I spend most of my vacations with my mom, who lives in another state. And I’ve started making sure that on every visit, I take stock of how she’s managing on her own, and if she might need more support. Over the past year, I’ve collected tips on spotting warning signs of an aging parent needing home care. That is, someone to come to their house and assist with activities of daily living (ADLs). ADLs are the fundamental skills required to live independently. The official list of basic ADLs includes:

There’s also a list of instrumental ADLs. These require more complex thinking and organizational skills:

If we have an older family member who's struggling with anything on these two lists, it’s time to start thinking about in-home care—or if they can afford it, a transition to an assisted living facility.

Understanding the Aging Process

Normal aging involves gradual changes like a decrease in bone density, muscle strength, and flexibility. Mild forgetfulness, decreased energy, and minor aches and pains are also part of the natural aging process. On their own, these may not be indicators that an older adult needs home care services.

On the other hand, if we start to notice sudden or significant changes in physical or cognitive abilities, difficulty performing daily tasks or personal care, or a decline in overall health and well-being, these may be signs that a grandparent or parent needs assistance. Are they managing their personal hygiene? Are they mentioning falls they've taken? Are they taking their medications on schedule and keeping up with doctor appointments? These are the kinds of things we need to observe and assess when we're with our family. 

Physical Warning Signs

Mobility issues

When we spend time with our aging loved ones, we should notice how they move around. Has their walking become unstable or slow? Do they complain about soreness or stiffness? Do they have unexplained bruises or injuries? Difficulty with balance? All of these can be signs of decreased mobility. And this can put them at risk of falling. Remember, bones get more brittle as we age. So a fall for an 80 year old can result in a broken hip, rib, or vertebrae. A walker can give them more stability. But don’t be surprised if they resists this suggestion and need constant reminders to use it. This can be a difficult transition for them to make. But recovering from a hip replacement is a lot more difficult. 

Hygiene

‍A noticeable decline in personal hygiene may indicate underlying physical or cognitive issues. Does our parent appear unkempt? Do we notice a strong odor? They may be experiencing incontinence problems. Or they could be avoiding the shower for fear of a fall.

Weight Loss

‍Are they dressed in clothes that fit? Baggy clothes could indicate weight loss, which could be a sign of illness or inability to prepare meals. They may need to see a doctor and could benefit from help with meal planning, grocery shopping, meal prep, and/or meal delivery.

Home environment

‍Is there unopened mail lying around? Are there piles of laundry or an overflowing hamper? Is there expired or moldy food in the fridge, or very little food at all? These can be signs that our loved one needs help with household tasks, errands, or meal prep. While we’re looking around, we should check their bathroom(s). Do they have night lights and grab bars installed to prevent falls? If not, it's a good idea to pick up some night lights at the store and arrange for a contractor to install grab bars—they often need extra blocking inside the walls to support the weight.

Cognitive Warning Signs

Memory loss or forgetfulness

Signs of memory decline include forgetting recent events, repeating questions, and relying on memory aids like notes around the house to remind them to do this or that. If they have hearing aids, are they wearing them? If not, do they know where they are and how to work them? Are late payment notices piling up on their desk? Loss of memory or focus could be early signs of Alzheimer’s or other dementias. It’s important to distinguish normal forgetfulness from concerning lapses in memory. Misplacing keys occasionally is normal. Getting lost in familiar places is a cause for concern.

Confusion or disorientation

Does our loved one have difficulty following a conversation, or get disoriented in a familiar environment? These are signs of cognitive decline—a.k.a. dementia—and are a red flag that they may need support to live safely in their home and perform necessary daily tasks. We might also consider asking their doctor for a cognitive assessment, as there are some medications that can slow the decline.

Social/Emotional Warning Signs

Increased social isolation

The impact of social withdrawal on mental health and well-being can be profound. If we discover that an aging loved one has significantly reduced their social interactions, has lost interest in activities they’ve previously enjoyed, or has little or no communication with friends and family, this social isolation puts them at risk of depression, anxiety, and cognitive decline. They could benefit from trips out to a senior center or adult day care, or frequent visits from friends and family. 

Mood swings or behavioral changes

We should keep our eyes out for shifts in mood or unexpected changes in behavior. Are they uncharacteristically aggressive, anxious, or apathetic? These changes can be a sign of underlying emotional or physical distress, depression, or cognitive decline. There are also some new tech options that have shown to decrease loneliness and social isolation, such as virtual communities or programs, AI powered companions, and even robotic therapy pets.

Medical Warning Signs

Unmanaged chronic conditions

If our loved one has a chronic condition that’s suddenly getting worse, it could be that they’re not taking their medications as scheduled, skipping doctor appointments, or not following doctor’s orders in terms of diet or exercise. It's crucial to manage chronic health conditions effectively to ensure the well-being of our loved ones. We should let their doctor know about their health issues. In turn, they can help determine the level of care our loved one needs to get back on track and stay there.

Frequent medical appointments

An increase in medical visits could indicate the need for additional support. Proactively communicating with healthcare providers can help address any emerging concerns.

Having the Conversation

It can be hard to know when an elderly parent needs help to live safely at home. It can be even harder to talk with them about the needs we discover. It's important to approach this delicate topic with empathy and sensitivity. I expressed my concerns for my mom 1:1 with her. I started from a place of love, and guided her gently to accept my help. I also used “I” messages to express concerns without accusing her. For example, "I feel worried about your safety at home" instead of "You need help because you're not safe." So she didn’t feel backed into a corner. And I did a lot of listening. I asked her perspective and involved her in the decision-making process. By acknowledging her feelings and preferences, we were able to work together to explore the available care options. And, if it got too difficult for her, we stopped for a while. As a result, she felt respected and in control of the situation.

Holidays provide a great opportunity to check in on our aging loved ones. They enable us to look for physical, cognitive, social/emotional, and medical warning signs that they may need support at home. The sooner we pick up on these things, the more likely we are to stave off further decline, illness, or injury, and prolong their quality of life. So many people suddenly find themselves in the caregiver role after a loved one's medical crisis. Preventing that crisis can give us and any other family members the time we need to put together a care plan for providing the support our loved one needs. 

RELATED: How to Talk with Aging Parents about Their Finances

At RubyWell, we’re paving a path to financial stability for all family caregivers. Our Family Leave Finder provides state-by-sate info on family leave laws. Soon, family caregivers will be able to make the most of a loved one’s health insurance benefits with our Medicare Advantage Benefits Navigator. And ultimately, we're developing compensation solutions so that every family caregiver can be a paid caregiver. If you’d like to be among the first to hear about future products, join our waiting list.

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