In-Home Senior Care: Warning Signs Your Loved One Needs It

What to look for and how to find services that can help

Becoming a caregiver for a parent or loved one is a noble but potentially difficult task. There are times when you can't be there to help them, and some issues require medical attention or a trained expert. You will face all sorts of caregiving challenges, but you don't have to get through them alone.

It's important to recognize your limitations and call in-home care professionals when the time comes. Home health care includes in-home caregiver services, transportation services, companion services, nurses, service workers, and nursing and retirement homes, per the National Institute on Aging (NIA).

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"I think [the signs of decline] really differ for every person, from what I've seen in my practice," Jennifer Reckrey, MD, an associate professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai, told Health.

The main thing to look for is a significant change: "Someone who's been one way their whole life, concerned with their appearance, or always on top of birthdays, and then that starts to change," Dr. Reckrey, whose research focuses on home-based primary care and the role caregivers have in the home, explained.

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Warning Signs Your Parent May Need In-Home Senior Care

It can be difficult to determine something is wrong if you don't see the person you care for regularly. The next time you're with your loved one, pay close attention. Is there evidence of behavioral changes? What about cognitive or physical declines? Here are what those signs might look like, according to the NIA.

Behavioral Changes

The gradual changes you may see include:

  • Severe mood swings
  • Increased agitation
  • Hiding things or believing other people are hiding things
  • Imagining things that are not there
  • Wandering away from home
  • Hitting you or other people
  • Severe mood swings
  • Misunderstanding what they see or hear

You might also notice:

  • Their home appears unusually cluttered or dirty
  • They keep expired groceries
  • They've lost interest in their favorite activities
  • Their sleeping patterns have changed
  • They forget to take their medications frequently and miss doctor's appointments
  • They are late to pay bills or have stacks of unopened mail

Cognitive Decline

If you're worried that your loved one is experiencing cognitive decline, look out for:

  • Loss of reasoning skills
  • General confusion
  • Difficulty keeping track of time, appointments, or medications
  • Excessive forgetfulness
  • Memory loss

These could also signal a more serious decline, such as Alzheimer's disease, according to the Centers for Disease Control and Prevention (CDC). Alzheimer's disease is the most common cause of dementia among older people. Dementia is not a normal part of aging. The loss of thinking, remembering, learning, reasoning, and behavioral abilities in dementia disrupts daily life and function.

Physical Changes

Upon first glance, there are several physical signs that can let you know your loved one is struggling. Changes include:

  • Weight loss or difficulty eating or drinking
  • Difficulty standing, sitting, walking, or moving around
  • Bruises or injuries (this could indicate a fall or incident they're too embarrassed to share with you)
  • Poor personal hygiene such as loss of grooming habits, wearing the same outfit over and over, or donning disheveled or dirty clothes
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Types of Home Care Services

Different warning signs sometimes require different levels of care. Perhaps your loved one is mentally astute but needs help with physical tasks such as housekeeping, meal prep, and transportation. Or they may need someone who can offer companionship when you're not around. Here are a few examples of home care services that can help, per the National Library of Medicine MedlinePlus resource:

  • Household tasks: Errands, housekeeping, and meal preparation
  • Personal care: Bathing and dressing
  • Feeding: Cooking at home or delivering meals
  • Money management: Filling out forms and checking bill payments

There are also home healthcare services available, per the Administration for Community Living (ACL). These are typically provided by licensed healthcare professionals such as nurses, therapists, or home health aides:

  • Speech, physical, and occupational therapy
  • Administering medications
  • Nursing
  • Recovery from illnesses or injuries

You may need to pay for home services yourself. Sometimes, they are covered by health insurance or government programs such as Medicare, Medicaid, Older Americans Act, and the Veterans Administration, according to the ACL. You may also be able to find free or donated community services, per MedlinePlus.

The Conversation

"In my experience, people may be hesitant to have people come into their home to help," Dr. Reckrey said. "They've already figured out a way to cope with their problems, whatever they may be, so it can be a difficult conversation." However, it is still an important discussion to have because you don't want to make any decisions about your loved one's well-being without consulting them first, if possible.

"Determine if there's an opening, if there's anything they think they might need help with. Start small, like offering them someone to help with laundry (as opposed to bathing or something more personal)," Dr. Reckrey suggested. "There can be a lot of fear that someone coming into the home will take away their independence, so be sure to explain that it will actually bring out more freedom for them," such as being able to grocery shop for themselves again or be driven to events with friends.

Dr. Reckrey also recommended framing in-home senior care as a way to help you, the caregiver. You might say, "I'm doing this for me. I need help with these things to make sure you're OK because I can't be there to help with these things."

"When in-home care works, it's not only filling a gap, it's creating a meaningful relationship, and I think it's a positive thing," Dr. Reckrey said, adding: "What works for one family may not work for everyone. It's a relationship, and you want everyone to be comfortable and communicate and work together. You may not find the right person the first time, but that doesn't mean in-home senior care won't work; it just means you need a better fit."

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How To Find the Right Caregiver

Once you've decided what type of care is right for the person you care for—talking to their healthcare provider can help with that process—then you will need to find the right caregiver. If you go for the home care services route, some services can match you with a caregiver to watch after your loved one.

If a retirement home or nursing home is the next step, research establishments near you and ask for referrals from friends, family, and trusted medical experts in your community. Your local Area Agency on Aging (AAA)—a public or private non-profit agency that coordinates services for older adults—is another resource, per the ACL.

When you find some options for in-home healthcare agencies, consider the following, per the ACL:

  • Qualifications: How long has the agency been open? Is it an approved Medicare provider? Do they have the right licenses and certifications? What sort of training does the staff receive?
  • Services: Will the agency prepare and update a care plan? How will caregivers ensure confidentiality?
  • Availability: Are staff members available whenever necessary? Is there on-call assistance?
  • Cost: Is there financial assistance or a sliding fee schedule?

Make sure to interview the caregiver candidate and ask for their references and capabilities: For example, can they provide wheelchair or other mobility assistance? Once you've hired a caregiver, provide additional information about the person you care for, such as hobbies, interests, medications, allergies, and underlying conditions. Clearly state what qualities you're looking for in a caregiver to create the best personality match.

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