This is a question that  families dread.  You sense that your loved one is no longer safe living at home, but you don’t want to have to move him or her out of the place known as home. Knowing the signs that indicate a need for ongoing care can prevent your family from scrambling at the last minute to find a placement.

Signs to Watch for If Your Parent Lives Alone

Many people suffering from dementia are able to hide or explain away their symptoms. However, the more time you spend with them, the better the chances are that you will get an accurate sense of their abilities. What can be covered up over the course of an afternoon visit will often be revealed over the course of a few days. Here are some indicators that a parent is no longer safe living alone:

• Medication management. You find that your parent is not taking his or her medication in an organized fashion (i.e., a pill box), so no one can verify if the person has taken the medication. Another sign is that your parent is exhibiting symptoms that are inconsistent with taking medication as prescribed.
• Problems with Finances. You look at your parent’s mail and realize bills are not being paid,  or the checkbook or online banking account is in disarray.
• Problems with Transportation. Your parent’s car has signs of fender benders or other mishaps that you did not know about. The car mileage seems excessive given your parent’s previous driving habits. If your parent normally uses public transportation, he or she is unable to give clear instructions about how to get from the house to a common destination.   
• Meal Preparation. You find that there is little food in the kitchen, or the food in the refrigerator has gone bad. Perhaps you see that your parent is losing weight without explanation.
• Personal Hygiene. Is there a lot of undone laundry in the house?  Or does everything seem clean, except for the outfit that your parent seems to wear every day? Is your parent maintaining his or her usual patterns of bathing and grooming?
• General Confusion. Is your parent keeping appointments?  Does he or she get confused about the day of the week? Does your parent repeatedly ask you the same question? Does your parent call you in the middle of the night or at other times that signal that the parent may not be oriented in time?
• Reports from others
• Are neighbors mentioning troubling behavior that they are seeing, such as your parent wandering outside or having difficulty doing routine tasks?

Any of these signs are worthy of a closer evaluation of your parent’s living situation.

If Your Parent Lives with A Spouse

If your parent lives with a spouse, the spouse usually is aware of your parent’s declining abilities, but may be reluctant to give a full report, thinking that they can manage without help, or that they do not want to say something that will result in a person being transferred from the home.

Over time, people with Alzheimer’s typically require more care than one person can give. For a family who wants the parent to age in place, supplemental help can provide some relief. Options can include hiring someone to come into the home on a scheduled basis to allow the care giver time to see friends and do errands, or enrolling the parent in an adult day program. These programs not only support the caregiver, but also can allow the parent to engage more fully with the community and to maintain social skills

Even with extra help from home health agencies and adult day programs, families should be alert to signals that the care requirements are threatening the health of the caregiver. People with dementia who wake at night or wander pose special challenges that cannot be addressed by just one person for very long. Examples include wandering out of the home, especially while the caregiver is asleep, and unsupervised cooking. It is not uncommon that these situations end with a crisis, either with the caregiver too exhausted to help or the parent being injured while not being supervised.

Whether your parent lives alone or with a family member, once you realize that your parent requires on-going supervision, it is a good idea to start researching support options and residential alternatives. You might start by identifying adult day programs and home health agencies. You may not want to think about residential placements, but knowing what the options are can provide peace of mind, and allows for thoughtful planning. This research can take time, especially if the family is geographically scattered, since you may need to evaluate residences in different areas. When the family realizes that the parent can no longer live at home, it is far less stressful when the family knows what placement option is best for them. In subsequent blogs, we will review what to look for when touring assisted living residences and skilled nursing facilities.