How Do I Know When It’s Time to Think About Senior Care?

Many older adults prefer to age in place, or, stated differently, prefer to grow old in their own home. In fact, a recent survey by AARP (American Association of Retired Persons) reveals that nearly 80% of persons age 50 years and older wish to continue living in their own home as they age. This is an understandable desire as relocating to a long-term care facility, such as an assisted living facility or a nursing home, means not only leaving the familiarity and comfort of home but also giving up some of their independence. However, it is vital that a senior’s desire to remain independent be balanced with his or her safety and health needs. The needs of caregivers are also important, and it’s crucial that the stress and potential - or reality - of caregiver burnout be weighed against the needs and demands of providing senior care.

The good news is that, in this day and age, there are more senior care options than ever before. Many of these options offer seniors maximum independence and a higher quality of life, while simultaneously ensuring their physical and mental needs are met in a safe living environment. In addition, some of these care options can prevent or delay residential care in an assisted living or nursing home facility, allowing seniors to remain in the comfort of their own home for as long as possible. 

Indicators that an Older Adult May Need Senior Care

Making the decision that an older loved one requires senior care is difficult, particularly since many seniors are resistant to receiving care assistance. However, there are telltale signs that indicate it is - or may be - time for some level of senior care, such as in-home care, adult day care, or residential care. 

Activities of Daily Living

An extremely common indicator for measuring a senior’s need for care is his or her ability to independently complete common daily living activities, referred to in the field of senior care as activities of daily living (ADLs). In fact, this measurement of care need is frequently utilized to determine if a senior meets the functional criterion for financial long-term care assistance programs, such as Medicaid.

Activities of daily living (ADLs) are activities that a person must do on a daily basis to properly care for him or herself. Examples include:

  • Bathing
  • Toileting
  • Grooming
  • Dressing
  • Eating
  • Transferring (moving from one position to another, such as sitting to standing)
  • Mobility (moving around a living space)

Instrumental activities of daily living (IADLs) are activities that do not have to be performed on a daily basis but are a necessity for living independently. Examples include:

  • Laundry
  • House cleaning
  • Meal preparation
  • Paying bills
  • Taking medication
  • Driving or taking public transportation
  • Shopping for groceries and other essentials

If a senior is no longer capable of performing ADLs without assistance, or cannot independently complete several IADLs, it is a strong indication that it may be time for some type of senior care. Based on the senior’s level of functioning, this could mean hiring an in-home personal care aide, or, in more extreme cases, it may indicate a need for residential care.

Other Signs

In some cases, signs that a senior may require additional care may be somewhat subtle. In other cases, the signs may be very noticeable. For seniors with Alzheimer’s disease or dementia, particularly in more advanced stages of the disease, there are generally very pronounced signs. However, with any exhibited signs for the potential need for care, it is important to consider the frequency with which the signs are occurring and their level of seriousness.

One crucial consideration is the safety of the senior and the safety of others around them. It is also essential to weigh the safety of the senior’s living environment. For instance, does the senior’s home have stairs which he or she must navigate on a daily basis, and, if so, is he or she able to do so safely? 

Another important question to answer: Does the senior know what to do in the event of an emergency, and, if so, is he or she able to act in a timely manner? The following examples are signs that it may be time to consider senior care. Please note that this list is not exclusive.

  • Memory issues (forgetting to pay bills, missing appointments, leaving the stovetop on after cooking, misplacing important items)
  • Wandering away from home and becoming lost
  • Exhibiting verbal, physical or sexual aggression
  • Becoming isolated (withdrawing socially from people and activities enjoyed in the past) 
  • Unusual or out-of-the-ordinary behavior (wearing dirty and wrinkled clothes, ignoring personal hygiene)
  • Weight loss (may be an indication that the senior has not purchased groceries or has forgotten to eat)
  • Frequent falls and/or accidents (cutting oneself while cooking, burning oneself while taking a dish out of the oven)
  • Increased need for medical care
  • Ignoring home and property care (messy or dirty home, unmowed yard)
Did You Know? According to a 2015 collaborative study by the National Alliance for Caregiving (NAC) and AARP, more than 34 million Americans served as an informal (unpaid) caregiver of an adult 50 years of age and older within the previous year. This figure is assumed to have grown, and will soon be updated, as the NAC and AARP are currently compiling a 2020 report.
How to Know When a Senior’s Needs are More than a Caregiver Can Provide

For caregivers of seniors, it is important to recognize when the needs of the care recipient are greater than can be handled by the caregiver. In addition to ensuring the senior’s needs are met, a caregiver’s physical and mental needs must be met as well. When a caregiver’s needs go umet, it can be difficult - or even impossible - to provide the senior with the care he or she requires. Signs of caregiver stress and burnout can overlap, but the list in the following section, while not exhaustive, may indicate that the senior requires a greater level of care than the caregiver can provide alone.

Caregiver Stress

The stress of caregiving can become extremely overwhelming, particularly when the caregiver has other responsibilities, such as employment, caring for children, and maintaining other relationships. The immense and often unrelenting stress of caring for a senior can seriously impact the caregiver’s physical and mental health, as well as other aspects of his or her life. As a caregiver, consider the following:

  • Do you feel you have more responsibilities than you can handle?  
  • Are you performing poorly at work?  
  • Are your relationships with your spouse, children and friends suffering? 
  • Do you frequently feel ill? 
  • Are you quick to anger? 
  • Do you feel anxious, depressed, irritable, or resentful? 
  • Are you having problems sleeping?
  • Are you able to care for your loved one without potential injury to yourself and/or him/her? 
Caregiver Burnout

There can - and often does - reach a point when the continuous stress of caregiving can lead to physical, mental, and emotional exhaustion. This is known as caregiver burnout. Signs of caregiver burnout include:

  • Not taking care of your own needs
  • Lack of patience/feeling irritated with your care recipient
  • Feeling a sense of hopelessness
  • Feeling as if you have no life outside of caregiving
  • Gaining/losing weight
  • Increased/decreased level of eating and/or sleeping
  • Constant exhaustion even with adequate sleep
  • New or increased use of alcohol/tobacco/illicit drugs
  • Family and/or friends expressing concern for your wellbeing
  • Loss of interest in activities you used to find enjoyable
All states offer financial/care assistance programs for seniors who require care but do not have the means to pay for it. To find Medicaid and non-Medicaid programs in the state in which your loved one resides, click here. Please note that these programs have eligibility requirements, usually taking into consideration the senior’s income, assets, and functional ability.
Senior Care Options

When considering senior care options, it is important to determine the senior’s ability to complete activities of daily living, as well as any other signs that might indicate a senior requires some level of assistance. It’s also important to note that not all care options are appropriate for all persons. The decision as to what type of care is most appropriate is a very personal one based on the senior in need of care, his or her loved ones, and the unique circumstances. For instance, a senior who occasionally forgets to water plants, does a poor job of house cleaning, and isn’t stocking the refrigerator with healthy food may benefit from having a personal care aide come to the home a few days a week to offer assistance. On the other hand, if a senior’s level of functioning is so poor that 24/7 supervision and assistance is necessary, a nursing home may be most appropriate option. Learn more about the various senior care options below.

Independent Living

As mentioned previously, the majority of seniors prefer to age in their own home, also called “aging in place.” Fortunately, many types of in-home care allow for independent living, either in the senior’s own home or the home of a family member or close friend. For instance, personal care aides can provide personal care assistance (bathing, toileting, grooming, dressing, eating, transferring, and mobility), light house cleaning and laundry, grocery shopping and meal preparation, medication reminders, and transportation to and from physician appointments. In addition to this type of in-home care, there is also in-home health care for seniors who also require minimal medical assistance. In addition to the above personal care tasks, in-home health aides can check vital signs, change bandages, and administer medications.

For family members who serve as primary caregivers for their loved ones, adult day care is another option, which provides daytime supervision, meals and snacks, assistance with daily living activities, recreational and social activities, and, sometimes, transportation to and from the adult day care center. Another senior care option for family members serving as primary caregivers is respite care. This type of care gives primary caregivers a break from caregiving duties by providing an alternative caregiver for a few hours at a time, overnight, or even for a few days.

While not a type of senior care, home modifications can help a senior to live independently at home for as long as possible. Examples of home modifications include grab bars in bathrooms, toilet seat risers, roll-in and walk-in showers, pedestal sinks to allow wheelchair access, chairlifts and stairlifts, wheelchair ramps, and the addition of first-floor bedrooms. Learn more about home modifications and financial assistance here.

Assistive technologies such as personal emergency response systems (PERS), while also not a type of senior care, can enable some seniors to continue living safely at home. PERS can call for help in the event that a senior falls or has another emergency, track the location of a senior who has wandered away from home, and even monitor a senior’s vital signs. Learn more about PERS and financial assistance here

Assisted Living

Assisted living facilities provide assistance for seniors who can no longer live independently but don’t have a level of care need so great that they require nursing home care. This type of senior care is aimed at residents maintaining as much independence as possible, while still providing them with the care they need. In addition to housing, the following may be provided: meals, personal care assistance, housekeeping services, social and recreational activities, 24/7 supervision, and health-related services. 

Alzheimer's Care

Alzheimer’s care is specifically for seniors who have Alzheimer’s disease or a related dementia. Also called memory care, this type of care is provided in stand-alone facilities or in designated wings of assisted living or nursing home facilities. Staff are trained in dementia care and are well equipped to handle the cognitive, behavioral, and emotional consequences of the disease. In addition to room and board, assistance with activities of daily living, 24/7 supervision and security, and social and recreational activities, including those intended to stimulate memory and other cognitive skills, are often provided. 

Skilled Nursing Facilities

Another type of residential care option are nursing home residences, also referred to as skilled nursing facilities. In a skilled nursing facility, meals and snacks, 24/7 skilled nursing and supervision, personal care assistance, recreational and social activities, and a variety of therapies - physical, occupational, and speech - are available. The only location that offers a higher level of medical care than a skilled nursing facility is a hospital. 

Continuing Care Retirement Communities

Continuing care retirement communities, often abbreviated as CCRCs, offer many different levels of care in the same “community.” CCRCs offer independent living, assisted living, and nursing home care in one location, and, as a senior’s care needs progress, the type of care changes. For instance, a senior may first live in an independent living apartment within a CCRC, and, as the need for assistance with daily living activities increases, relocate to an assisted living facility within the CCRC. These communities often offer a variety of amenities, such as group dining rooms, gyms, and swimming pools. Opportunities to socialize and participate in other activities are also available.

Learn about the costs of senior care here.