You may be going to visit loved ones for the holidays.  For those who live at a distance, it may be the first visit in a while.  When visiting older relatives for the holidays, families often notice that things have changed.  What should you be watching for when you visit?  What signs indicate that it may be time for some additional help or a transition of some type?  What do you do next?

To start, here are some things you should observe and ask yourself:

• What is the shape of your parent’s home?  Compare the cleanliness and upkeep with what is normal for your parent.
• Observe the kitchen (pantry, cabinets, refrigerator) for signs of nutrition management.  Is there spoiled food or an excess of “junk” or “convenience” foods compared to normal?  Is there very little in stock or signs your parent has stopped cooking?
• Try to observe how your loved one is handling medications.  What is the state of how he or she keeps her pills (expired medications, organization, etc.)?  Does he or she seem to be taking medications as directed? 
• Pay attention to behavior (actions may speak louder than words).  Your loved one may not want to admit limitations, but you may notice he/she choosing not to participate or making excuses, being more withdrawn or cutting out normal activities due to fears.

It is likely time to make some changes to ensure your loved one’s wellbeing if he/she has:

• Experienced a fall/falls (often if you know of one, more minor ones have occurred that are not mentioned) or unexplained injuries;
• Decreased activity, withdrawn from social activities, or appears fearful of going out or participating in regular activities or exercise;
• Exhibited forgetfulness or memory loss, which they may try to cover for but you notice perhaps they forget to pay a bill or ask a question twice, or perhaps allow a relative to speak for them more often;
• Neglected personal hygiene or household duties? (this may be subtle, such as someone who was previously meticulous starting to clean less or repeat outfits);
• Changed eating habits (eating less or hoarding items, cooking less or eating more sweets or snacks vs. cooking meals or eating nutritiously);
• Missed appointments or left prescriptions unfilled;
• Made unusual purchases or decisions that seem uncharacteristic/in bad judgment;
• Shown signs of depression and loneliness (You may wish to visit Aging Wisely's Signs and Symptoms of Depression in Older Adults for potential signs.)

You may want to start by gathering some information on the types of help available.  Two good places to start are: the local Area Agency on Aging (which can be located via www.eldercare.gov) and a local geriatric care manager (see www.caremanager.org).  The local aging organization can provide you referrals to various agencies, services and facilities in the area as well as potential financial and government assistance programs.  A geriatric care manager can consult with you about how to approach your concerns with your loved one and provide an independent evaluation and assessment to come up with specific recommendations that are most appropriate.  Both of these resources can be accessed if you feel the situation is a crisis as well.  Call them while you are visiting to engage help immediately if you feel a strong concern about your loved one’s safety.

Just a few examples of the various senior care options that may be available to help include: home health care/in-home caregiver agencies; meal programs (Meals on Wheels, dining sites and other meal deliveries); transportation services; adult day care; geriatric care managers/patient advocates; telephone reassurance/check-in; personal emergency response systems and in-home monitoring/technology; cleaning services and household help; Assisted Living Facilities; Nursing Facilities.  It helps to know what is available in advance when possible so it is never too early to begin gathering information.  It helps to have an understanding of costs and financial assistance as well.  For example, many families are surprised to learn that Medicare covers very little in terms of the types of services discussed above.  By finding out the options, you can best determine what might work for your loved one and what type of transition is needed.

Here are some additional resources caregivers might find helpful this holiday season:

Caregiver Tips: Making the Best of the Holidays

Gift Ideas for Seniors

Making Life Brighter During the Holidays for Assisted Living and Homebound Elders

How to Handle Concerns as a Long-Distance Caregiver

Click here to read Shannon Martin’s article, “Home Sweet Home: Creating and Paying for an Affordable Home Care Support Plan”.

Shannon Martin, M.S.W., CMC, is Director of Communications at Aging Wisely, LLC (http://www.agingwisely.com), a professional care management and patient advocacy organization and EasyLiving, Inc. (www.easylivingfl.com), a licensed home care agency, in Clearwater, Florida.  Shannon created a course on “Eldercare” as an adjunct professor at Eckerd College in St. Petersburg, FL.  Prior in her career, Shannon served as social services director and admissions coordinator in an assisted living/skilled nursing facility and worked as a social worker and volunteer coordinator for a large hospice.   

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