Seniors fear the loss of independence more than they fear death. According to the American Association of Retired Persons (AARP), 90% of seniors desire to remain in their own homes as they age. Therefore, they might not be honest about the challenges they are having at home or with driving. As you start to consider options for a friend or a family member, it’s essential to know the common signs someone might be struggling with typical daily routines. Here is a list to help get you started. This is not an all-inclusive list, but it should provide enough information for someone to ask the right questions about what is best for their loved ones.

Seven signs a senior might need help:

  1. A Decline in Personal Hygiene. Going a week or more without bathing, forgetting to brush their teeth, and having untrimmed nails and unkempt hair may indicate the person has challenges with taking care of their hygiene.
  2. Change in Eating Habits. Any changes in eating habits, including disinterest in food, barely eating, or an empty fridge can signify that help is needed. Proper nutrition is critical to support well-being and can slow declining health.
  3. Unexplained Bruises. Older adults frequently bruise because their skin has become thinner with age. Another reason may be vitamin deficiencies or certain medications. It is a good idea for the older person to seek medical advice to determine the root cause. If the bruising is typical aging, the reason may be changes in mobility or indicate falls.
  4. A Change in the Condition of the Home. A significant change in housekeeping routines, stacks of unopened mail, or trash buildup could indicate that the person cannot complete these tasks independently.
  5. Under or Over Medicating. Over 55% of seniors do not correctly take their medications[1]. Studies indicate up to 30% of all hospital readmissions are due to medication non-adherence. If a loved one forgets to take their medication or takes incorrect dosages, this could adversely affect their health.
  6. Change in Reasoning, Memory, and Judgement. A senior may show increased confusion or loss of reasoning skills when asked questions or in a light conversation. Normal age-related memory loss is typical as we age. Memory loss that disrupts a person’s ability to function in daily activities can be early signs of something more serious. Cognition is a process in the brain that includes learning, remembering, and making judgments. When cognition is impaired, it can impact a person’s health. Cognitive decline can range from mild cognitive impairment to dementia[2].
  7. Decreased Mobility. Walking, balance, and mobility are typical concerns with seniors. A fall can trigger many health problems. According to a study in the Journal of Clinical Epidemiology, one out of three older adults (65+) falls each year, but only half talk about it with a healthcare provider. Decreased mobility can be one of the most challenging problems that older adults face and create many challenges for families.

Now that you have a basic idea of what to look for, it is hard to know where to turn. Figuring out your options can become overwhelming, especially when this is new to the family. Often families only have a general idea about home care and a surface-level understanding of assisted living. Therefore, weighing each option’s pros and cons is essential. Home care and assisted living both fulfill a need, but key factors differentiate the two, and it is vital to know what they are. It is up to the family to decide the best option for their loved one, both personally and financially.

Assisted Living

This option is the new shiny penny and often attracts residents with ice cream shops, movie theaters, and endless activities. While this may be attractive to some, families must determine if this is the desire of their loved one. Not all senior adults are looking for a new social life. Many seniors prefer more familiar surroundings and people they know. Congregant settings are not for everyone, and families should discuss with their loved one what their desires are. Do they want to consider assisted living, or is this out of the question? The advantage of an assisted living facility is that they have staff available 24/7. While this can provide peace of mind for the family, knowing a professional is nearby, families should ask questions about the availability and level of care available overnight and on weekends. What most people think assisted living facilities will do, doesn’t necessarily match the agreement signed. Another advantage is that the dining facility provides three meals a day. However, some plans only include one meal a day. The family should understand how many meals are included in the monthly fee and the additional cost for a senior to add a meal. Compare the senior’s current living situation to what they will have in assisted living. Typically there will be the option of a one-bedroom or two-bedroom apartment-style residence. The size can limit the number of personal belongings a person can bring. Limiting sentimental items during a significant life change can be difficult for seniors, causing stress in their new home.

A good question to ask when considering assisted living is the average amount of time staff will interact with residents daily. Typically, a caregiver will have 15+ residents they take care of each shift. Therefore, depending on the needs of the resident, they may only see a staff member for minutes each day. If the senior is not outgoing and willing to participate in activities, this could lead to isolation. The senior may experience bouts of depression due to feeling lonely and in an unfamiliar place. 

The monthly fee does not include everything offered. Things like housekeeping, laundry, meals in their room, overnight visitors, additional bath visits, and transportation could have additional fees. One thing most families need to consider is that a senior can be asked to leave. If the resident causes issues, threatens themselves or others, or requires substantial care, the resident can be discharged. Families should always have a backup plan should this occur. Pets are an essential part of many seniors’ lives. Not all assisted living communities will allow pets. If the senior has a pet, this should be discussed before making a decision. During the pandemic, most assisted living communities were closed to visitors, including family members. Ask questions about their policy should there be a rise in Covid or flu cases.

What are the benefits of home care?

First, home care can assist with all seven signs mentioned above, plus more. In-home care services include personal care, meal preparation, light housekeeping, medication reminder, companionship, mental stimulation, and assistance with transferring and walking.

Since the pandemic, home care has been highlighted as an option many had not previously considered. To be able to age in place has always been the desire of most senior adults, but they are often unaware it is truly an option. The comfort of home has long been proven to create a better healing environment and promote continued independence. Home care allows the family and the aging loved one to make independent choices about their care. The home care agency and family can work together to provide a positive experience for everyone and the best care plan for the loved one.

Home Care is not usually a family’s first thought. Why? Because they think it’s too expensive and only for the wealthy. Home care can be more cost-effective than assisted living. Adding technology along with home care can provide the same type of coverage as assisted living. For example, 20 hours of home care plus an emergency response system and medication dispenser can offer a similar experience to a 24/7 nurses station at an assisted living facility. The cost difference can be nominal, depending on the location. Another option is vitals monitoring. For those who have to take blood pressure, weight, glucose, or blood oxygen daily readings, an easy-to-use vital sign monitoring system is available at a reasonable price. Many home care agencies have partners who can offer this type of service. Meal delivery services beyond Meals on Wheels can be a resource for quick, healthy meals. Silver Cuisine, Hello Fresh, and Freshly offer microwavable meals for around $9.00. These are nutritionally prepared with special diets in mind. Other options include thermal monitoring, which tracks movement without infringing on the senior’s privacy.

The advantages of remaining home are vast. First, the senior will remain in the home they know in the community with which they are familiar. Staying in their home provides a sense of independence, so increasing their feeling of freedom is a huge advantage. Feeling independent can boost their mental state, reducing the chance of depression. Home care provides a one-on-one caregiving experience, personalized care, and customized meal plan. The client gets the opportunity to develop a professional relationship with their caregiver, who can encourage taking walks, playing games, or watching a favorite movie together. The family and the home care agency decide how they will care for the senior. Everyone’s tastes are different, and with home care, the client chooses what types of food they like versus cafeteria-style set meals in assisted living. 

Another big difference between home care and assisted living is that an assisted living facility can restrict visitation during COVID or flu season. Home care allows the family to visit and make those decisions.

There may come a time when the home is no longer safe for the senior. At this point, home care can still be an option in combination with assisted living. Home care can fill the gaps where assisted living does not provide the services needed. Check with the assisted living staff to determine if they allow outside home care to provide services.

 It can be challenging to navigate the process, but vital that everyone involved feels comfortable with the decision. A couple dealing with an ailing parent was once told, I am sorry you are being forced down this journey. Unfortunately, for most families, this is how it feels. Aging family members struggling with activities of daily living can be a scary journey, but it does not have to be one traveled alone. Recognizing signs that a loved one needs help, understanding the options available, and reaching out to experts to help navigate the journey provide the best possible outcome for the aging senior.

Avatar photo

About Cheryl Hammons CFE, CSA

Cheryl Hammons is an experienced home care professional, published author, and frequent speaker. She has held several roles throughout her 12 years in the home care industry, including training, support, and operations. She currently serves as Strategic Partnership Director at Veterans Care Coordination where she focuses on building value-driven relationships, developing revenue-generating programs, and creating educational materials for home care partner companies. Cheryl is the author of "Embracing a New Normal: Dealing with Grief" and "Respecting Religious Differences in Home Care."