Does My Aging Parent Need Help?
As our mom approached 90, we "kids" had to find a good way to determine when it was no longer safe for her live on her own. This was very tricky to do, because we didn't want to step in too soon. . . but we also didn't want to wait too long and risk illness or injury. It was even harder for her, though: She was an independent, capable woman who'd worked two jobs and raised five children. She didn't want to be a burden to us but she also didn't want to relinquish any of her precious independence.
What made it even harder was that her deterioration didn't go in a straight line from point a to b: She had good days, and then she had bad ones. She'd get sick. . . then she'd bounce back. It was hard to tell the difference between typical memory loss and pessimism and the signs of dementia or depression. To top it all off, she was determined to hide all the evidence of her decline. All of this made the process of assessing her capability to live on her own much more difficult.
Agnes Schare (RN, BSN, and the VP of a care management and home care company) told us,
"Change is challenging for all family members involved. Losing independence is difficult and overwhelming, especially for the aging parent. It is important to begin discussions slowly to offer reassurance to all family members involved, remembering that an open dialogue is key. Proactivity in the care of your family members can potentially create a safer outcome and deter any potential risks."
Depriving an adult of their independence is not an easy task. Below, you'll find a list of signs to look for if you want to know if your parent is getting too old to take proper care of themself. This is the list we used.
Signs Your Elderly Parent Needs Assistance
- Illness. "Increased infections (urinary or pneumonia), advancement in any medical conditions, or increased hospital visits" are signs to watch out for, according to Agnes Schare (RN, BSN, and the VP of a care management and home care company).
- Personality changes. If they have a dramatic personality shift, start acting like a child, or become utterly silent or disengaged. According to Iris Waichler (MSW, LCSW, and author of Role Reversal: How to Take Care of Yourself and Your Aging Parents), "sudden changes in behavior or personality, increased agitation, aggression, hallucinations are sources of concern and can contribute to safety concerns."
- Dirt and messes. If you see dirt accumulating in their home, stacks of dirty dishes and clothing, piles of unopened mail and bills, or rotten food in the refrigerator, these are signs that your parent may no longer be able to manage a household alone.
- Injury or damage. If you see burned items in the kitchen, cuts or bruises on your parent's body, or dents or damage on their car, this may be a sign that they have become a danger to themself.
- Physical degeneration. If they have trouble keeping doctor's appointments, suffer from inertia or lack of exercise, show worsening medical conditions, are losing or gaining weight, then staying healthy may no longer be possible without help.
- Hygiene issues. Unchecked incontinence, dirty or ragged clothes, the neglect of personal hygiene: A lack of awareness in these areas may be a sign of mental deterioration.
- Loss of mobility. If they can no longer navigate their home (stairs too steep, floors too slippery, can't get up), or if they're falling down, they probably need help.
- Basic routines broken. If they skip meals, forget to drink water, and forget to take their medications, they become a risk to themselves.
- Financial troubles. When bills are going unpaid, utilities turned off, collection agents start calling, and money disappears, your parent needs assistance.
- Disconnection. If they want to stay in bed all day, stop changing their clothing, do nothing but watch tv, refuse to go out, and stop answering the phone, it may be time to step in.
- Confusion. If they are getting lost, forgetting where they are or how they got there, or forgetting once-familiar places and people, this could be cause for concern.
- Mental health issues. If they become anxious, paranoid, or depressed, it's definitely time to talk to a doctor.
How to Use This List
As you read the signs listed above, keep track of how many descriptions fit your parent. But what does your final tally mean? Well, that depends. If you only check one item off, that may not be enough of a reason to step in... on the other hand, if it's something dangerous, maybe one item is enough.
For example, if your mom keeps forgetting and leaving the kettle on to stove to burn, both she, her house, and her neighbors are at risk of fire. On the other hand, dirt is not life-threatening, so a dirty kitchen might no matter that much, especially if your parent was never particularly tidy! There's no magic number to tell you what to do. It's not a graded quiz, it's just something to help you start thinking and talking about what's happening.
Get together with your parent, your family members, and close friends to discuss this list and decide what to do. You may also need to involve your parent's doctors.
Losing independence is difficult and overwhelming, especially for the aging parent. It is important to begin discussions slowly to offer reassurance to all family members involved, remembering that an open dialogue is key.— Agnes Schare (RN, BSN, and the VP of a care management and home care company)
What Kind of Help Does Your Elderly Parent Need?
Wait! An assisted living facility is not the only solution. In fact, if your parent is against it, it should be your last recourse. There are many other levels and types of assistance. This list should help you determine exactly what kind of help your parent really needs.
- If possible, talk to your parent's doctors to find out what your parent medical needs are and let them know about what you notice. It's a great idea to enlist the doctors' help and get on the same page with them.
- If your parent only needs someone to check in on them, decide how often and create a schedule. If family and friends live nearby, assign them slots on the schedule. If not, perhaps the neighbors could help. If not, check in with local charity groups or hire a home care company to send someone over. This article,
How to Hire Home Elder Care Aides, has a lot of good ideas.
- If there is someone in the family who's good at numbers and deadlines, ask them to step in to help with the finances and bills or hire a financial planner.
- If your parent needs help around the home like help doing dishes, bathing, or doing laundry, take turns helping or hire someone to come in.
- If they need help with food, consider grocery or meal delivery services or look into meals-on-wheels.
- There are programs set up to help with the finances if you take care of your elderly parent. Read Family Caregiving: Getting Paid for Taking Care of Your Loved One.
Independence or Assistance: Whose Decision Is It?
Unless your parent is completely unable to participate in the discussion, it's always best to leave them in control of their life for as long as possible. At the same time, it's important that the whole family sits down to discuss concerns, fears, and desires openly.
How to Discuss and Decide What Your Elderly Parent Needs
- Firstly, before your parent gets too old, take the time to sit down as a family to discuss everyone's desires. How does your parent feel about assisted living? What is the financial situation to pay for assistance? Who can help? What is the end-of-life plan? What is the Advanced Care Directive? Don't wait until they're too confused to seriously consider the situation.
- When you do sit down together, take notes about what was said and have each of the participants sign and take home a copy of the notes. This will help remind everyone about what was decided and possibly help clear up confusion later on.
- Although resistance to help is common, getting expert advice is extremely important. Attorneys that specialize in elder law, geriatric care personnel, and financial consultants can all be utilized to make decisions and aid the conversation.
- As your parent continues to age, continue to have these meetings every couple years or as needed, and continue to take these notes. As the situation changes, everyone's response may shift, too.
- As the needs arise, arrange a schedule for help or hire someone to come clean, do taxes, help pay bills, or do whatever is needed.
- However at some point, even if your parent resists, you may need to get more assistance. If the time comes, you may have to move your parent to an assisted living facility. Hopefully, if you've been having that discussion for years, it will be less upsetting than if it seems to come out of the blue.
What are the laws regarding the care of elderly parents?
There are no laws or government policies to help you determine if your loved one is too old to live on their own.
However, in some states there are Filial Responsibility Laws that require adult children to pay for their aging parents' needs. At least 30 US states and Puerto Rico have passed laws that require adult children to financially support their parents if they can't take care of themselves (including food, clothing, shelter, healthcare, medical bills, and assisted living costs). To learn more about this and look at your state's policies, read Advice For Caregivers: Does State Law Require You to Support Your Aging Parent?
Signs That It Is Time for Your Parent to Live in an Assisted Living Facility
When you find yourself no longer able to provide adequate home care, it might be time to move your parent to a facility that is set up to attend their needs.
If Your Parent's Needs Are Escalating
You can only do so much. When your parent needs more help than you can give, it's time to get help.
If Their Illnesses Are Advancing
Advanced illnesses—including late-stage dementia and Alzheimer's—may be too much for the family to handle.
If Your Parent Becomes Aggressive
Physical, emotional, or even sexual aggression can occur with dementia, and if it poses a threat to your parent or to others, it might be time to get professional help.
If They Are No Longer Safe at Home
If your parent is not safe at home, and you can't arrange for 24 hour care, then it may be time for assisted living.
If Caregiver Stress Gets Too Overwhelming
If the care and worry of your parent has started to take its toll on your and your family's life, it's okay to seek help.
Our Family's Story
My mom "kept trucking" for a long time. She was 90 years old before we started to worry.
When she stopped reading, it was the first red flag that gave me pause. Her mystery novels had been her greatest joy, but when she said she could no longer follow the plot, I started to panic a little. What will she do if she can't read?!?! I got her some audio tapes and those helped for awhile, but it was the first sign that she wasn't her same old self.
Then one night she phoned to tell me she couldn't turn her lights on. It turned out she'd forgotten to pay the bill. That's when my brother started helping open the mail and pay the bills. We siblings all took turns visiting her, cooking meals, and helping.
She held out for another two years before we finally brought her to an assisted living facility. She'd broken her hip on a trip to the bathroom in the middle of the night and we didn't find her until the next day. I told her she could move in with me and stay in my daughter's old room, but she insisted that this would be best. She had two friends in the same facility and the nurses were very nice. We were very lucky to have a decent, affordable solution. Not everyone does.
We were also very lucky to have three of our five siblings living nearby to help. Not all families are this lucky. My mother died at 94, with all of us at her side.
What about your experience with your elderly parent?
What is the most stressful issue for you?
Where Can I Get Help for My Elderly Parent?
- Get a good geriatric doctor. Not only can they help with proper diagnosis and treatment, but a doctor can point you to various agencies that may be able to assist, and can more closely observe your parent the next time they are in for an appointment.
- Geriatric care personnel can help. A geriatric care manager is usually a licensed nurse or social worker who specializes in helping to care for older people, either in their home or in a care facility. These are people who can assist you and your family identify and meet your parent's needs.
- Consult with elder law attorneys and financial planners for financial and legal guidance and support.
- If you're worried about the care your parent is receiving, a report can be made to Adult Protective Service (APS) to ensure the safety and well-being of your family member.
- The National Council on Aging is a good resource.
- Check your local charities to find out what resources are available to you. Meals-on-wheels programs are a great help, and so are online grocery and meal delivery services.
What Are the Warning Signs of Dementia or Alzheimer's?
By age 85, 35% of people show signs of dementia, a broad term used to describe symptoms that include impaired thinking and memory loss. Alzheimer's Disease, a progressive mental deterioration that affects 10% of people 65 and older, is one type of dementia. Here's what to look for:
- sleep difficulty (trouble falling sleep, waking up often, and shifts in sleep cycles)
- disorientation (forgetting where they are or what they're doing)
- forgetfulness or memory loss (a little memory loss is normal, but when it starts getting dangerous, it's time to worry)
- behavioral changes (has your parent become uncharacteristically anxious, depressed, irritable, confused, or fearful?)
- disorganization (inability to complete normal tasks)
- agitation (embarrassment, anger, or nervous excitement)
- lack of concentration (does your parent seem easily distracted or have trouble focusing or following along?)
- difficulty with complexity (perhaps they can no longer do math, follow complex conversations, read long books, or multitask)
- loss of motor function (when your parent can no longer take a shower, drive, or cook)
- impaired judgment (wearing the wrong clothes, making dangerous decisions)
- paranoia (losing touch with reality: feeling persecuted, jealous, or fearful that others are out to get them)
- hallucinations (seeing, feeling, hearing, tasting, or smelling things that don’t exist)
- inappropriate or aggressive sexual behaviors (a sudden lack of inhibitions and boundaries)
- cognitive decline (loss of memory, language, etc.)
- apathy (withdrawal from society, loss of interest, flat emotions)
These signs may or may not be clues of the onset of dementia. They are not proof, they are just things to watch for and discuss with a doctor.