Deciding whether it's time for elder relatives to make new living arrangements takes the keen observation and the subtle questioning of a Sherlock Holmes, says Susan Fleischer, president of the National Association of Professional Geriatric Care Managers. Elders minimize and camouflage difficulties. Adult children and caretaker spouses struggle with guilt and fear. Denial is common.
"Making the decision is about 50 percent emotional and 50 percent reality," says Linda Fodrini-Johnson, past president of the national association and executive director of the Eldercare Services in San Francisco.
The decision about what to do frightens people so much that they delay recognizing problems, says Lue Taff, geriatric care manager for Dallas' the Senior Source. "People always think they're going to have to make a move," she says, "but if there are funds, people can often stay in their homes." She recommends first focusing solely on whether the family is at what she calls "the decision point."
Here's how to make that assessment:
Notice if conversation changes.
Long tales about what she bought at the grocery may be trying, says Fodrini-Johnson, but they show that memory is working. When elders begin to cut off conservation or answer vaguely, they could have become anxious about what they were going to say.
Watch for disguised problems.
For instance, Taff's mother always answered the phone promptly, which made it seem as if she were up and mobile. But she was keeping the phone in the bed with her and not getting up at all.
Monitor medications.
Merely depending on daily pill boxes isn't enough, as Fodrini-Johnson found out when her mother casually mentioned that because she had forgotten to take her medication yesterday, she would take two doses that evening.
Check the kitchen.
Leaving items too close to the edge of the counter could mean a change in perception from a small stroke, Fodrini-Johnson says. Look in the refrigerator. "If they aren't emptying it, they aren't eating properly. Look for spoiled food. Notice what's on the counters. One woman left mayonnaise on the counter for days," Taff says.
Notice if they're wearing the same clothes or soiled clothes.
"We take so many things for granted that people need help with. Doing laundry is a huge task," Taff says.
Check for fender benders or traffic citations.
Examine the condition of the car regularly, looking for new dents or scrapes. You can also check for traffic citations. Have them do the driving occasionally, so you can see how they handle the road.
Take reports by neighbors and friends seriously.
They may notice things family members are too close to see or aren't around to know about, such as wandering or erratic driving.
Notice changes in lifelong habits.
If someone who always loved parties stops going to them, he could be afraid he won't remember the names of longtime friends, Fodrini-Johnson says. If a person who always reads directions before starting a project stops doing that, she might have trouble reading or comprehending.
Bear in mind that some problems may be caused by treatable or temporary conditions.
"Depression is a big problem. When you're depressed, you can't make decisions and everything takes too much energy," Taff says. Stress, hearing loss, grief or side effects from medications can also cause changes in behavior. "They might be doing fine on a new medication and then three days later start to have reactions," Fleischer says. Geriatric pharmacists can review medications to make sure drugs aren't reacting together in harmful ways.
Geriatric-care managers can help with assessment and in locating resources. Their services range from $95-$180 an hour. An initial assessment takes 6 to 7 hours and may take several days. Many care managers will also do spot checks afterward to make sure things are going well.
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