Tamara and Michael Myer had always been an active couple, traveling and curious about the world and continually embarking on new experiences.
Michael was fortunate to reach his late 90s with no health issues, but Tamara, who is nine years younger, was not so lucky. She began having cognitive difficulty in her late 80s.
It happened slowly. For only minutes at a time and sporadically, Tamara would become disoriented, not knowing where she was. Slowly, her family realized that she’d forgotten she’d put food in the oven or that they’d she’d put laundry powder in the refrigerator. From there the decline began to accelerate.
Her daughters, who often visited from other states, witnessed the difficulty. They spoke with their parents about hiring a caregiver to cook their meals, drive them to appointments or wherever else they wanted to go and to keep a “watch” on them.
As Michael approached his 100th birthday, still in remarkably good shape, he was awakened one night to the sound of moaning: Tamara had fallen in the bathroom and was lying on the cold floor. Michael pressed his medical alert system button, which his daughters had insisted he wear. It was the worst day of his life.
The daughters, shaken and anxious, insisted that if Michael and Tamara wanted to continue aging in their own home, they would need to hire a home care or home health care aide, mostly to help their mother with activities of daily living, but to also help their father if needed.
“For aging adults, home care plays a major role in allowing them to remain and age in their own homes rather than in a hospital or nursing home,” says Tessa Jones, assistant professor in the Brookdale department of geriatrics and palliative medicine at Icahn School of Medicine at Mount Sinai in New York. “For people who don’t think they need help, it unfortunately usually takes an event — such as a fall — to agree to the help.”
[READ: Understanding the Different Roles of In-Home Care Providers]
In-Home Health Care vs. Home Care
Both home health care and home care are types of in-home care that provide assistance to patients to allow them to remain independent. However, there are certain key differences:
— Home health care. Home health care is care prescribed by a doctor after an illness, injury, surgery or to treat a chronic condition. Skilled medical professionals, such as licensed nurses, physical or occupational therapists or health care aides, administer this kind of care.
— Home care. Home care is nonmedical support that allows older adults to stay safely at home and maintain a decent quality of life. Home care workers include personal care aides, home care aides and family members.
Here are 12 common indications that it’s time for in-home health care.
[READ Home Health Care vs. Home Care: What’s the Difference?]
1. Increasingly Complex Care Needs
A 2025 AARP and National Alliance for Caregiving report found that more than half of family caregivers are handling complex medical and nursing tasks, though only 20% have the training to do so.
When your family member is recovering from a hospital stay, has a chronic health condition or a short-term setback, they will likely need home health care, which is in-home care provided by a licensed skilled professional. Examples of that kind of care include the following:
— Wound care
— Physical therapy
— Occupational therapy
— Medical social work
— Ostomy care
Who qualifies for home health care services?
To qualify for home health care coverage under Medicare, you must meet certain criteria, including:
— You need part-time or intermittent skilled services.
— You are homebound (you have difficulty with or an inability to leave your home without assistance).
— You have a health care provider’s order certifying that you need home health services.
[SEE: Technology to Prevent Falls for Seniors]
2. Frequent Falls or Mobility Issues
According to the National Council on Aging, falls are the leading cause of fatal and nonfatal injuries for older people. One in 4 — or 14 million — older adults in the U.S. fall each year, causing 3 million emergency room visits for fall-related injuries and about 30,000 deaths. Those statistics don’t include “near falls,” but the number of actual falls suggests that the number of close calls with an actual fall are also high.
Some of the signs that the risk for falls is high include the following:
— Inability to stand or walk without help
— Grabbing walls when walking
— Shuffling feet when walking
— Holding furniture for support
— Unsteadiness
— Bruises or injuries
3. Difficulty Managing Personal Hygiene
As we age, it can become more difficult to manage personal hygiene. For older adults, limited mobility, strength and memory can make bathing, grooming and brushing your teeth even more difficult. Additionally, normal decline in sight, taste, hearing and smell makes it harder to recognize that you’re not managing well.
Poor personal hygiene increases the risk for infections and illness, and it’s often one of the most reliable early indicators that caregivers are needed to help at home.
Signs that self-care is becoming harder include the following:
— Strong body odor or bad breath
— Dirty clothes
— Greasy, uncombed hair and long, dirty, broken or overgrown nails
— Dry, flaky skin, rashes and bed or pressure sores
4. Rapid or Unexplained Weight Loss
Rapid or unexplained weight loss in seniors living in their own homes can be a sign of an underlying physical or psychological health problem and should warrant a visit to a physician. Sometimes this can be a result of an illness, a medication side effect or depression. Weight loss can also be a sign of malnutrition.
Signs that in-home help is needed, however, can include some of the following:
— Difficulty preparing meals
— Difficulty shopping for food
— Expired food
— Empty or dirty refrigerator
— Spoiled food in the refrigerator
— Multiples of the same food
— Difficulty chewing and swallowing
— Skipping meals or forgetting to eat
5. Medication Management Mistakes
Sixty percent of seniors take more than five medications. That, combined with increased forgetfulness can be taxing for even the highest functioning individuals. It’s important, however, that medication management mistakes be corrected quickly. Have a doctor periodically look over your medication lists, including over-the-counter medications and dosages, to prevent duplication and adverse reactions, including those that increase the risk of falls.
Some signs that you or a loved one needs in home health care to help with medications include the following:
— Taking too much or too little dosage
— Skipping doses
— Taking medications at the wrong times or in the wrong way (swallowing or under the tongue or on an empty stomach, for instance)
— Keeping expired medications, which may be less effective
6. Cluttered or Hazardous Home Environment
There is a strong correlation between the ability to keep order in the home and cognitive strain or decline. Sometimes, even normal aging can diminish the brain’s executive functions that are responsible for planning, organizing and making decisions.
A significant uncharacteristic change in your loved one’s home environment is a sign that there may be a need to bring in caregivers to help.
Signs that the home environment is unsafe include the following:
— No handrails on stairs and steps
— Slippery floors and rugs
— No grab bars in the showers and other areas of the bathroom
— Bathtub is too high
— Poor lighting
— Unwashed dishes in the sink and laundry piles
— Loose rugs and unsecured rugs or edges of rugs
— Loose lamp, light fixture and appliance cords
— Forgetting to turn off the stove and other appliances
— Dirty and sticky walls, door knobs and handles and a general decline in cleanliness
7. Poor Financial Management
It’s hard for many seniors to lose their independence. They are often reluctant to hand over any chores to relatives or others, especially when it involves finances. If you see that your loved one is having difficulty keeping up, you might suggest that financial matters be turned over to either a professional or a family member.
Some of the signs that it’s time to get help include the following:
— Piles of unopened mail and bills
— Unpaid bill notices
— Collection calls
8. Repeated Minor Accidents
You may notice signs that your loved one is having difficulty remaining safe and that they’ve had accidents they may not be telling you.
Some indications of repeated accidents include:
— Burn marks
— Cuts
— Scratches
— Infections
9. Isolating and Withdrawing From Others
Surveys show that approximately 24% of older adults living independently in the U.S. are socially isolated.
Being lonely and socially isolated is a known major health risk, often compared to cigarette smoking. In fact, older adults who are lonely and/or socially isolated are at higher risk of premature death than others.
Isolation can also increase the risk of depression, dementia, coronary heart disease and cognitive decline.
Here are some things you might see when someone is withdrawing:
— Increased irritability
— Increased sadness
— Lonely and feeling helpless
— Depression
10. Mood Changes
Along with increased isolation, shifts in mood and temperament can alert you to the need for care in the home.
Some signs to look for include:
— Behavioral shifts that are uncharacteristic
— Withdrawal
— Anxiety
11. Memory Loss
When forgetfulness interferes with daily living, it’s time to be concerned. It’s not just uncomfortable; it can compromise the safety of your family member. If, for example, your loved one forgets to lock the door, that could put them in danger.
Signs of memory loss and cognitive decline include the following:
— Forgetting appointments
— Confusion
— Getting lost in familiar places
— Misplacing items in odd places
— Mixing up and missing medications
— Unable to keep track of time
— Losing track of important conversations
— Loss of reasoning skills
12. Caregiver Burnout
Nearly 1 in 4 adults (63 million) are caring for an adult or child with a complex medical condition or disability, according to the AARP and National Alliance for Caregiving report.
Stressed out family caregivers may experience fatigue, anxiety and depression and be physically, emotionally and mentally exhausted. In fact, studies show that 60% of caregivers experience burnout.
When you devote most of your time to helping another person, you often end up neglecting yourself, which isn’t good for you or your loved one.
It’s important to acknowledge your limits and to bring additional help into your family member’s home. Together, you and your extra helpers can form a partnership to ensure an environment conducive to safety and well-being for both you and your loved one.
Signs that you need to bring in additional help include the following:
— Too much responsibility. You may feel solely responsible for another person’s well-being, but this responsibility is realistically too much for one person.
— Imbalance. Caring for another person may affect your ability to balance your own life and health needs.
— Role confusion. It may be difficult to separate your role as a caregiver from your role as a spouse, child or friend to your loved one.
— Lack of recognition of burnout. You don’t realize that you’re exhausted, and that’s negatively impacting the care you’re giving.
— Guilt. It’s not uncommon for caregivers to feel they aren’t doing enough when in fact they are also balancing jobs and family duties.
Bottom Line
When you start to notice these kinds of signs, it’s time to make some decisions on how to move forward because if your family member wants to and is financially able to remain in their home, more hired help probably needs to be brought in.
Contact your doctor or a professional home care agency for a risk assessment.
“Generally, people are late in bringing aides into the home, many times because old family dynamics are still in play,” says Barry Jacobs, a clinical psychologist and family therapist and co-author of the “AARP Caregiver Answer Book.”
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12 Signs It?s Time for In-Home Health Care originally appeared on usnews.com