kaf HaChaim, ibid.). However, if there is more than one caretaker, each one of them must excuse themselves at a different time in order to fulfill the mitzvah. (Mishneh Brura, ibid, subarticle 10). See the Shulchan Aruch 38:8, the Rema and the Biur Halacha there, ד”ה אם צריך לטרוח. Based on this rationale, Rabbi Yitzchok Zilberstein writes (Torat HaYoledet, chapter 14, article 6) that a person accompanying a woman in labor is exempt from various mitzvot, one of which is hearing the megillah. Therefore, one taking care of a dementia patient who requires constant supervision and does not go to synagogue – is exempt from going to synagogue to hear the megillah since there is a risk involved in leaving the patient alone. However, if the patient can read or hear it at home while being supervised and it is possible without being burdensome, he is obligated to hear the megillah, and this rule applies to other Purim mitzvot as well. One who takes care of a sick person who is not in danger is exempt during the treatment and obligated when the person does not need them. The medical and nursing team are also exempt from mitzvot while taking care of patients. See Rabbi Yitzchok Zilberstein, ibid., chapter 46, article 122 and in the addendums and commentaries, page 561; Rabbi Nachman Nuria, ‘When is the Medical Team Exempt from Fulfilling Mitzvot?”, Assia Books, 9 5764, pages 59-72.
5. The Shulchan Aruch (685:7) writes: “There are those who say that Parshat Zachor and Parshat Para Adumah are obligated to be read from a biblical perspective”. From his words there it seems that one must read it with a minyan, and this is also written in article 146:2. Even though the authorities have disagreed whether the mitzvah is biblical or rabbinic in origin and if there is an obligation to read it with a minyan and a Sefer Torah, all opinions believe one should first and foremost “hear Parshat Zachor from the shaliach tzibur who is reading the Torah” (Yechave Da’at Responsa, volume 1, article 84). The Mishneh Brura (article 685:16; Shaar HaTzion, subarticle 5) writes that there is no clear source for the obligation of reading the megillah with ten men and according to him and Rabbi Ovadiah Yosef (Yabia Omer Responsa, volume 8, Orach Chaim, article 54), one may fulfill their obligation without a minyan. The Mishneh Brura (ibid., subarticle 14 and 17) also writes that one should beautify the mitzvah by reading from a Sefer Torah even when reading without a minyan, but if there is no Sefer Torah one can read from a Chumash (this is also written by the Kaf HaChaim, ibid., subarticle 35 and Mikra’ei Kodesh, Purim, Arba Parshiot, article 7, page 88). Women are not obligated in hearing Parshat Zachor, but many tend to listen to the reading at synagogue or in their home, and this is the proper thing to do (See the opinion of Rabbi Ovadiah Yosef in the two aforementioned responsa). Therefore, a man with dementia who normally would go to synagogue should hear the reading there with the congregation, and if it is difficult for him to come – he should read it or listen to it at home from a Chumash. A woman with dementia, even if she would regularly listen to the reading in the past, can be lenient with this obligation, and if she wishes to hear – it should be read for her in her home, at synagogue, or she should read it herself.
6.  The Shulchan Aruch (686:2) rules that we fast on the 13^th of Adar, and the Rema adds that this fast is not an obligation and one may be lenient if necessary, such as in cases of a pregnant or breastfeeding woman and a sick person who is not at risk of life, but all other healthy individuals should not deviate from the congregation. Even though there are Rishonim who hold that the fast day is of rabbinic origin, and there are those who hold that this is the opinion of the Shulchan Aruch (so writes the Mateh Yehuda, article 686; Kaf HaChaim, article 686:17), even the Shulchan Aruch agrees that a pregnant and breastfeeding woman and a sick person are exempt, as he rules regarding all fasts beside for Tisha B’Av (554:5-6, in contrast with the Rema who is stringent there). So too writes Rabbi Ovadiah Yosef (Chazon Ovadiah, Purim, MeHilchot Taanit Esther, article 2 and footnote 4; according to him the Shulchan Aruch also holds that the fast is a custom). It is also written there that even a very elderly individual who is frail is exempt from and is not permitted to fast. All the more so are these matters true for a dementia patient. Regarding one taking care of a dementia patient, as the Rema writes, the rest of the healthy population should not deviate from the congregation, including one who is journeying and having difficulty fasting (Mishneh Brura, article 686:6; Chazon Ovadiah, ibid.). However, when the caretaker is having great difficulty fasting and there is a concern that the fast will negatively impact the treatment of the patient, there is room to be lenient. These matters are especially true regarding an elderly spouse taking care of a person with dementia (and this has also been written in the name of Rabbi Shlomo Zalman Auerbach regarding doctors and nurses on the four fast days, and in extreme cases even Tisha B’Av. See Halichot Shlomo, Moadei HaShana, Nissan-Av, chapter 13, footnote 12, page 400).
7.  Esther 9:22, see Shulchan Aruch 696:7 as well.
8. Regarding the mitzvah of being joyous on the holidays, the Rambam emphasized the obligation to feed the convert, orphan, and widow together with all the downtrodden poor people, and writes that anyone who cares only for themselves – “This is not joy of a mitzvah but of his stomach” (Mishneh Torah, Hilchot Yom Tov, chapter 6:18). The Mishneh Brura brings his opinion by the halachot of Purim as well and learns from here that “better to increase one’s gifts to the poor than to expand his feast and sending mishloach manot to his friends”.  Therefore, there is a unique obligation to care for the joy of those who need help on Purim.
9. See what we have written in “The Holiday Season for a Person with Dementia” (earlier footnote 3). Our conclusion there is every person has the right to be part of the congregation and there is also benefit to having a person with dementia maintain their social connections. Therefore, it is the obligation of the congregation to assist him in this, aside from situations where the disturbance to the congregation is very great.

10. Granted that even when one does not recite the megillah in synagogue there is preference to reading the megillah with ten men, however one can read it even by themselves (Shulchan Aruch, 690:18). During the recital there is a need to listen to each word and according to the majority of authorities, one who does not hear a portion of the megillah, even one word, does not fulfill their obligation (so writes the Rashba Responsa as well, volume 1, article 467, and so rules the Mishneh Brura, article 690:5:19:48. See also later on.). Aside from the fact that the commotion at synagogue can harm a person with dementia, it seems that he will have difficulty following after every word in this recital and therefore it is advisable to propose the idea of hearing the megillah at home, with or without a minyan. In this case there is preference to an at-home recital, even from one who is not an expert at precise reading of the text with the proper intonations (see Shulchan Aruch, ibid., 14), in a manner that considers the needs of a person with dementia, and with breaks when necessary. Regarding reciting the megillah with breaks, see later on, article 12. 

    According to Rabbi Isaiah Acharon (brought in the Shiltei Giborim, Megillah 5a, article 2), if the reciter forgets words that do not change the meaning of the reading – one has fulfilled their obligation. Granted that the majority of authorities disagree with him (this is written explicitly by the Beit Yosef, article 695, ד”ה ומ”ש רבינו, and the halachic authorities write that this is also implied from the Shulchan Aruch, 690:14. This is also the ruling of the Magen Avraham, article 690:4:15, Pri Megadim, Eshel Avraham, ibid., subarticle 19, and additional articles referred to there; as well as the aforementioned Mishneh Brura and Biur Halacha, article 690, ד”ה אין מדקדקין). However, the Baal Knesset HaGedola (article 690:1) brings the opinion of Rabbi Isaiah Acharon and does not disagree with him. There are those who were concerned for the opinion of Rabbi Isaiah Acharon regarding blessings where one must recite the blessing over if they miss words (see Chayei Adam, volume 2-3, klal 155, article 16; the aforementioned Biur Halacha at the end; Kaf HaChaim, article 690:17). Therefore, a person with dementia who did not hear a few words can rely on the few authorities who believe that one has fulfilled his obligation, since it would be difficult for him to listen to the entire recital again.

11. The Shulchan Aruch (689:2) writes that there are those who say that women do not fulfill a man’s obligation in megillah reading, but according to the first opinion of the Shulchan Aruch, a woman can fulfill the obligation of a man since she herself is obligated. The Kaf HaChaim (ibid., subarticle 12:14:15) writes that the opinion of the Shulchan Aruch is like the first one he proposes, and therefore, even though one should be concerned for the second opinion, in times of need one may fulfill their obligation with the recital of a woman and this is the opinion of Rabbi Ovadiah Yosef (Chazon Ovadia, Purim, MeHilchot Mikra Megillah, article 4). As proposed earlier, footnote 9, there are times where there is a need for a person with dementia to hear a personal reading tailored to his needs, and then there is a preference to this recital by a woman over the recital of a man that will not provide for the needs of the patient.
12.  Similar to all mitzvot where there is a doubt if one is obligated in it, one should not make a blessing because in cases of doubt we are lenient (and do not invoke God’s name in vain). See the Mishneh Brura, article 687:3 regarding reciting the megillah between sunset and the appearance of stars (bein hashmashot); ibid., article 67:1; Biur Halacha, ibid., ד”ה ספק; and many more.
13.  The Shulchan Aruch (690:5) rules that if one stopped reciting the megillah, and even delayed enough to have enough time to finish the entire scroll, he returns to the place where he stopped. The Rema (ibid.) adds that this rule applies when one speaks during the break as well, even though this is prohibited and one should rebuke those who talk – and it is clear that one should not rebuke a person with dementia. Granted the Mishneh Brura (ibid., subarticle 18) writes that if one was delayed due to matters beyond their control (such as stopping to allow the patient to go to the bathroom, where one is unable to recite the megillah) one should start from the beginning, however the Biur Halacha brought there (article 65, ד”ה קראה לסירוגין) writes that one should be lenient regarding rabbinic mitzvot, such as the reading of the megillah.
14.  The Rema (692:4) rules that one should not eat before fulfilling the mitzvah of reading the megillah, even if the fast is difficult for him. However, a person who is weak and for who waiting to eat will be detrimental to their health is permitted to eat (Mishneh Brura, ibid, subarticle 16). A person with dementia requires organized and fixed eating routines and must eat before the megillah recital as they normally do. According to the Magen Avraham (ibid., subarticle 7) and the Mishneh Brura (ibid., subarticle 14), it is permissible to eat a little only when there is a great need, such as when dealing with a sick person or one who is struggling during the fast. According to Rabbi Ovadiah Yosef, it is permissible to eat a little even when there is no need (Yabia Omer Responsa, volume 9, Orach Chaim, article 67; and Chazon Ovadiah, Purim, MeHilchot Mikra Megillah, article 17, and he adds that one who is stringent will be blessed).
15.  The time for reading the megillah is ideally from tzeit hakochavim (Shulchan Aruch, 687:1; Mishneh Brura, ibid., subarticle 1). The Shulchan Aruch (ibid., 692:4) rules that if one is slightly compelled to (ones), such as if the fast is difficult for them, they may recite it from plag hamincha onwards. Granted that the Mishneh Brura (ibid., subarticle 14) writes that there are those who disagree and therefore in situations like these it is best to eat before the recital and read the megillah on time, yet he agrees (in the Biur Halacha, ד”ה מפלג מנחה ולמעלה) that one who is lenient for a sick person and one who is suffering has what to rely on. Rabbi Ovadiah Yosef too (Yabia Omer Responsa, volume 1, Orach Chaim, article 43) writes that one can be lenient if necessary. Therefore, for a person with dementia who requires a fixed schedule one can be lenient and recite it from plag hamincha. Regarding their caretaker, this is considered as a place of necessity and they can fulfill their obligation with this recital.
16.  Halachic authorities of the past generations have discussed the question of whether one can fulfill the obligation to read the megillah, Havdalah, and the like through a speaker or telephone. On the one hand, many prohibit this, including Rabbi Shlomo Zalman Auerbach in Minchat Shlomo Responsa, volume 1, article 9 and Rabbi Ovadiah Yosef in Yabia Omer Responsa, volume 1, Orach Chaim, article 19 and in Yechave Daat Responsa, volume 3, article 54. On the other hand, there are those who permit this. So writes Rabbi Shlomo Zalman Auerbach on the margins of his responsum in the name of the Chazon Ish, according to whom sound is created by the speaker and heard immediately similar to the manner of speech can be considered “sound” and fulfill one’s obligation, and this is also the opinion of Rabbi Tzvi Pesach Frankin Mikraei Kodesh, Purim, Kriyat HaMegillah, article 11, pages 95-96. Rabbi Moshe Feinstein writes in various responsa (Igrot Moshe Responsa, Orach Chaim, volume 2, article 108; volume 4, article 91; ibid., article 126) that one should permit this only in extenuating circumstances, for example when a woman is in the hospital and cannot hear Havdalah any other way; this is also the opinion of the Tzitz Eliezer Responsa, volume 8, article 11. During the COVID-19 pandemic the authorities deliberated reciting the megillah on a direct feed through Zoom and the like and there are those who instructed that this was permissible when there is no other way to fulfill the mitzvah. This is also the opinion of the London Beit Din Tzedek in their ruling from the 28^th of Tevet, 5781; Rabbi Tzvi Shachter, Piskei Corona, article 58; Kefelach HaRimon Responsa, volume 1, article 11:3. Based on what has been stated here, a person with dementia who is unable to hear the megillah reading in another manner and wishes to fulfill the mitzvah – may hear it through the phone or another electronic medium. As we have written in footnote 2, our opinion is that a person with dementia is exempt from any mitzvah that would burden him significantly, and if this recital is beneficial for him in any case – if one can fulfill their obligation in this manner, he fulfills it; and if one cannot fulfill their obligation, he is exempt. However, both from a halachic and psychological perspective, it is proper to find a way to have a person recite the megillah for a person with dementia in their home if that is what they wish.
17.  See what we have written in ‘The Holiday Season for a Person with Dementia’ (earlier footnote 3), footnote 9, regarding blowing the shofar. Granted that for reading the megillah “we are not particular about mistakes” (Shulchan Aruch, 690:14), however one should say and hear every word, and aside from this reading the megillah takes a significant amount of time and the congregation’s burden can be large. Therefore, if one can convince him kindly not to be the reader, it is best; and if it is not possible to convince him and there is disturbance to the public because of this, the congregation’s honor and its obligation to fulfill the mitzvah come before the honor of the individual. Only when the burden of the congregation is small can one allow him to read.
18.  Even if he is not obligated in fulfilling the mitzvah of matanot le’evyonim anymore (see earlier footnote 1), providing charity from his funds is beneficial for him, as the Shulchan Aruch rules (Choshen Mishpat, 290:15) that for one who loses mental competency – Beit Din determines how much charity to give from their assets. This is also the opinion of Rabbi Yitzchok Zilberstein (Torah Lessons for Doctors, volume 3, article 208, pages 485-486) and he relies on the opinion of the Maharit Responsa, volume 1, article 127, and Chatam Sofer Responsa, Orach Chaim, article 2. The minimum amount for matanot le’evyonim when another person is responsible for their financial affairs is as much as he would have given when he was healthy, however according to his capabilities nowawdays, as we have written in ‘Guidelines for Channukah’, https://bit.ly/49cRsgz, endnote 13, and this rule applies regarding gifts to grandchildren and the like, if he was accustomed to giving on Purim.
19.  According to Rabbi Yitzchok Zilberstein (earlier footnote 3), when giving to a sick person, one fulfills the mitzvah of matanot le’evyonim even if he does not have the competency for the mitzvah, however one cannot fulfill the mitzvah of mishloach manot. However, see Rabbi Yoni Rosensweig and S. Harris, I Ask For My Soul: Halachot of Mental Health, Jerusalem 5782, page 147, article 26 and footnote 35, who brings additional opinions (from oral responsa) – there are those who say one fulfills mishloach manot as well, and there are those who say that one cannot fulfill matanot le’evyonim at all. Since the accepted custom is to increase the amount of mishloach manot, but the main mitzvah is only one, and it is possible that this will bring joy and benefit to the person, it is proper to give him, but not to rely on this alone and fulfill the mitzvah through giving to others.
20.  Granted that the mitzvah is to have an extravagant Purim feast and it is proper to do it in a group because it is impossible to properly be joyous by oneself, however one fulfills their obligation with a meal of one. This is the opinion of the Rema at the beginning of article 695 and the Mishneh Brura, ibid., subarticle 9. The Rema (ibid, 2) writes that the custom is to do the Purim feast after the Minchah service, however he adds that one can do it in the morning as well, and the Shlah writes that this is praised (so he writes in the name of the Mishneh Brura, ibid., subarticle 9; Kaf HaChaim, ibid., subarticle 23). From all of this it arises that there is no preferred time for the feast and one can fulfill their obligation at any time. It is proper to consider beforehand what the best time for a person with dementia to participate in the feast, and if the feast drags on, he should retire at the appropriate time.
21.  Even though from the opinion of the Shulchan Aruch (695:2) it is implied that one should drink wine ”until they do not know [difference between good and evil]”, the Rema (ibid.) writes that one does not need to drink that much, but should drink more than their habitual amount, and the Mishneh Brura (ibid., subarticle 5) writes that this is the proper thing to do. Anyone for who drinking wine will harm him is not obligated to drink at all, especially those who are taking medications that cannot be mixed with alcohol, see earlier footnote 2.
22.  See earlier footnote 16. Also here, the permit is based on the fact that it is possible they are not obligated in the recital at all and one should not rely on this in other situations.
23.  As we have written earlier, footnote 2, when fulfilling the mitzvah involves suffering or great difficulty, the patient is exempt from the mitzvah.
24.  See ‘Tzohar Ad 120’, Second Section, Chapter 12, https://bit.ly/49clHo2