Tips for Caregivers:
Knowing When a Loved One Needs Extra Help and Care

Robert F. Bornstein, PhD & Mary A. Languirand, PhD

The second edition of our book on assisted living and nursing home care was released in 2009. Since the book came out we've given a number of talks on various eldercare-related issues, and part of what we do is try to dispel myths about assisted living facilities and nursing homes--myths that prevent people from planning effectively for the future. One statement we've made at a number of talks always seems to surprise people and stick in their minds:

No one has ever entered a nursing home because they have Alzheimer's disease, or because they broke a hip or had a stroke. No one. Never happened, never will. There's only one reason anyone ever enters a nursing home: They can no longer carry out activities of daily living.

Activities of daily living--or ADLs--are those well-practiced everyday tasks we do automatically, reflexively, almost without thinking. Getting dressed, for example, or bathing on our own. These tasks seem simple, and for most of us they are. But illness or injury sometimes impairs our ability to carry out ADLs. Sometimes the problems are temporary, but sometimes they're more chronic. And that's when extra help and care-assisted living or nursing home care--is needed.

Eldercare professionals divide ADLs into two categories: basic and complex. Basic ADLs include things like using the bathroom without help, or dressing appropriately for the weather. Complex ADLs include things like shopping, cooking, and managing one's medication. When a person loses the ability to carry out complex ADLs, most often they require assisted living or in-home care. When a person loses the ability to carry out basic ADLs, nursing home care is almost always required.

How can you tell when someone is showing enough functional decline to require in-home or out-of-home care?
Five warning signs to look for:

  • Food problems
    These usually take two forms: improper food storage or improper preparation. If you arrive at your mother's apartment and find milk stored in the kitchen cabinet, that's a red flag, and cause for concern. Ditto if she serves you near-raw (or grossly blackened) hamburger--especially if she's usually a good cook.

  • A decline in cleanliness
    Again, two forms--surroundings or self. Sometimes you'll notice a decline in cleanliness of the home (for example, dustballs in the bedroom or a filthy bathroom floor). In other cases the problem may lie in the person's hygiene--clothes unwashed (and more than a bit whiffy), or makeup sloppily applied.

  • Unpaid bills or unopened correspondence
    People who can no longer read or remember well enough to balance a checkbook may cope by ignoring their bills or throwing them out, hoping the problem will go away. Needless to say, it doesn't.

  • Confusion regarding day and date
    Everyone is off a day or two every once in a while, thinking it's the 12th when it's really the 11th. But when a person mistakes January for May, or asks if you've gotten your Thanksgiving turkey in July, it's a troubling sign of disorientation, and an indication of cognitive decline.

  • Forgetting familiar objects
    Forgetting where you left your keys is no big deal--we all do that. Holding a key in your hand and not remembering what to do with it....that's a much more serious problem, and a telltale sign of cognitive deterioration. Not necessarily Alzheimer's disease (because a number of conditions can cause this symptom), but definitely something serious enough that you should take action.

Robert Bornstein and Mary Languirand are the authors of When Someone You Love Needs Nursing Home, Assisted Living, or In Home Care, published by Newmarket Press.
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