Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly
Consider Assisted Living
The decision to help an aging adult move out of a current home is a complex one -- both emotionally and practically.
Above all, you want the person to be safe and well. How can you all feel more confident about whether circumstances suggest that your loved one should no longer be living alone?
Although every situation is different, looking at the following 11 signs will give you valuable information to help make the decision.
1. Big-picture signs
2. Up-close signs
3. Social signs
4. Money signs
5. Driving signs
6. Kitchen signs
7. Around-the-house signs
8. Pet-care and plant-care signs
9. Home-maintenance signs
10. Help from others seeing signs
11. Caregivers' signs
1. Big-picture signs it might be time for assisted living
Keep the big red flags in mind
Certain situations make it more obvious
that it's wise to start thinking
about alternate living arrangements.
Look for :
Recent accidents or close calls. Did your loved one take a fall, have a medical scare, or get in a fender bender (or worse)? Who responded and how long did it take? Accidents do happen, but as people get older, the odds rise of them happening again.
A slow recovery.
How did the person you're caring for weather the most recent illness (for example, a flu or bad cold)? Was he or she able and willing to seek medical care when needed, or did last winter's cold develop into untreated bronchitis?
A chronic health condition that's worsening.
Progressive problems such as COPD, dementia, and congestive heart failure can decline gradually or precipitously, but either way, their presence means your loved one will increasingly need help.
Increasing difficulty managing the activities of daily living (ADLs) and instrumental activities of daily living (IADLs).
ADLs and IADLs are the skills needed to live independently -- dressing, shopping, cooking, doing laundry, managing medications, and so on. Doctors, social workers, and other geriatric experts evaluate them as part of a functional assessment, which is one way to get an expert's view of the situation. Difficulties with ADLs and IADLs can sometimes be remedied by bringing in more in-home help.
2. Up-close signs it might be time for assisted living
Give your loved one a big hug.
Clues aren't always visible from a distance;
especially when you don't see the person every day,
you might learn more through touch.
Look for :
Noticeable weight loss.
Does the person feel thinner? Are clothes loose, or has he added notches to his belt? Many conditions, from depression to cancer, can cause weight loss. A person who is having trouble getting out to shop or remembering how to cook (or to eat) can lose weight; check the fridge and watch meal-prep skills.
Seeming more frail.
Do you feel anything "different" about the person's strength and stature when you hug? Can your loved one rise easily from a chair? Does she or he seem unsteady or unable to balance? Compare these observations to the last time you were together.
Noticeable weight gain.
Common causes include an injury slowing the person down, diabetes, and dementia (when someone doesn't remember eating, he or she may indulge in meals and snacks all day long). Someone with money troubles may choose fewer fresh foods and more packaged goods or dried pasta and bread.
Strange body odor.
Unfortunately, a close hug can also reveal changes in personal hygiene habits. Causes range from memory trouble to depression to other physical ailments.
Changes in appearance.
Does the person's hair and makeup look all right? Are clothes clean? Someone known for crisply ironed shirts who's now in a stained sweatshirt may lack the dexterity for buttons or may have lost the strength for managing an ironing board and iron. A formerly clean-shaven man with an unkempt beard may be forgetting to shave (or forgetting how to shave).
3. Social signs it might be time for assisted living
Think realistically about your loved one's social connections
Social circles tend to shrink with age,
which can have health and safety implications.
Look for :
Signs of active friendships.
Does your loved one still get together for lunches or outings with friends or visits with neighbors, or participate in religious activities or other group events? Does he or she talk about others or keep a calendar of appointments? Lack of companionship is associated with depression and heart problems in older adults. If friends have died or moved away, moving to a place where other people are around could be lifesaving.
Signs that your loved one has cut back on activities and interests.
Is a hobby area abandoned? Has a club membership been given up? A library card gone unused? There are many reasons people cut back, but dropping out of everything and showing interest in almost nothing is a red flag for depression.
Days spent without leaving the house.
This sometimes happens because the person can no longer drive or is afraid to take public transportation alone and lacks a companion to come along. While many older adults fear being "locked away" in a retirement home, many such facilities offer regular outings that may keep them more mobile and active, not less.
Someone who checks in on a regular basis.
If not you or another family member, who does this? Is your loved one willing to consider a home-safety alarm system, a personal alarm system, or a daily calling service?
A plan for a worst-case scenario.
If there's a fire, earthquake, flood, or other disaster, is someone on standby to assist? Does your loved one understand the plan?
4. Money signs it might be time for assisted living
Look for the mail.
Your loved one's mail can offer an often-overlooked clue
to how he or she is managing money,
a common early warning sign of cognitive trouble.
Look for :
Snowdrifts of mail in various places.
Finding lots of mail scattered around raises concern about how bills, insurance, and other matters are being managed. (Piles of mail are also a potential tripping hazard.)
Unopened personal mail.
Everybody skips junk mail, but few of us can ignore a good old-fashioned, hand-addressed letter.
This can indicate that your loved one is having difficulty managing finances -- one of the most common first signs of dementia
Letters from banks, creditors, or insurers.
Routine business letters aren't worrisome. But it's alarming if they're referring to overdue payments, overdrawn balances, recent accidents, or other concerning events.
Thank-you messages from charities.
Older adults are often vulnerable to scammers. Even those who have always been fiscally prudent are vulnerable if they're having trouble with thinking skills (a common sign of Alzheimer's disease). Some charities hit up givers over and over, and your loved one may not remember having donating the first time.
Lots of crisp, unread magazines.
The person may unknowingly have repeat-renewal subscriptions he or she doesn't need.
5. Driving signs it might be time for assisted living
Take a drive with your loved one behind the wheel,
if he or she is still driving.
Living independently in our culture
often depends on the ability to drive
(or the arrangement of alternate transportation options).
Look for :
Nicks or dents on the car.
Notice the car body as you get in and out. Damage marks can be signs of careless driving.
Whether the person promptly fastens his or her seatbelt.
Even people with mild dementia usually follow the rote basics of driving. It's worrisome if he or she is forgetting this step.
Tension, preoccupation, or being easily distracted.
The person may turn off the radio, for example, or be unwilling to engage in conversation while driving. He or she may avoid certain routes, highway driving, or driving at night and in rain -- a safe kind of self-policing but also signals of changing ability.
Signs of dangerous driving.
People whose driving ability is impaired are more likely to tailgate, drift from their lane, go below the speed limit, react slowly to lights or other cars, and mix up gas and brake pedals. See 8 ways to assess someone's driving.
Check out the dashboard as you ride along. Does the car have sufficient oil, gas, antifreeze, windshield-wiper fluid?
6. Kitchen signs it might be signs for assisted living
Go through the kitchen,
from fridge to cupboards to oven.
Because people spend so much time in this room, you can learn a lot.
Look for :
Stale or expired foods.
We all buy more than we need. Look for signs that food is not only old but that this is unnoticed -- mold, sour milk that's still used, or expiration dates well past due, for example.
Multiples of the same item.
Ten bottles of ketchup? More cereal than can be eaten in a year? Multiples often reveal that the shopper can't remember from one store trip to the next what's in stock at home.
A freezer full of TV dinners.
Your loved one may buy them for convenience sake, but frozen dinners tend not to make healthy diet. If there's not much fresh food in the house (because it's too hard to for the person to procure or cook), your loved one might be ready to have help with meal prep or delivery services.
Check them all: microwave, coffeemaker, toaster, washer, and dryer -- any device you know your loved one uses (or used to use) routinely.
Signs of fire.
Are stove knobs charred? Pot bottoms singed badly (or thrown out)? Do any potholders have burned edges? Also look for a discharged fire extinguisher, smoke detectors that have been disassembled, or boxes of baking soda near the stove. Accidents happen; ask for the story behind what you see. Accidental fires are a common home danger for older adults.
Increased use of takeout or simpler cooking.
A change in physical or mental abilities might explain a downshift to simpler recipes or food choices.
7. Around-the-house signs it might be time for assisted living
Look around the living areas.
Sometimes the most obvious sign is hard to see
because we become so used to it.
Look for :
Lots of clutter.
An inability to throw anything away may be a sign of a neurological or physical issue. Obviously it's more worrisome in a neatnik than in a chronic slob. Papers or pet toys all over the floor represent a tripping hazard.
Signs of lax housekeeping.
Spills that haven't been cleaned up are a common sign of dementia -- the person lacks the follow-through to tidy. Keep an eye out for cobwebs, bathroom mold, thick dust, or other signs of slackness. Physical limitations can mean your loved one needs housekeeping help or a living situation where this is taken care of for him or her.
Bathroom grime and clutter.
A common scenario: Your loved one makes an effort to tidy up living areas but overlooks the bathroom. Or the guest bath is clean, but not the one the person uses all the time (the one off a bedroom, for example). Here you may see a truer picture of how your loved one is keeping up.
8. Pet-care and plant-care signs it might be time for assisted living
Be sure to check out
how the other living things are faring.
An ability to take care of pets and plants
goes along with self-care.
Look for :
Plants that are dying, dead, or just gone.
Most of us have seen plants go brown sometimes. Keep an eye out for chronic neglect, especially in a former plant-lover's home.
Animals that don't seem well tended.
Common problems: dogs with long nails, cat litter boxes that haven't been changed lately, or dead fish in the fish tank. Poor grooming, overfeeding, and underfeeding are other red flags.
9. Home-maintenance signs it might be time for assisted living
Walk around the yard.
or lack of it
can yield clues that your loved one
isn't faring as well at home alone anymore
Look for :
Signs of neglect.
Look for discolored siding or ceilings that might indicate a leak, gutters choked with leaves, broken windows or fences, dirty windows.
Newspapers in the bushes.
Are papers being delivered but ignored? Sometimes people pick up those they can see on a driveway but not those that go off into the yard.
Mail piled up in the mailbox.
Go out and check -- it's an indication that your loved one doesn't even retrieve it regularly.
10. Get help looking for signs it might be time for assisted living
Get the input of others
who know your loved one
in order to collect a fuller picture of reality.
Gently probing about what others think isn't nosy;
you're being loving, concerned, and proactive.
Look for :
Input from those in your loved one's circle.
Talk to old friends and close relatives to get their sense of how the person is faring. Listen for stories that hint that the person doesn't get out much ("She doesn't come over anymore." "She quit book club."). Pay attention to comments that indicate ongoing concerns ("Has he had that heart test yet?" "We were worried the day the ambulance came.").
With appropriate permission, your loved one's primary doctor may share your concerns about his or her patient's safety at home -- or may be able to alleviate those concerns or suggest where to get a home assessment.
A second opinion.
A social worker or professional geriatric care manager visits older adults' homes and does informal evaluations. While your loved one may initially resist the notion of a "total stranger" checking on them, try pitching it as a professional (and neutral) second opinion, or ask the doctor to "prescribe" it. Some people wind up sharing doubts or vulnerabilities with a sympathetic, experienced stranger that they're loathe to admit to their own children or family.
11. Caregivers' signs it might be time for assisted living
Finally, realize that some of the information you collect is intangible -- it has to do with feelings and emotions, and the stress levels of everyone involved.
Look for :
How you're doing.
While this decision to remain in one's home is not primarily about you -- the son, daughter, grandchild, caregiver -- your own exhaustion can be a good gauge of a decline in older adults' ability to care for themselves. Keeping someone at home can require lots of hands-on support or care coordination, and this is time-consuming. If your loved one's need for care is just plain wearing you out, or if a spouse or children are feeling the collective strain of your caregiving activities, these are major signs that it's time to start looking at other options.
Your loved one's emotional state.
Safety is crucial, of course, but so is emotional well-being. If someone living alone is riddled with anxieties or increasingly lonely, then that may tip the scales toward a move not solely based on health and safety reasons.
If your loved one has a full life, a close neighborhood and community connections, and seems to be thriving, it's worth exploring as many in-home care options as possible before raising stress levels by pressing a move from a beloved home.
If, on the other hand, your loved one is showing signs that living alone is a strain, it may be time for a talk. Broach the subject of where to live in a neutral way and you may find that your loved one harbors the same fears for current and future safety and security that you do. Find out what your loved one fears most about moving and about staying before launching into your own worries and what you think ought to be done.
This article was written by Paula Spencer Scott, (Spencer Scott P, 2014).
Downloaded and edited by Dr Angelo Grazioli, Jan 2014
This is one of several topics presented in the Thorny Issues sector of this toolkit
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