March 15, 2021

Is it time?

Knowing When Help Is Needed

How do you know when your aging loved one needs help?

One way to answer this question is to pre-plan. Start the conversation early, allow plenty of time to explore options (over weeks or even months), and revisit the topic from time to time. Initiating a discussion when a change is not imminent takes the pressure off decision making. You will have a much easier time talking about hypothetical situations and reaching agreement on “If this happens, then it is time to get help.”

Keep a notebook with a list of observations to review; these notes may clarify when it is time to get help. A record of observations helps everyone, especially when memory becomes an issue. Ideally, have your loved one write observations in the notebook. This way they can later see their own handwriting and will be less likely to feel like others are dictating their choices. 

Creating a list now helps you avoid the stress of making a decision during an emotional time, such as the loss of one parent or a medical crisis. It also gives you time to research communities and/or home health aides. As a result, when it is time, you already know your options and can feel better about your decision.

If possible, include your loved one in any decisions. Their involvement gives them some feeling of control and a chance to look forward to a new chapter in their life story. If they are expecting a change, then the transition may be easier. Include other family members in the discussions as well so that they will feel ready and can support—not undermine—the decision.

Periodically discuss the items below and document your observations so that you can clearly see the changes that occur over time:

Safety Issues

• Is the door locked regularly?
• Is the house well-lit and uncluttered?
• Can they physically move about the house (e.g., get up from a chair, pick things up from the floor)?

Medical Conditions

• Are medications being taken at the appropriate time and dose? You may need to discreetly count the number of pills in each bottle and check the number after a few days to see if they were properly taken.
• Is there a risk for falling? (See blog post “Fall in Love…Not Down”).
• Keep in mind that many medical problems are chronic and can be progressive, thus requiring more care over time (e.g., dementia, macular degeneration, Parkinson’s, osteoarthrosis).

Shopping and Cooking

• Are meals being skipped?
• Are there signs of dehydration? As one ages, it is important to consume enough liquid. (See blog post “Every Drop Counts”).
• Can they plan, shop, and make a nutritious meal?
• Are bills paid on time, checkbook balanced, and investments looked over?
• Are there any unexplained charges on the credit card?
• Have they been scammed?

Housekeeping and Laundry

• Are there any dirty dishes left out (or in the sink or cabinets)?
• Are their clothes clean?
• Are they taking showers?
• Some problems can be easily remedied with weekly maid service. (Bonus: If they are not used to this service, it presents a good opportunity to take a first step in accepting help from others in their home.)

Social Environment

• Do they attend outings with friends?
• Do they belong to groups and/or go to activities?

Driving Issues

• Do you see unexplained dents or scratches on their car(s)?
• Do they drive too fast or too slowly? You may need to follow them to observe.

Memory Problems

• Do they wander (on foot or in a car) and/or get lost in places they should remember?
• Do they ask the same question multiple times?
• Is there a sudden change in mood or behavior?

You in a Caregiving Role

• Can you physically assist your loved one up (e.g., lift from bed or chair or in/out of car)?
• How much time do you have each day to dedicate to caregiving?
• Do you live nearby or far away?
• How comfortable are you with personal care (e.g., helping with toileting and bathing)?
• Are you emotionally able to do caregiving?

Clear and open communication with family members can help alleviate issues. Be empathetic and understand how difficult these conversations can be. Observe closely and let this list help you see changes occurring over a course of months or even years. You will then know when it is time.

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