When to Consider a Change - Part 1

Often as people age, they look at ways to stay as independent as possible by “downsizing” in terms of living arrangements. Sometimes downsizing is totally the choice of the person who sees changing needs. But more often, it is a joint decision of the individual involved and his or her children. It’s not an easy choice – but it is a necessary one. So how do you know it’s time to consider changes? Mostly that’s by taking a realistic look at both physical needs and manageability of current living arrangements. There are some “big picture” signs that may be helpful in considering a change in housing options. Look for big red flag issues.

• Has your loved one had a fall recently? Or a medical scare?  Who responded, and how long did it take? Accidents happen, but consider frequency.
• How did your person weather the most recent illness? Did last year’s cold turn into untreated bronchitis?
• Does your family member struggle due to a chronic illness (COPD, CHF, dementia)? That will never improve.
• ADLs (activities of daily living) and I(instrumental)ADLs are the skills needed to live independently—dressing, shopping, cooking, laundry, managing medications. Has your loved one had a recent functional assessment?

Up Close Signs Clues aren’t always visible from a distance or over the phone.  You can, however, learn more through touch.  Give them a big hug, and pay attention.

• Does your person feel thinner? Are clothes loose? Have notches been added to the belt?  Many serious conditions, from depression to cancer, can cause weight loss.  A person who has trouble getting out to shop, or even remembering how to cook (or eat) can lose weight.
• Do you feel anything different about the person’s strength and stature when you hug? Can he rise easily from a chair?
• Does she seem unsteady or unable to balance? Compare what you see to the last time you saw her.
• A close hug also can reveal changes in personal hygiene habits. Causes can range from memory problems to depression or other physical ailments.
• Does your person’s hair and makeup look all right? Are clothes clean?  Someone known as a sharp dresser who now has food stains all over his clothes has an issue.  A formerly clean-shaven man with an unkempt beard may be forgetting to shave or even how to shave.

Social Signs Does your loved one still get together for lunches or outings with friends?  Does she still participate in things like she used to – church, cards and social groups?

• Does he keep his 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 with people around might be lifesaving.
• Has she abandoned her hobbies? Maintained club memberships?  There are many reasons people cut back, but dropping out of everything and showing interest in almost nothing is a red flag for depression.
• When was the last time he left the house? Is it because of lack of transportation or a companion to join them?  Adults who fear being “locked away” in a retirement home need to understand that those places are not prisons, but offer outings and people to “out” with!  They’ll have opportunities to be more mobile and active, not less.
• We all need someone who checks in on a regular basis. Used to be that our neighbors would check on us if they didn’t see the drapes open or the newspaper leave the driveway.  Not so much anymore. Who checks on your person?
• In the event of a fire, flood, earthquake or other disaster, what’s the plan? Is someone nearby to assist?  Does your loved one understand the plan?

Money Signs Your loved one’s mail can offer an often-overlooked clue to how he or she are managing money, which is a common early warning sign of cognitive trouble.

• Is there lots of mail, scattered in lots of places? Do you see bills, insurance, and other matters not being managed?  Piles of mail and papers are also a tripping hazard.
• Unopened bills can indicate someone is having trouble handling finances – one of the first signs of dementia.
• Routine business letters from utilities or banks are normal, but it’s alarming if they refer to missed payments, overdrafts or recent accidents.
• Older adults often are vulnerable to scammers. Even someone who always has been sharp is vulnerable if he is having trouble thinking.
• Some charities hit up givers over and over, and your person might not remember giving the first time.
• Stacks of unopened magazines might mean that he may have unknowingly renewed a subscription several times or ordered things he didn’t need.

Driving Signs Take a drive with your person behind the wheel.  (I know, but this is important!)

• Walk around the car when you get in and out. Damage marks can be a sign of careless driving.
• Even people with mild dementia usually follow the rote basics of driving – put on the seatbelt, check the mirrors.
• The person may turn off the radio, or even avoid conversations so that he can concentrate on what he is doing.
• He or she may avoid certain routes, roads or highway driving – a kind of self-policing that also can signify changing abilities.
• A person whose driving ability is impaired is more likely to tailgate, drift from his lane, go below the speed limit, react slowly to lights or other cars and mix up the gas and brake pedals.

Kitchen Signs Because people spend so much time in the kitchen, you can learn a lot there.

• We all buy more than we need at times. Look for signs that food is not only old, but that this is unnoticed.
• Mold, sour milk that’s still used, and expiration dates well past can be clues.
• Ten bottles of ketchup? More cereal than could be eaten in a year?  Multiples often reveal that the shopper can’t remember from one trip to the next what she has at home.
• Frozen dinners are convenient, but few are actually healthy. If there’s not much fresh food, your loved one already might need help with meal prep.
• Check all the appliances – microwave, coffee maker, toaster, washer and dryer – any device that should be used routinely.
• Are stove knobs charred? Pots singed? Potholders with burned edges? Look for smoke detectors that have been detached.

Around-the-House Signs Sometimes the most obvious sign is hard to see because we’ve become so used to it.

• Inability to throw anything away may be a sign of a neurological or physical issue. Obviously that’s more worrisome in a neatnik.
• Things all over the floor are a trip hazards.
• Spills that haven’t been cleaned up are a common sign of dementia – the person lacks the follow-through to keep tidy.
• Look for cobwebs, bathroom mold, thick dust or other signs. Physical limitations can mean your loved one needs help.
• Look in the bathroom. Some may make a particular effort to clean everywhere else, but never expect anyone to go into their bathroom

Pet/Plant Care Signs

• Most of us have seen a plant go brown occasionally, but keep an eye out for chronic neglect, especially in a former plant-lover’s home.
• How are the pets doing? Check the dog’s nails.  Litter box clean?  Dead fish in the tank?  Poor grooming, overfeeding, and underfeeding all are red flags.

Home Maintenance Signs

• A lack of yard maintenance can mean your loved one isn’t faring well at home.
• Look for discolored siding or ceilings that might indicate a leak, gutters choked with leaves, broken windows or fences and dirty windows.
• Are papers being delivered but ignored?
• Check the mailbox. A full mailbox is an indication your person can’t make it out there often.

Get Help Looking for Signs Talk to old friends or neighbors to see how your loved one is doing.  Listen for hints that she doesn’t get out much – things like “She doesn’t come over anymore” or “She quit book club.”

• Pay attention to comments that indicate ongoing concerns. (“Has he had that heart test yet?”, “We were worried when the ambulance came.”)
• With appropriate permission, your loved one’s doctor may share concerns about his patient’s safety at home – or may be able to alleviate concerns with a home assessment.
• A social worker or home health professional could visit and do an informal evaluation. While older people may resist a “total stranger” coming in, you could try pitching it as a neutral second opinion or “doctor’s orders.”   Some people wind up sharing doubts or vulnerabilities with a sympathetic, experienced stranger that they never could admit to their children or family.

Sometimes the information we collect might be impacted by our feelings, emotions, and the stress levels of everyone involved, so consider how YOU’RE doing. While the decision to remain in one’s home is not primarily about you (son, daughter, grandchild or caregiver), your own exhaustion can be a good gauge of a decline in an older adults’ ability to care for himself.  Keeping someone at home can require lots of hands-on help, support and care coordination.  It can wear you out and stress your relationship.  You’ll all feel the strain. Safety is crucial, but so is the emotional state of your loved one.  If someone living alone is riddled with anxieties or increasingly lonely, that may tip the scales toward a move not solely based on health and safety concerns. It’s probably time to see what options are out there.     Brian Rega is the Director of Senior Services/Housing for St. Bernards Healthcare based in Jonesboro. St. Bernards offers almost 300 housing units for adults age 55+ including the flagship St. Bernards Village; Cottage Homes; Benedictine Manor, (affordable housing for low-income elderly), and the latest addition, St. Bernards Villa featuring memory care and assisted living. He has held the position since 1998. A native of Ash Flat, (Arkansas); Rega is a licensed residential care/assisted living facility administrator, and is an instructor in the administrator certification program. He holds a bachelor ‘sdegree in communications from Arkansas State University-Jonesboro, and is a certified business trainer. In 2006, he completed studies to become one of only two “Certified Aging Services Professionals” in the state of Arkansas, through the University of North Texas.   He was first elected to the Board of Directors of the Arkansas Residential Assisted Living Association in 2000, and then appointed chairman of the board by his peers each year between 2003 and 2013. He remains on the Board today.