As our parents age, we may face the reality that they can no longer safely live at home alone. Perhaps you’ve noticed things that troubled you, such as dirty dishes piled in the sink, unexplained bruises, weight loss or increasing forgetfulness or confusion. It can be hard to navigate the role reversal between parent and child, and you may meet with resistance as your parents cling to their independence. Knowing when to step in can make a difference to your parents’ health and wellbeing.

Professional caregivers perform an assessment of the activities of daily living (ADLs) to understand how well an older adult is coping. Look for the following signs when deciding whether to intervene:

• Recognize changes in their daily living patterns: not cooking but relying instead on packaged meals or snack foods, not cleaning the home, leaving dirty dishes, laundry not done regularly, bills not paid, spoiled food in the refrigerator.

• Parent neglects personal hygiene: not bathing, brushing teeth, has body odor or wears smelly or obviously dirty clothing.

• Your parent isn’t able to make it to the bathroom in time.

• Weight loss that stems from an inability to prepare healthy meals or from simply not eating enough. 

• Parent mentions falling frequently or has unexplained bruises or other injuries.

• Increased forgetfulness, missing appointments, unable to remember special dates, struggling with conversation.

• Withdrawal and increasing isolation: no longer attending church, family gatherings, other community events they once enjoyed, declining social invitations.

• No longer enjoying hobbies like reading, artwork, sewing, etc.

• Inappropriate behavior, excessive fatigue, difficulty comprehending or concentrating.

You may notice cognitive or emotional changes in your parent. Increased irritability, agitation, anxiety or depression are not normal signs of aging but stem from underlying stress that may be due to health problems, grief or struggling to cope with daily responsibilities alone. Inappropriate behaviors can be a sign of dementia or other medical conditions like a urinary tract infection. Common examples include rude, insensitive or sexually suggestive remarks, public nudity, failure to understand social cues, reckless decisions or uncharacteristic impulsiveness. 

Pay attention to other issues that may arise such as decreased mobility – an unsteady gait, resistance to exercise or movement, increased sedentary lifestyle, avoiding stairs, difficulty getting out of a car, chair or bed. Problems driving like getting lost, avoiding going places, unexplained dents, scratches on the car or hesitant driving can indicate that your parent no longer needs to drive. Chronic illnesses like diabetes, heart disease or arthritis can become more difficult for an older person to manage alone, especially if they aren’t capable of taking their medications as directed. 

In a perfect world, you and your parents have already had several conversations about their wishes as they age. Hopefully your parents have a will and have designated someone to act as a financial power of attorney and an advance directive like a living will and medical power of attorney to take care of their health preferences. These legal documents will ensure your parents’ wishes are honored. Start the conversation early before you notice problems by asking what their plans are for the future. Don’t wait for a medical emergency to force the issue.

There are steps you can take to start the conversation. Chose the right time, lead with empathy and honor their desire to maintain their independence as much as possible. Explain that you’ve noticed a few things aren’t as they should be and that you are concerned. Use “I” statements instead of “you” statements. Listen actively by acknowledging their fears, frustrations and feelings. Validate their feelings instead of minimizing them. Suggest scheduling a doctor visit to rule out a UTI, medication side effects or to address nutritional deficiencies.

Research care options nearby to determine what is available and how much it costs. Point out benefits: more opportunities for socialization, activities, meals prepared for them, safety and housekeeping. Tour communities together and help them determine which best fits their needs and pocketbook. Realize that it will be an ongoing process that may take several months. Expect resistance, but let your parents feel in control by allowing them to make decisions when possible.

There are many levels of care available designed to keep older adults safe and as independent as possible. In-home care is for those who need help with things like meal prep or house cleaning but are otherwise fine living at home. Independent living is basically an apartment complex designed for those who are still active and fully capable of ADLs but would rather someone else manage cooking, maintenance of living quarters and cleaning. Assisted living provides 24/7 support for adults who need help with medication, meals and some mobility issues such as bathing but who do not need skilled nursing care. Memory care is for those with advanced dementia or Alzheimer’s who need constant supervision. Skilled nursing or long-term care provides comprehensive medical supervision for those who are bed bound or unable to take care of most activities of daily living.

Having your parents move in with you is an option that will save money and may strengthen family bonds, but it will involve a massive shift to your family’s life. You must evaluate your parents’ care needs and decide whether you are capable of providing that care. You must look at your home’s setup and safety for their needs and evaluate your own emotional and physical capacity for caregiving.