Signs an Older Parent Needs Help at Home: What to Look For

Nobody gets a letter telling them it is time. What happens instead is that you visit, something is slightly off, and you spend the drive home trying to decide whether you are worrying about nothing.

Here is what we would look at, in the order we would look at it, based on what families actually describe on a first call.

Start in the kitchen

The fridge is the single most useful thing in the house, and almost nobody checks it.

• Expiry dates. Not one out of date jar. A pattern of food bought and never eaten.
• The same meal, repeatedly. Toast, or cereal, or nothing. Cooking is a complicated sequence of steps and it is one of the first things to go.
• Weight. Rings turning on fingers, a watch strap moved in a notch, trousers held up with a belt on a new hole. Weight loss in someone living alone is very often a cooking problem rather than an appetite problem.
• The bin. Empty for a week means nothing has been prepared.

Then look at the person

• Grooming. Unwashed hair, the same clothes on two visits running, stubble on a man who has shaved daily for sixty years. Washing is hard and frightening when balance goes, and people stop long before they mention it.
• Getting out of a chair. Watch it once, properly. Rocking forward two or three times to build momentum is a real change.
• Bruises, particularly on forearms and shins, and particularly ones that are not explained. Most falls are never reported to anybody.
• Feet. Nails nobody has been able to reach for months, swelling, shoes worn down unevenly.

Then look at the house

• The post. Unopened envelopes, particularly the official looking ones, is one of the earliest and clearest signals there is.
• Laundry and bedding. Stripping and remaking a bed is heavy work.
• A room that has stopped being used. Very often the upstairs, which tells you the stairs have quietly become the boundary of the world.
• Medication. Full boxes past their date, or two of the same prescription. Not a memory question so much as a management one.
• Smell. Uncomfortable to write and to notice, and it matters.

The single most reliable signal in our experience is not any of the above on its own. It is somebody who no longer leaves the house . Once going out stops, everything else declines faster, and the reason is usually mechanical rather than medical: the front steps, or no ride.

What is urgent and what can wait?

Not everything on that list is the same weight. These are the ones we would act on this week.

• A fall that was not mentioned. The strongest single predictor of the next one.
• Essential medication not being taken. Heart, blood pressure, diabetes, anticoagulants.
• The stove left on, or the front door left open, or leaving and not knowing the way back.
• Not eating. Days rather than one poor meal.

The rest is real and is not an emergency. It is the case for two or three hours a week, starting now, before the crisis that would otherwise set the terms.

What if they will not hear of it?

Extremely common, and there is a way through it that does not involve a family meeting or an argument about safety. What to do when a parent refuses help covers what usually works and, more usefully, what usually makes it worse.

How much would it take?

Less than most families assume. A one hour visit every morning at $45 an hour is $315 a week. Three mornings a week at three hours is $405. There is no minimum contract and no assessment fee, so you can start with the two hardest mornings and add nothing else.

Most people we start with are on a few hours a week, not a few hours a day. The full FAQ, with prices, is here.

Where to go from here

Two different problems, two different places to start.

• If the difficulty is the week itself. Tell us what the week actually looks like and we will say what it would take and what it would cost, on the call, before you commit to anything. Home health aide care is $45 an hour.
• If the difficulty is getting out of the house. Book a ride and stair assistance here. Wheelchair transport is $115 each way or $230 round trip within five miles, and stair assistance is $200 a visit.

If you are not sure, call and describe what you noticed. A fair number of these conversations end with us saying it is too early, or that the Council on Aging already covers it. That is a real answer and we give it most weeks.

Care Remedy Inc, 100 TradeCenter Suite G-700, Woburn, MA 01801. Call 781-957-8076 . Home health aide care, wheelchair transportation and stair assistance across Greater Boston, with offices in Woburn, Brockton and Springfield.

Sources: Mass.gov, Home Care Program. Our rates are current as of publication. This article is general information and is not medical advice. If you are concerned about an immediate risk, contact the person's physician.