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.
To help you make the determination, experts have identified a number of signs for adult children to look out for.
In this guide, we’ll list those signs as well as questions to ask and tips for how to approach the topic of extra care for your parents.
11 Best Questions to Ask to Evaluate Elder Care Need
New or changed behaviors might be a clue that 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 care for themselves?
— Is your loved one experiencing significant memory loss?
— Is your loved one safe at home?
— Can your loved one still safely drive a car?
— Has your loved one lost weight?
— Has your loved one’s mood or spirit changed significantly?
— Have your loved one’s sleeping habits changed?
— Is your loved one socially active?
— Can your loved one walk safely and steadily?
— Can your loved one manage their household and finances?
— Can your loved one manage their medical conditions and medications?
1. Is your loved one able to care for themselves?
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 lack of food — that your parent might not be caring for themselves properly.
Personal hygiene, a standard daily living task, 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: Having the Conversation With a Loved One About Senior Living.]
2. Is your loved one experiencing significant memory loss?
One red flag to watch for is increasing forgetfulness and confusion.
“(Not) everyday memory lapses, such as misplacing one’s keys,” clarifies Dr. Elizabeth Landsverk, a geriatrician based in the San Francisco area, “but rather, not being able to find their way home from the grocery store.”
Finding your parent wandering outside with little idea of how or why they got there is a warning sign of possible dementia.
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: What Are the Stages of Dementia?]
3. Is your loved one safe at home?
Safety is a major concern for an aging parent who may not have the mobility they once did, and this may show up with some physical signs.
“Unexplained bruises, scrapes or cuts could be signs that your loved one has experienced a fall and could indicate that they are having trouble with strength and balance,” notes Nicole Brackett, director of quality and care delivery with Homewatch CareGivers, a personal care service company headquartered in Greenwood Village, Colorado.
It’s a very common problem among older adults, Brackett says, citing Centers for Disease Control and Prevention data that 1 in 4 Americans age 65 and older falls each year.
“Falls are also one of the leading causes of hospitalizations among seniors,” she adds.
You can mitigate fall risk 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 for 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.
You should check with your parent’s doctor about current medications that could be making them feel dizzy or unbalanced as well.
[READ: Understanding the Impact of Health Conditions and Medications on Seniors]
4. Can your loved one still safely drive 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.
5. 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.
6. Has your loved one’s mood or spirit changed significantly?
How your parent engages with the world around them can be an indication that their living situation needs to adjust.
Some examples include:
— Difficulty with concentration or comprehension
— Agitation and irritability
— Excessive fatigue
— Symptoms of depression
— 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,” notes Dr. Victoria Leigh is an internal medicine physician with Providence 65+ Health Center, part of the Providence St. Joseph Heritage Medical Group in Tustin, California.
Underlying conditions — such as dementia or insomnia, chronic pain, constipation and some medications — can trigger delirium.
7. 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 with lack of sleep, “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.
8. 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.
9. Can your loved one walk 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.”
10. Can your loved one manage their household and finances?
An inability to stay 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.
11. Can your loved one manage their medical conditions and medications?
“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.
Tips for Providing Senior Care at Home
Needing 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.
Hire a home health aide
“If your loved one is minimally struggling, it might make sense to stay in their home or find a senior independent living community and seek a few hours a week of home care assistance,” says Stacey Eisenberg a senior care expert and owner of A Place At Home — North Austin home care and placement in Round Rock, Texas.
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 perform these basic duties can make a world of difference, Landsverk notes.
Create a supportive 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.
Find a balance between 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, notes Francine Hwang, CEO and founder of FrannyCares, a caregiver placement company based in the Los Angeles area.
“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.'”
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.
Alternative Living Arrangements
There are lots of different ways families solve the problem of providing care for elderly loved ones
Having your loved one 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 often falls heavily on the adult 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.
Assisted living
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:
— Assistance with activities of daily living, such as grooming, toileting, eating and medication management
— Socialization opportunities
— A smaller day-to-day burden on family members
But there can be some downsides, especially cost. Genworth Financial’s 2023 Cost of Care Survey reports that the median monthly cost for an assisted living facility is $5,350. 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 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.
Nursing homes
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 health care expenses associated with nursing care, most of the cost will have to be paid out of pocket.
According to Genworth Financial, the median cost is $8,669 per month for a semi-private room and $9,733 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.”
Continuing care retirement communities (CCRCs)
Another option, Eisenberg suggests, is to find a senior community that offers different levels of care so your loved one can move once and get the care they need indefinitely.
“These are commonly called continuing care retirement communities (CCRC). CCRCs provide a range of care options, from independent living to assisted living and skilled nursing care, all within the same community,” Eisenberg says.
While these communities tend to be quite expensive, the upside is “residents can transition to higher levels of care as their needs change, without having to relocate to a new location,” she explains.
You Don’t Have to Do It Alone
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.
Getting advice from a professional, such as a geriatric care manager, 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.
Landsverk also advises contacting:
— Your local county division on aging
— A caregiver support group
— An elder care attorney to make sure financial and legal issues are in order
Explore Top-Rated Senior Care Options With U.S. News
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. You can start your research on the best senior living options near you with U.S. News’ Best Senior Living 2024 rating. The 3,500 facilities included in this best-of list have been vetted and based on more than 400,000 survey responses from residents and their family.
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11 Signs Your Aging Parent Needs Senior Care originally appeared on usnews.com
Update 09/16/24: This story was previously published at an earlier date and has been updated with new information.
