How do I know when my parents need help at home?


By Judith Boyko

Caregiving advice is plentiful, but how do we know when our aging parents need assistance or when we need to become a caregiver?

Certain indicators may help determine whether it’s time to begin supportive care. These include frequent forgetfulness, balance, walking or mobility difficulties, a decline in maintaining personal hygiene and mismanaging medications.

Compounded with others, these issues contribute to additional dangers for elders and may further warrant reliability on caregivers.

headshot_jboykoFrequent forgetfulness may be due to the onset of Alzheimer’s disease or dementia, which, according to the Mayo Clinic, “describes a group of symptoms affecting thinking and social abilities severely enough to interfere with daily functioning.”

It’s one thing to forget where he put the house keys, but when dad forgets where he lives or whether or not he ate lunch, he probably has significant memory issues.

Falling is the leading cause of death among elders. Thirty percent of seniors fall annually, and in 2010, 2.3 million fall injuries among older adults were treated in emergency departments, according to the Centers for Disease Control and Prevention.

Elders with balance, walking or mobility issues might be hesitant to get in and out of the shower for fear of falling. They might withdraw socially for the same reason, leading to feelings of isolation and despair.

Many factors contribute to a decline in personal hygiene, including depression, arthritis, memory impairment, loss of sense of smell and/or sight and loss of energy.

Mom can’t get to the store to purchase soap, shampoo and other personal items; or her arthritis is bothering her and it’s too difficult to get dressed. If she’s depressed, maybe mom “just didn’t feel like it.”

According to the Family Caregiver Alliance’s Home Alone study, more than 96 percent of family caregivers provided activities of daily living (ADLs) supports (e.g., personal hygiene, dressing/undressing or getting in and out of bed). However, what happens if family members are unavailable to help mom or dad with ADLs?

Are items throughout mom’s house — mail, newspapers or laundry — piling up? Maybe she isn’t sleeping well at night and is too tired to read mail or fold laundry.

Is an odd smell emanating from the kitchen or bathroom? Maybe cleaning has become too difficult or cleaning equipment too heavy.

Many older adults live with multiple chronic conditions and take several medications daily. The Center for Improving Medication Management says they are at greater risk for adverse drug interactions and are more likely to consult multiple healthcare providers, each of whom may prescribe medicines. This makes it difficult for a pharmacist or doctor to identify potential dangers.

Many medications must be taken more than once daily — and some only once daily — making it confusing for older adults to keep track of them. Elders may also be in danger of taking expired medications, overdosing or under-dosing.

If family members are not nearby or work full-time, it might be difficult for your parents to feel engaged and part of a community. It might be time, therefore, to consult a professional caregiver who can provide companionship, support and stimulation. After all, feelings of isolation can lead to early onset dementia, risk of physical and mental decline and even an increase in the risk for death.

Judith Boyko, MBA, MS, RN, is CEO of Century Health Systems, Natick Visiting Nurse Association and Distinguished Care Options. She can be reached at For additional information, visit, or Archives of her articles may be found at