Is My Loved One Safe Living at Home? When to Consider an Elder Care Facility

When to Consider an Elder Care Facility

It’s time to consider long-term care if your loved one struggles to take care of their health, personal needs, home, or finances – tasks known as “activities of daily living” (ADLs) and “instrumental activities of daily living” (IADLs).

If your loved one is struggling in some of these areas, keep in mind that moving to a facility is not the only option for long-term care. In-home support may be enough to keep them safe and successful for the time being.
However, all these signs should be regarded as red flags which require investigation and, in most cases, some sort of intervention.
By addressing concerns early, it’s often possible to prevent them from escalating into major problems.

Signs a Senior May Not be Safe at Home

Keep an eye open for signs that your loved one might be struggling or unsafe at home.

1.) Memory Loss and Cognitive Changes

Occasional misplaced keys or forgetfulness is common and is no reason to be alarmed. Memory loss that interferes with your loved one’s ability to take care of themselves is a concern. Memory loss should be evaluated by a doctor.

Concerning signs of memory loss in loved ones:

  • Forgetting where they are
  • Getting lost in familiar places
  • Confusion about familiar people
  • Confusion about time
  • Frequently losing items
  • Difficulty following recipes or instructions
  • Repeatedly asking the same questions
  • Forgetting events or appointments
  • Unlikely to be able (or know how) to evacuate in time in an emergency
  • Unlikely to be able to call for help if needed or recognize that help is needed

2.) Hard-to-Manage Medical Conditions

Many medical conditions can be challenging to manage at home, especially without support.

Common examples of conditions that can be difficult for seniors to handle alone include:

  • Amputation
  • Arthritis
  • Alzheimer’s or other forms of dementia
  • Blindness or vision loss
  • Cancer
  • Chronic pain
  • Depression
  • Diabetes
  • Heart disease
  • Lung disease
  • Obesity
  • Parkinson's disease
  • Strokes
  • Wounds (including bedsores or pressure ulcers)

3.) Difficulty with Medications

Problems with medications can have catastrophic effects on older adults, so it’s imperative they take them correctly.

Signs that your loved one may not be taking their medications as prescribed include:

  • They have problems refilling medications
  • Pill bottles are expired (suggesting they haven’t been refilled recently)
  • Pill bottles are spread throughout the house
  • They don’t follow special instructions about storing or taking medications (such as keeping it refrigerated or taking it on an empty stomach).
  • There’s no clear routine or system for remembering which medications to take when
  • They’ve had health problems resulting from skipped (or multiple) doses

4.) Struggles with Mobility

Mobility problems, such as unsteadiness while walking or difficulty getting out of a chair, can result from a variety of causes. Some can be treated with physical therapy, adaptive equipment, or other interventions, so be sure to communicate with the doctor about any concerns.

Mobility challenges that may indicate a need to move include:

  • Difficulty getting in or out of bed
  • Trouble getting around the home, up or down any stairs or over thresholds
  • Unsteady on their feet or difficulty walking
  • Unlikely to be able to get out in time in an emergency
  • Unlikely to be able to get to the phone or call for help if needed

5.) Falls

Falls are a huge concern for older adults. One in four adults falls every year, and falling once doubles their chance of falling again. One in five falls results in a broken bone or serious injury. The good news is that falls are largely preventable when proper precautions are taken.

Be aware of the factors that contribute to your loved one’s risk of falling, and talk to the doctor about any concerns. There are also plenty of good resources available for preventing falls in older adults.

Risk factors for falls include:

  • Multiple falls (or near-falls)
  • Taking five or more medications
  • Taking medications that cause sleepiness, dizziness, or a need to rush to the bathroom
  • Muscle weakness
  • Foot pain or numbness
  • Difficulty walking
  • Poor balance
  • Shoes and slippers that aren’t properly fitted and supportive
  • Dizziness when first standing up
  • Confusion
  • Alcohol use

6.) Weight Loss or MalnutritionWhen older adults don’t get the nutrition they need it can affect their thinking, mood, and ability to take care of themselves. Signs of malnutrition should be acted on immediately and reported to the doctor.

Malnutrition is common among seniors for several reasons:

  • Struggling to prepare meals, shop, or afford groceries
  • Medications and health conditions that affect appetite and sense of taste and smell
  • Trouble remembering to eat
  • Loneliness, grief, or depression
  • Tooth, mouth, or denture discomfort
  • Swallowing problems
  • Difficulty getting food to their mouth (due to tremors, weakness, or other conditions)
Signs of malnutrition:
  • Unintentional weight loss (most noticeable around the face, temples, hands, and back)
  • Clothing fits more loosely
  • Dentures or jewelry become loose
  • Fatigue or weakness
  • Apathy or irritability
  • Lack of appetite
  • Dry, brittle hair

7.) Problems with Personal Care

A decline in hygiene and personal care can be a red flag that your loved one is struggling, especially if it’s a change from their previous, lifelong habits.

Look for signs of difficulty with personal care:

  • Body odor
  • Unshaven
  • Messy or greasy hair
  • Long, broken, uneven, or dirty fingernails or toenails
  • Wrinkled, torn, or soiled clothing
  • Clothing that’s not appropriate for the weather

8.) The Home Needs Upkeep

Your loved one’s home can tell you a lot about how much they may be struggling. It doesn’t have to be spotless, but it should be safe and sanitary.

Look for:

  • Mold
  • Insect infestations
  • Unsanitary bathrooms or toilets
  • Stained carpets or furniture
  • Spilled liquids or powders on the floor
  • Cluttered walkways
  • Spoiled food in the fridge
  • Scorched pots, pans, or stovetop
  • A general state of disrepair (burned out lightbulbs, etc)
  • Soiled sheets or towels
  • Piles of dirty laundry
  • Unkempt yard

9.) Financial Mismanagement

If you don’t have access to your loved one’s finances, it may be hard to know for sure what’s going on, but keep your eye open for outward signs of concern and listen to your gut.

Potential signs of declining ability to manage mail and finances include:

  • Stacks of unopened mail
  • Evidence of unpaid bills (disconnected power, final notices, etc)
  • Signs of excessive spending or scam activity

10.) Trouble with Transportation

A lack of transportation can leave your loved one stranded in their home, contributing to isolation and an inability to meet a number of needs.
If your loved one is no longer driving, check that they’re able to get to:

  • Medical appointments
  • Shopping and errands
  • Social engagements
  • Other meaningful activities
If your loved one is still driving, look for signs that they may not still be safe to do so, such as:
  • Accidents or near misses
  • Traffic tickets or warnings
  • Driving too slow (or fast) for safety
  • Sudden lane changes
  • Missing stop signs or traffic lights
  • Seeming stressed by driving
  • Dings or dents in the car
  • Getting lost in familiar areas

11.) Lack of Socialization

Isolation and loneliness are serious concerns for seniors. Isolated adults lack social connection, while loneliness is the feeling of being all alone, even if people are around. Both are very common among older adults, with about one in three feeling lonely and one in four experiencing isolation.

Older adults who are lonely or isolated have surprisingly severe health risks, rivaling those of smoking, obesity, and inactivity. They’re much more likely to experience dementia, heart disease, stroke, depression, anxiety, suicide, hospitalization, and death from any cause.

Your loved one may not admit they’re feeling lonely, so be aware of the possibility and look for outward signs.

Signs of loneliness can include:

  • Low energy
  • Restless sleep
  • Changes in appetite
  • Difficulty with mobility
  • Changes in buying habits
  • Withdrawing from family or friends
  • Disengaging with social circle or community
  • A general decline in health or cognition with no clear cause
  • Language, cultural or other differences with those around them (if they interfere with a sense of belonging)
  • Few opportunities for meaningful, personally rewarding activities and social interactions

12.) Mood, Personality, and Behavior Changes

Changes in mood, personality, or behavior can be a sign of a variety of physical or mental health concerns. Many of these can be treated medically, so talk to the doctor about any concerns.

Potential medical causes of mood, personality, or behavioral changes include:

  • Medication side effects
  • Urinary tract infection
  • Depression
  • Dementia
  • Stress

13.) Watch for Signs of Elder Abuse and Self-Neglect

Part of determining whether your loved one is safe in their own home is to ensure that they are free from abuse, exploitation, and self-neglect.

Unfortunately, elder abuse, exploitation, and neglect are much more common than most people realize. It’s believed that about 10% of Americans over the age of 60 have experienced abuse, but that only one in every 24 cases is ever reported.

Two-thirds of the people who commit elder abuse are the victim’s spouses or adult children. This is in part due to caregivers becoming stressed, burned out, overwhelmed and unable to handle a situation that has grown out of control.

There are seven types of elder abuse:

  • Physical abuse: Non-accidental use of force resulting in pain or injury (includes inappropriately medicating or restraining an elder)
  • Emotional abuse: Yelling, intimidating, humiliating or otherwise harming an older person emotionally or psychologically.
  • Sexual abuse: Non-consensual sexual activity
  • Financial exploitation: Scams or using an older adult’s property or funds without authorization.
  • Healthcare fraud and abuse: Committed by medical professionals or caregivers who deceive, defraud, overcharge or take advantage of an elderly patient.
  • Elder neglect: A caregiver fails to take care of the older adult to the extent they’re obligated
  • Elder self-neglect: An older adult fails to take care of their own needs, often due to physical or cognitive challenges.

Signs of elder abuse can include:

  • Unexplained bruises (especially those that appear on both sides of the body symmetrically, resemble fingerprints, are near the breasts or genitals, or are otherwise suspicious)
  • Unexplained fractures or injuries
  • A caregiver who won’t allow you to see your loved one alone
  • Threatening, controlling, or belittling treatment by a caregiver or family member.

Signs of financial exploitation or healthcare fraud can include:

  • Sudden or suspicious changes in your loved one’s finances, accounts, will, or property titles
  • Items or cash missing
  • Unnecessary services, subscriptions
  • Signs of inadequate care by a professional
  • Duplicate billings or evidence of overcharging

Signs of neglect or self-neglect can include:

  • Weight loss, malnutrition, or dehydration
  • Poor hygiene
  • Dirty, soiled clothes or messy hair
  • Untreated sores or other health concerns
  • Unsanitary or unsafe living conditions\

This is not a complete list of potential signs of abuse. If something feels off to you, be sure to learn more about elder abuse and talk about it with your loved one while you’re alone together.

Talk to your state’s Adult Protective Services office regarding any concerns about possible abuse, neglect, or self-neglect. If your loved one is in immediate danger, call the police first.
Signs it’s Time to Move Sooner than LaterAlthough some signs that a senior’s struggling can be managed in the home with the right support, there are a few concerns that warrant an imminent move to a facility (or 24-hour in-home care).

Signs a move may be needed right away:

  • Wandering or behavioral concerns that you or the family caregivers can’t manage
  • Severe impulsiveness, impaired judgment, or unpredictable behavior
  • Feeling very isolated and lonely (moving to the right senior community can make a big difference)
  • Family caregiver losing patience, getting sick, or experiencing caregiver burnout (profound physical, emotional and mental exhaustion)
  • Mobility needs beyond the ability of a caregiver to safely assist (first consult with physical therapy to ensure you have the necessary equipment and training)
  • Complex medical needs or frailty beyond the ability of a family caregiver to manage

Plan as Far as Possible in Advance for a Move to Senior LivingIt’s highly recommended that you get familiar with long-term care options in your area long before you anticipate needing them. If you leave it to the last minute, your choices will be much more limited, the transition more chaotic and stressful, and your loved one will be less likely to end up in the best place for them.

Moving to a facility that’s not a great fit means they’ll be generally more stressed and unsatisfied. Their overall experience will be worse, and you may have to choose between toughing it out and going through another stressful move.

Start planning for long-term care in advance with these steps:
  • Learn about the types of long term care available (No Wrong Door is a great resource)
  • Tour several facilities in person, with your loved one if possible. (Bring along a checklist of what to ask about and look for)
  • Talk with your loved one regarding their wishes and concerns about long-term care. Ask how they would know they need more help, and how they’d like to handle situations in which their safety was in question.
  • Consult with professionals (health care providers, a physical therapist, a geriatric care manager) to weigh in on your loved one’s situation.

If you find yourself crunched for time, it may be well worth the investment to consult with a geriatric care manager – they can offer personalized recommendations and assistance to find the best facility or in-home support for your situation.

If your loved one is in the hospital, you can turn to the hospital’s discharge planner for direction. The discharge planner won’t charge additional fees for their service, but they’ll probably be busier than a geriatric care manager (and less invested in finding the very best place for your loved one). Their focus will be on finding the first appropriate place with an open bed.

Olera Guide to Long-Term Care OptionsA Hard Decision

It can be really tough to face a loved one’s changing abilities and to think about the potential need for long-term care. Sometimes it seems easier to avoid the issue altogether and pretend there aren’t any problems. However, this rarely leads to the best outcome for anyone. So, while it may be hard, considering long-term care options now ultimately benefits your loved one tremendously.
Identifying ways to support your loved one in their current situation is a great start. Next, by doing the footwork ahead of time, you’re enabling any future move to unfold as smoothly as possible into a setting that’s ultimately a good fit for them.

Finding the right in-home support or senior living, facility for their unique needs, preferences, and personality is key to ensuring not only their safety but also their quality of life.

Author Bio

Laura Herman is an elder and dementia care professional who advocates for better senior care in America. This article has been reviewed by TJ Falohun, co-founder and CEO of Olera. He is a trained biomedical engineer and writes about the cost of healthcare in America for seniors.

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