This is one of the most emotionally-charged questions I hear when I am called by a family member who is concerned for the well-being of their older parent/s living alone at home. There is a lot of emotional attachment to “home sweet home,” “home as castle” and more that has been learned over time. The question of whether home is still the best or safest place for an aging loved one is not just about the physical space. When invited to evaluate a situation, we look at both the individual’s capacity to reside in a space and the environment’s capacity to accommodate their needs. In this posting I talk about how we help explore the individual’s capacity to get around in their home.
If you as a family are unsure about a loved one’s ability to safely live independently, you can start with an assessment of how that person handles the basics of what we call activities of daily living (ADLs). Here is a checklist of the six basic categories of ADLs and how you can make an initial assessment yourself:
Hygiene: Do you see signs that they are not bathing, brushing, grooming as regularly as they once did?
Continence: Are there signs of “accidents” that they or their spouse may be trying to hide?
Toileting: Very simply, can they manage the bathroom on their own?
Dressing: Do they have the balance or strength to change in and out of clothes?
Eating: Do they have the dexterity to bring a utensil from the plate to their mouth, cut their own meat, etc.?
Transferring: Can they get from a chair to the bed, from the bed to another location, in and out of a car, etc.?
Take the example of one of my client’s; I’ll call Rose. Rose was living alone and independently. The first sign she might be having trouble was when she “forgot” to turn off her gas stove (fortunately it was lit); the kids bought her a microwave. When she consistently burned toast, they took away the toaster. It wasn’t until she flooded her basement three times by leaving a kitchen sink running that the family accepted that either moving out or 24/7 in-home care would be their only recourses.
If your loved one is having difficulty with any of these, they may still be able to live independently, but some accommodation may be necessary. A GCM can help with an objective assessment of these functions as well as recommendations for accommodations. We are objective, because we don’t represent a retirement home, a home health agency, etc. Also, a GCM can help with assessing the more nuanced or complex activities, what are termed instrumental activities of daily living (IADLs). These are more of the cognitive issues that may either be accommodated by outside assistance or be the red flags that home no longer is a safe or secure environment. Examples of these activities can include looking up phone numbers, cooking meals, doing housework, managing medications, etc. Here again a GCM or social worker can help assess if these are insurmountable shortcomings or if outside accommodations can provide the right level of assistance.
Just because a person does not always remember to take their meds or does “not get around” as they once did are not necessarily reasons to move them from their home. Accommodations, particularly those that can be brought to the home, will be in my next blog.
Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families throughout metropolitan Chicago. Please email your questions to Charlotte Bishop.
