Rebecca and her husband live 500 miles away from her 82-year-old mother, who is exhibiting signs of early Alzheimer's disease and suffers from arthritis. Rebecca worries about her mother’s safety, but every time she shares her concerns, the answer is always the same: “Everything is fine. Stop worrying about me.”
Then one day, Rebecca receives a phone call from a hospital social worker. Her mother fell down the stairs, broke her hip and was hospitalized. Rebecca’s mother insists it could happen to anyone and that she is perfectly safe at home and able to take care of herself.
“This is a common scenario,” says Pamela Braun, MSW, LCSW, CPF, President of Geriatric Assessment, Management & Solutions in Sun City, Arizona. “When questioned about their situation and needs, an elderly person may hide the truth from family members. Often the adult children find out what is truly going on from a third party, such as the hospital or a neighbor.”
A person’s home represents familiar comforts, self-sufficiency and privacy. That is why the prospect of moving in with a relative or transitioning into a senior living facility is one of the most difficult decisions a person must make in their lifetime. For families who are struggling with this transition, rationale often takes a back seat to powerful emotions.
However, the difficult task of determining whether an aging loved one can remain at home safely must be addressed. Geriatric care managers (GCMs) frequently help families through the process. A GCM is a professional who specializes in assisting older people and their families with long-term care arrangements. They typically begin by conducting a thorough assessment to determine if a senior is physically and mentally able to continue living in their own home.
Braun says allowing an aging parent to remain at home is the least invasive intervention and can be successful. “When people move out of their home, it is usually after Plan A (remaining at home) did not work. Trying the least restrictive approach first is advisable, but family members must be realistic about their loved ones’ abilities.”
Evaluating a Senior’s Ability to Age in Place
To determine if an elderly person can continue living at home, take a good look at all aspects of their present housing situation and how each one affects their safety and quality of life. An in-person visit offers the most accurate evaluation. Braun says this assessment should include the following topics and questions:
- Medication management. Do they remember to take their medications at prescribed doses and times? Have they had any hospitalizations or health issues due to mismanaging their meds? If you aren’t sure, look for expired medicines and pill bottles that are spread out in different rooms with no apparent structure or routine.
- Meal preparation. Can they cook for themselves? Are they eating balanced meals? Are they able to safely operate appliances? Have there been any incidents where they have forgotten a meal in the oven or accidentally left the stove on?
- Safety and mobility. Do they have difficulty getting around or taking stairs? Have they fallen in the home? Do they have a plan in place to contact help in case of an emergency? If mobility is an issue, can the home be equipped with grab bars, an emergency response system and other tools to ensure safety? If they do not use a mobility aid for added stability, would they be open to using one?
- Personal hygiene. Can they bathe themselves, groom adequately and launder their clothes and linens? Are they bathing frequently enough? A generally unkempt appearance, body odor and soiled clothing are clues that a senior is unable or unwilling to care for themselves properly.
- Transportation. Are they still driving? Should they be driving? Do they have alternate means of transportation for doctor’s appointments, grocery shopping and other errands?
- Socialization. Are they isolated from others most of the time? Do they have friends? How often do they get out of the house? Are they showing signs of depression?
- Home management. Is the house clean or in general disarray? Take a peek in each room (including bathrooms) to get a feel for their level of cleanliness. Keep an eye out for stains on furniture and carpets and spoiled food in the refrigerator.
- Financial management. Are they paying their bills on time? Are there stacks of unopened mail, unpaid bills or late payment notices lying around? Are there signs that they’ve been spending excessively? Do they get calls from telemarketers or creditors?
Interpreting the Results
It’s important to recognize that, even if a loved one is experiencing difficulties in some of the areas discussed above, it doesn’t necessarily mean that they need to move to a long-term care facility. For example, in cases where household chores and meal preparation are a challenge, help is available. A cleaning service, meal delivery service or a few hours of in-home care can ensure these needs are met.
For some seniors, social issues may be the priority. They may not necessarily need assistance with activities of daily living but could benefit from a new living arrangement. If they can no longer drive, have an increasingly limited social life and show signs of loneliness, senior living might be the answer. Residents in independent and assisted living need only leave their apartment in order to engage in activities, socialize with their peers and catch a ride to the doctor.
In some cases, the assessment may reveal hazards associated with a senior’s current living situation and signal serious changes in their mental and physical health. Poor money management can make them more vulnerable to financial elder abuse, a burned pot left on the stove could turn into a house fire, and unresolved mobility issues could result in a life-changing fall. It is up to you to objectively look at their situation, be realistic about the implications of what you find and take proactive steps to ensure their wellbeing.
Braun has been involved in many of these assessments and acknowledges that it is a delicate situation. “The entire process constitutes a role reversal between adult children and their parents, and it typically is not welcomed by elders.” Acting on the results of your evaluation can be challenging if a loved one is resistant to change, but there are some tips for beginning this discussion that can help.