How do you know when your older loved one needs help in the home?

Usually as we age, most of us would prefer to stay independent in our own homes. It’s familiar and comfortable; a place where we feel we have control over our daily lives and the freedom to do what we want. But continuing to live independently at home can become risky for many of our older loved ones, even though most likely they will downplay or hide any issues they are having.

It can be challenging to know when, and how, to step in and become more involved in your older loved one’s care. The decision to step in might come quickly after there is an accident (such as a fall), or a sudden decline in health (such as a stroke) or it might come after some investigative work, asking questions, popping in unannounced and regularly monitoring their physical and mental abilities. As caregivers, we walk a fine line between making sure our loved one is safe and taken care of without restricting their independence. 

Signs to watch for:

• Neglecting household responsibilities: Changes in tidiness and organization in a previously well-kept home, stacks of unopened mail and unpaid bills, spoiled and out-of-date food, stained or wet carpet or furniture, evidence of hoarding, and urine odor in the home
• Neglecting personal hygiene and grooming: Noticeable body odor, poor oral care, disheveled appearance, wearing the same clothes several days in a row, continence issues, maintaining a healthy diet and keeping hydrated
• Challenges with mobility: Difficulty moving around, transferring from a seated position to standing, unexplained bruises, cuts, and scrapes
• Changes in behavior and mental status: Moodiness, apathy, changes in personality, agitation, disorientation to time and place, missed appointments
• Changes in cognition: Memory, attention and concentration, ability to find words, ability to process information, problem solving, ability to multi-task, repetitive speech and inability to complete sentences, consistently making poor judgement choices

If you notice your loved one is struggling with any of the above warning signs, it’s time to have an open and honest conversation with them. But knowing it is the right thing to do doesn’t make the discussion any easier. Most of the time our older loved ones know their cognitive and physical abilities are waning and realize they will have to rely on someone else to help manage their daily needs. And this can bring a flood of emotions — anger, denial, resentment. They may see it as an invasion of their privacy, they may blame you for taking away their independence, and they may become even more stubborn and refuse your help. It is a difficult line to walk.

What can you do?

• Be open and honest. Share your feelings and concerns, no matter how uncomfortable this may be.
• Remind your loved one that you are here to support them. It is easy for your parent or loved one to feel threatened and see you as the enemy when they feel their independence is being taken away.   
• Acknowledge and validate their feelings and emotions. Remember, this is just one more turning point in their life. Validating their feelings and emotions is demonstrating that you understand what they are feeling without trying to talk them out of it or shame them. It doesn’t mean you agree with them, or you think their emotional response is warranted.
• Include them in the decision-making process. Give your loved one some control in all the decisions by providing them with as many options and as much information as they can understand and process.
• Keep the lines of communication open with your loved one.
• Keep things in perspective in your own mind. You have a life beyond caregiving. You need to set boundaries on what you are willing and able to do.

What do you do when they resist?

The goal is not to take away anyone’s independence, but to keep them safe while maintaining as much of their independence as possible for as long as possible in their own home. 

• Keep in mind that this will — most likely — be a process: Once you sense they are getting defensive, back off and steer the conversation to more common ground. Then try again in a few days.
• Do your homework: Determine realistically what type of care they will need. Take time to observe how they are doing, what they are capable of and what they struggle with. Focus only on what they are having difficulties with — meal preparation, housekeeping, medication adherence, transportation. Everyone needs a purpose, and the more they can contribute to their own well-being the less resistant they might be in accepting help for the things they are no longer able to do.
• Ask them about their preferences and what would make life easier for them: It’s important to get their input and make every effort to incorporate those preferences into the care plan. They will be less likely to reject your effort if they do not feel like you are simply taking control of the situation, but rather listening to them and allowing them to voice their opinions.
• Approach the need for care conversation respectfully: Choose a time when both of you are relaxed and are not feeling rushed. Be honest and open when explaining what type of care or help is needed. Talk about the fact that you both are dealing with changes. Let them know that you are trying to help them retain as much independence as possible, with as little upset to their routine as possible, all while keeping their safety a priority.
• Enlist help: asking a trusted family member, friend, or clergy who can act as a buffer as you explain why they need to make changes in their life. It may make a larger impact on them hearing the same concerns from more than just one person. It may make the point that your concerns are valid and their well-being matters.
   
• Suggest a trial arrangement highlighting the positives: give your loved one a chance to "test the waters" and experience the benefits of assistance. Ask them to try it for a limited amount of time. If they don’t like it, see if they would be willing to try something else – another home care service, another "heat and eat" meal program, etc.

It’s hard to understand someone’s resistance when the need is so clear to everyone else. But for many older people who have lived independently their whole lives, accepting any intrusions can be seen as humiliating and unnecessary. They may feel frightened, vulnerable, incompetent, or guilty that they are no longer able to care for themselves or their home. Go easy. 

In-home care:

• There are several in-home care agencies in our area. Please email me and I will send you a copy of the list. Many of the agencies are included in the 2024/2025 Pathways Guide; click HERE to request a copy. 
• Private Health Care, Inc. - Joan Bianco: Joan screens and vets caregivers for private care.  For more information, please call 859- 576-1540. 
• Bluegrass Area Agency on Aging | Home Care Program: Eligibility — must be 60 years of age or older and deemed eligible by a qualified case manager. Individuals need assistance in two activities of daily living such as eating, bathing, dressing, and toileting.  Cost is based on the recipient’s income using a sliding fee scale. For more information or to apply please call the Aging and Disability Resource Center at 859-266-1116.  
• Care.com – www.care.com    

When my dad was living with us, I came home one evening and found him on the floor of the kitchen struggling to get up. I knew it was time to get someone in to assist during the day. It was a difficult, but necessary, decision to make and a difficult decision for him to accept. And although we went through a few caregivers in the beginning, we finally found one that my dad trusted and enjoyed being with, if it is not working out, try again. 

Do not hesitate to call the agency or talk with the private caregiver explaining that it’s just not working out, not everyone is comfortable with everyone else and that’s OK too. 

Stay well, stay healthy, stay connected,

Terri