Aging is a fact of life, and many older adults may reach a point when they can no longer look after themselves. Often, their adult children are left to determine when that time comes — a challenging prospect for everyone involved.
However, experts have identified a number of signs for adult children to note.
In this guide, we’ll list those signs, give you questions to ask and provide guidance for how to approach the topic of extra care for your parents.
Warning Signs
Changes to or developing new behaviors might indicate your parent needs more assistance, says Dr. Paul Chiang, medical director of Northwestern Medicine HomeCare Physicians in Wheaton, Illinois, who makes house calls to homebound seniors.
Specific questions to ask and warning signs to look for include:
— Is your loved one able to manage self-care?
— Is there significant memory loss?
— Is your elderly loved one safe in the home?
— Is your loved one safe driving a car?
— Has your loved one lost weight?
— Has your elderly loved one’s mood or spirit changed?
— Have your loved one’s sleeping habits changed?
— Is your loved one socially active?
— Is your elderly loved one walking safely and steadily?
— Is your loved one able to manage their household and finances?
— Is your loved one able to manage their medical conditions and medication schedule?
Is your loved one able to manage self-care?
Adult children of aging parents need to “be a detective when visiting the aging parent,” says Jennifer Avila, executive director of Custom Home Care, a home services and home nursing agency in the Chicago area.
For instance, she recommends looking in the refrigerator for clues — like old, expired or a lack of food — that your parent might not be caring for themselves properly.
Personal hygiene can also be a strong indicator that your parent needs more help. Some older adults may begin to have difficulty showering regularly, washing their clothes and cleaning their living space, says Chiang, who also works for the Home Centered Care Institute, a nonprofit whose mission is to bring house-call medicine to complex patients across the country.
[READ: Assisted Living Checklist.]
Is there significant memory loss?
One red flag to watch out for is increasing forgetfulness and confusion.
“(Not) everyday memory lapses, such as misplacing one’s keys, but rather not being able to find their way home from the grocery store,” says Dr. Elizabeth Landsverk, a geriatrician based in the San Francisco area.
Finding your parent wandering outside with little idea of how or why they got there is a warning sign to keep an eye out for.
Other signs that dementia or Alzheimer’s disease may be developing include shifts in behavior or personality, such as increased alcohol consumption, inappropriate behavior, being quick to anger or being apathetic.
[READ: Memory Decline Isn’t Inevitable.]
Is your elderly loved one safe in the home?
Safety is a major concern for an aging parent who may not have the mobility they once did.
“Every 19 minutes in the United States, an elderly person dies from a fall,” says Francine Hwang, CEO and founder of FrannyCares, a caregiver placement company based in the Los Angeles area.
While that’s a scary statistic, it’s one you can mitigate to some degree by making changes to the home, such as:
— Removing area rugs.
— Installing grab bars in the bathroom.
— Making sure your parent is using the railings when navigating stairs.
— Investing in a fall detection monitor.
— Applying non-skid strips in showers or tiled areas that may become wet.
— Moving items from high shelves or cabinets to eliminate the need of a step stool.
— Making sure there’s adequate lighting in the home, including in halls and stairways.
You should also confirm that fire alarms and carbon monoxide detectors are functional and that emergency contact information is easily accessible, adds Dr. Sameer Amin, chief medical officer of L.A. Care Health Plan, the largest publicly operated health plan in the U.S.
Some safety and trip hazards in the home can be harder to spot, so Hwang recommends scheduling an appointment with an occupational therapist. She says the OT can conduct an assessment of the home and factor in your parent’s medical history, such as high blood pressure or osteoarthritis, which may contribute to a fall.
A physical or occupational therapist can also work with your loved one to help them regain strength, coordination and some of the mobility that may be waning, adds Dr. Victoria Leigh, an internal medicine physician with Providence 65+ Health Center, part of the Providence St. Joseph Heritage Medical Group in Tustin, California.
You should check with your parent’s doctor about current medications that could be making them feel dizzy or unbalanced as well.
[READ: Safety Measures at Assisted Living Communities.]
Is your loved one safe driving a car?
Some safety concerns are more immediate than others, notes Heather Prinzel, director of nursing with the Orlando Health Center for Rehabilitation in Florida.
“If your aging parent is driving and getting lost, they should no longer be alone,” she says.
That could mean 24-hour care every day at home or moving into a memory care unit sooner rather than later.
Has your loved one lost weight?
Weight loss could be a sign that your parent is struggling to eat right.
“Weight loss doesn’t necessarily mean that (your) parent needs to move, but it does mean that they may need some help in order to stay in their home longer,” Prinzel says.
Chiang notes that many of the seniors he cares for depend on food delivery services or eat a lot of frozen meals.
“While they’re easy to obtain or easy to make, they’re not necessarily the healthiest foods for seniors, especially if they have a heart condition or diabetes or kidney problems,” Chiang adds.
You or other family members might need to take over the burden of cooking or set your parent up with Meals on Wheels or a similar service.
Has your elderly loved one’s mood or spirit changed?
One indication a living situation may need adjusting is an overall shift in how your parent engages with the world around them, Leigh says.
Some examples include:
— Difficulty with concentration or comprehension.
— Agitation and irritability.
— Excessive fatigue.
— Headaches.
— Worsening chronic pain.
“We refer to these symptoms collectively as delirium, which is a phrase used to describe an altered state of mind relative to baseline,” Leigh notes.
Underlying conditions — such as dementia or insomnia, chronic pain, constipation and some medications — can trigger delirium.
Have your loved one’s sleeping habits changed?
A change in sleeping habits can signal an issue, says Namrata Yocom-Jan, president of Seniors Helping Seniors, a Reading, Pennsylvania-based franchise network of active seniors who support other seniors. Not sleeping well could point to a medical condition or anxiety, either of which can affect behavior and overall health.
Over time, “ordinary tasks might start to feel absolutely impossible,” Yocom-Jan says. This feeling can snowball, and your parent’s mood may change.
“Either they get cranky or angry. It’ll have an impact on how they behave,” she adds.
Inadequate sleep is also associated with weight gain and can impact the immune system, causing your loved one to get sick more often.
Is your loved one socially active?
If your loved one has always had an active social life, but you notice them starting to withdraw from friends, they may need more care than they’re letting on.
While many seniors may initially resist, accepting help or moving into an assisted living or memory care facility often brings new opportunities, friends and engagement in life.
“Quality of life is one aspect that we have seen improve when a senior moves into a senior care facility,” Prinzel says. “When at home, a person with limited mobility may find it difficult to go to the store or join in the weekly bingo game at the rec center, and life can become very lonely.”
In a senior living community, however, your parent may find that they’ve got lots to do and better social outlets.
“Senior care facilities vary in levels of care and activities, but they are all similar in that they bring an aging community together,” Prinzel says.
Is your elderly loved one walking safely and steadily?
Mobility is key to independence.
“When spending time with your loved one, pay attention to how they move from sitting to standing and how they navigate their home,” Leigh advises. “If you see (them having) difficulty moving around the home or many small objects, mats or furniture items around the house, discuss how to best clear a path to prevent injuries and falls.”
Is your loved one able to manage their household and finances?
An inability to keep on top of their mail, bills and other paperwork involved with maintaining a home can be a sign that your parent shouldn’t continue living alone.
“With my own grandfather, we knew something was off when we took a look at his desk,” Prinzel says. “He was normally a very organized man, especially with his bills, but we found checks everywhere, and then we found them written to all different organizations in varying amounts.”
She says the family later learned that the checks had been written to telemarketers who were taking advantage of her grandfather’s vulnerability.
“He had not only lost his sense of judgment but his ability to problem-solve, both of which are also symptoms of early dementia,” she adds.
This is a sadly common situation, so it’s best to keep an eye out for possible financial issues, such as bills that aren’t being paid on time or unusual spending or withdrawals. Avila says you can set up bank alerts on your parent’s behalf to keep tabs on what’s going in and out of their accounts.
Is your loved one able to manage their medical conditions and medication schedule?
“As we get older, many of us suffer from multiple conditions, and we need help from other people to support us,” Chiang says.
To that end, you should be aware of your parent’s ability to stay on top of their medication needs. He recommends asking whether they’re able to take their medications as prescribed. You should also ensure that they have access to medications and medical care when they need it. If your parent already has in-home care, that caregiver can be critical in helping you assess when it’s time to consider moving your parent to a senior care facility.
Home Care Options
Getting more help doesn’t always mean your parent has to leave their home or have round-the-clock care, Landsverk says. For many older adults, just a little extra help a few times a week may be enough.
Home health aides
Home health aides come into the home a set number of times or for a certain number of hours per week to help out with activities of daily living, such as cooking, shopping and laundry.
A caregiver coming in for four hours (the standard unit of caregiver time) a few times a week to prepare meals, do housekeeping tasks and laundry and perform other basic duties can make a world of difference, Landsverk notes.
Creating a supportive home environment
When seeking help, it’s important to “make sure the caregiver is diligent, is engaging the parent, is keeping them physically active and mentally stimulated (think crossword puzzles and playing cards) and staying connected socially,” Landsverk says.
She adds that you need to stay vigilant throughout the caregiver’s engagement to look for signs of abuse or neglect, which could include unexplained bruises or injuries and financial issues. To combat this, she recommends dropping by unannounced, calling often and asking neighbors their impressions of how the caregiver interacts with your parent.
Balancing independence and assistance
As your parent’s challenges progress, it’s probably time to have a conversation with them about their living situation. This can be a difficult topic to broach, Hwang notes.
“The conversation about moving into a senior care facility can often be distressing because your parent may feel as if they’re losing their freedom,” she explains. “It also can be emotional because of a reversal of roles where the child becomes the ‘parent’ and the loss of authority, no matter how small or big, can be off-putting for a parent.”
To help keep hurt feelings to a minimum, Hwang suggests “being frank and asking questions, such as ‘I know you don’t necessarily need care now, but how would you like to be cared for in the future? I want to be an advocate for you and your care wishes, so I would love for you to guide me.'”
Leigh recommends addressing in-home support first, before discussing a move to an assisted living facility. Doing so can seem more respectful of your parent’s independence.
“It’s important to meet your loved ones where they are open to accept the help,” Leigh says. “Framing the issue as a concern over safety and well-being, and using ‘I’ statements, like ‘I’m worried that if you fall no one will be here to help you get up, and you could get really hurt and sick,’ can be a helpful way to phrase the concern rather than saying directly, ‘You’re not safe to be at home alone anymore.'”
Hwang also recommends connecting with your parent’s inner circle to get insight into how your parent is doing. Try reaching out to their health care providers, friends, spiritual community and neighbors.
“This trusted circle will provide guidance and support as you navigate this transition with your parents,” Hwang explains.
Considering Alternative Living Arrangements
There are lots of different ways families solve the problem of providing care for elderly loved ones.
Assess whether your parent should move in with you
Having your parent live with you may cost less than hiring in-home care in a separate household or moving your loved one into an assisted living community or nursing home.
However, there can be downsides in the loss of independence for both you and your parent. The burden of caregiving typically falls heavily on the child, even if in-home health aides or nurses are part of the plan.
Consider how much money your parent may have to put toward care and how you might be able to use that to remodel or adapt your own home for their safety and comfort. Think about whether their funds will cover any respite caregiving so that you don’t have to do it all on your own.
Recognizing when assisted living might help
In some cases, continuing to live alone, even with in-home care, or moving in with family members simply isn’t an option. In these instances, moving your loved one into an assisted living facility might be the right option.
Assisted living communities provide a host of benefits, including:
— Assistance with activities of daily living, such as grooming, toileting, eating and medication management.
— Socialization opportunities.
— Less day-to-day burden on family members.
But there can be some downsides, especially cost. Genworth Financial’s Cost of Care Survey reports that the median monthly cost for an assisted living facility is $4,500. There’s a lot of variability depending on the location of the community, the services selected and the amenities, but living in assisted living can get very expensive.
If your loved one doesn’t have enough money to pay for this care — which is not covered by Medicare or most health insurance plans — then you’ll have to find another way to pay for these sometimes-pricey services.
Exploring nursing home options
If your loved one is quite ill and needs round-the-clock nursing care, a nursing home may be the best fit. Nursing homes care for residents who have chronic health conditions, such as diabetes or heart disease.
Nursing homes can also be expensive. While Medicare covers some expenses, most of the cost will have to be paid out of pocket.
According to Genworth Financial, the median cost is $7,908 per month for a semi-private room and $9,034 per month for a private room in a nursing home facility.
When you’re considering these alternative care options, it’s important to think and plan ahead.
“Start early before there is an imminent need,” Avila advises. “If you wait until there is a medical emergency, your options are immediately limited.”
Seeking Community and Professional Support
If you notice concerning trends in your parent’s ability to look after themselves, it’s time to act, says Daniel Jan, chief operating officer of Seniors Helping Seniors.
“The number one thing that a family can do is find local resources for their parents,” he says.
For adult children who don’t live near their parents, observing them can be tricky. Jan recommends partnering with a home care agency or tapping into the senior’s existing social support network, such as their house of worship or a local senior center.
Yocom-Jan also recommends contacting your local Area Agency on Aging to see what programs and support are available.
Bottom Line
Many seniors may eventually need in-home care or have to move to an assisted living community, memory care center or nursing home. All of these options have different pros and cons. Getting good local advice from a professional who knows the ins and outs of senior care can help you and your family sort through the options and find a sustainable path forward.
In all cases, keep the lines of communication open as much as possible.
“Being in touch with your family is super, super important for their healthy aging,” Jan says.
More from U.S. News
Types of Rooms in Assisted Living Communities
The Best Gift Ideas for Nursing Home Residents
Nursing Home Alternatives to Consider
11 Signs Your Aging Parent Needs Senior Care originally appeared on usnews.com
Update 12/04/23: This piece was previously published at an earlier date and has been updated with new information.
