• Long-Term Care Options (home health care, adult day care, assisted living, dementia care, skilled nursing facilities, hospice)
  • Continuing Care Retirement Communities
  • Hospice and Palliative Care
  • Residences that Offer Health Care
  • Senior Housing Locators
  • Services when the Adult Lives at Home

MAJOR ISSUES TO CONSIDER WHEN AN ADULT EXPERIENCES HEALTH CHALLENGES: Try to identify the problems with which your loved one needs the most help.

1. Activities of daily living (ADL's). You may hear this term from doctors, nurses, social workers or staff at care facilities. What does it mean? Health care professionals use this term to discuss the basic capacity a person has to care for herself, which they break down into the "activities of daily living". How much assistance does she need to bathe or shower, to dress, to eat, to get in or out of bed or a chair, to walk and to use the toilet? These very basic abilities can be affected by physical, cognitive or mental health difficulties. (NOTE: Benefits under many long-term care insurance policies are based on the insured person needing ongoing assistance with two or more activities of daily living -- read your policy to see exactly what triggers benefits.) Many of the issues below include difficulties with ADL's.
2. Hygiene. Is your loved one having trouble maintaining acceptable hygiene on a regular basis? Does he have body odor a good deal of the time? Does he look like he needs a shower? Is his hair dirty or unkempt? Is clothing stained and wrinkled? Does he stay in his pajamas or bathrobe most of the time? Problems like these could indicate that he is having difficulty getting in or out of the shower or tub safely, finds it difficult to do laundry or ironing or to dress (arthritis or disorders with tremors make it very difficult to fasten buttons or zippers). A lack of concern for personal hygiene could also indicate cognitive changes (changes in the brain that affect thinking and behavior) or depression.

3. Maintaining Home and Yard/Caring for Pets. Similar to the personal hygiene issues discussed above, someone experiencing physical, cognitive or mental health difficulties may not be able to keep her house or apartment clean and sanitary (the garbage doesn't always go out, dishes go unwashed, bathrooms aren't cleaned, clothing, magazines, newspapers and mail start to stack up, odors and possibly bugs or rodents move in). The grass doesn't get mowed, the garden isn't weeded, leaves aren't raked and walks aren't shoveled. If she is having severe difficulties, she may not feed or water pets properly or seek medical attention for them, litter boxes aren't emptied, dog or cat waste accumulates in the house and, in the worst of situations, the pets breed and overrun the home. Frequently, TV news crews will run a story on an elderly person found to have 40 or 50 malnourished pets in a home; this was a person who needed help before the situation got that bad.

4. Nutrition: Does your loved one eat well? Shopping, cooking and cleaning up requires quite a bit of energy. When an individual finds those activities difficult or exhausting, he may look for easier ways to feed himself. Fast food two or three times a day, or several days a week, may not be the healthiest option out there, especially if he has heart disease or diabetes. Many frozen foods are extremely high in sodium and fairly low in fiber. A box of donuts or a bag of chips slows down hunger pangs, but provides lots of sugar or fat and little nutrition. Someone who used to go have dinner at the local diner, which might not be a bad option, may stop doing that if driving becomes more difficult. Home-delivered meals, such as "Meals on Wheels" can be a big help. Home-made frozen dinners from the family or neighbors, frozen in single-serving microwavable portions, can be helpful. Inviting your loved one for dinner several times a week, and sending home leftovers, may help. If he experiences significant weight gain (eating the wrong foods) or weight loss (not eating enough), and you cannot work out a solution together, it may be time to explore residences that offer meals as part of their package of services. Particularly after someone loses a spouse, the surviving spouse, who may never have been a good cook, may find it difficult to cook for only one person, and nutritional levels suffer. Financial resources are also a concern; grocery prices keep going up and individuals living on fixed incomes, such as Social Security, may have trouble finding enough money for groceries. Transportation can also be a problem; if someone no longer drives or has difficulty carrying heavy grocery bags, bringing home groceries could be very difficult. Someone with dementia may forget to eat or may literally forget how to prepare meals.

5. Transportation: Is your loved one still a safe driver? Critical reflexes tend to slow down as we age. Many medical conditions impact driving, such as impaired vision, decreased hearing, difficulty turning the head to check traffic in other lanes and decreased muscle tone and strength in the legs and arms. Cognitive changes such as those often seen in dementias (such as Alzheimer's disease or vascular dementias after strokes) can also affect judgment (for example, is there time to go through the intersection before the light changes?) and memory (a driver with memory loss or confusion may become lost and unable to find her way home). Driving is often a necessary skill when an older adult lives in his or her own home and must get to the grocery store, drug store, church or synagogue, doctor's appointments, etc. Further, it is an emotional issue and, for many people, it is linked to his or her sense of independence. Take a ride with your loved one; let her drive. If that experience raises concerns, address the situation with her and with her doctor. Does the doctor believe she has any conditions that could limit her ability to drive safely? If your loved one should no longer drive for safety reasons, alternative methods of transportation must be located for her, or she may need to consider a different type of residence where transportation can be available. Many older drivers are very capable. The point, at any age, is to admit limitations and to stop driving when the driver is a danger to herself or others. Sometimes family needs to be a part of that discussion and decision. (Hint: If you visit and see multiple dings or scrapes on your loved one's car, and if you ask about them and answers are evasive, it may be time to evaluate her driving skills.)

6. General health and physical changes. Is your loved one experiencing physical changes or decline? Is he currently seeing a doctor regularly? Has he had his vision and hearing tested recently? When did he last see a dentist? If he has dentures, are they fitting properly? If he is on medications, does he understand what each is for and when it should be taken? Is he actually taking them as prescribed? If not, why not? Memory problems, confusion, side effects and financial considerations all influence whether an older adult takes medication as prescribed. If possible, have all medications dispensed through one pharmacy so the pharmacist can watch out for potential drug interactions (see our section on Pharmacies under Medical Specialists). It can be helpful to include a geriatrician on the health care team; geriatricians are physicians who specialize in treating older adults. It is important to identify and treat medical problems as early as possible and to understand how those problems can change the individual's ability to perform the activities of daily living, to care for a home or pets or to drive. It is also helpful to understand, in general terms, whether a medical problem is short-term (acute) or ongoing (chronic). If the condition is ongoing, will the individual's health continue to decline? What symptoms and problems may be expected?

7. Cognitive Changes. Is your loved one showing signs of cognitive changes (changes in the brain that affect thinking and behavior)? Is there some short-term memory loss (trouble remembering what happened today or yesterday)? Is there long-term memory loss (trouble remembering what happened 25 years ago)? Does she seem confused at times? Does she mix up days and times when you are supposed to meet or forget appointments altogether? Does she have more trouble than usual balancing her checkbook or focusing on a television show or movie? Has she gone somewhere and had trouble getting back home? Does she leave the water running or the stove on in the kitchen? Does she have trouble finding the right word when speaking, or does she substitute unrelated words that make no sense in that context? Many medical conditions can produce cognitive changes, some short-term and others more permanent. Certain medications, particularly at the wrong dosages, and anesthesia during surgery, can produce cognitive changes. Those medical conditions we call dementias, such as Alzheimer's disease or vascular dementias (vascular dementias are usually caused by major strokes or the mini-strokes knows as TIA's or transient ischemic attacks) can cause cognitive difficulties. Trauma to the head from falls, auto accidents or other injuries can also result in cognitive changes. An adult with dementia may develop paranoia (the belief that someone is trying to hurt him) and may also develop delusions or hallucinations that cause her to believe people are following her or are entering her home to cause her harm. Many older adults experience cognitive changes, with this more likely to occur as an individual continues to age. It is important, however, to see a doctor and to explore the cause of cognitive changes. Some can be reversed or stabilized (kept at about the same level) with medical intervention; others may get worse. Even with Alzheimer's disease, there are medications that can slow the progression of the disease and ease some of the anxiety or agitation that may accompany it, although there is no cure at this time (research is ongoing). Individuals with cognitive changes, particularly those with dementia, may be unsafe alone at some point. Do not wait for disaster to strike before asking for the help your loved one needs to be safe. (To learn more about dementia, see the listing for the Alzheimer's Association under the Government Programs/Social Service and Support Agencies on our site.)

8. Financial Management: Your loved one has every right to privacy in managing his finances, but it may be helpful to have a gentle conversation about how well that is going. Individuals who start to experience cognitive difficulties often start to have trouble managing money. Balancing the checkbook becomes more difficult and checks start to bounce. He may be more vulnerable to financial scams, may overpay for needed purchases or repairs, and may entrust his money to the wrong individuals (and end up losing much of it). Do not assume he cannot manage his own affairs, but do try to learn whether he could use a little help. Especially if family is not close by, an older person may rely on someone else for financial help, and all too often that friendly someone turns out to be a financial predator. Financial exploitation is a major problem for older adults. Please see our section on Attorneys to learn more about powers of attorney and guardianships that can help in managing assets for someone who can no longer manage them safely independently.

9. Loneliness/depression. Older individuals, especially if living alone or with an ill spouse, may become extremely isolated and lonely and may develop depression. People are social creatures. For many older adults, family is busy or far away, neighbors and friends have moved away or died, it may be difficult to get out and visit old friends or get to church or temple, and much of the day is spent alone, perhaps in front of the television. The older adult may be concerned about becoming increasingly more dependent on others and may be burdened by worries about his own health, the health of a spouse or sibling or financial concerns. Particularly when an older adult must become the primary care giver for a spouse or sibling, a task that would exhaust a healthy 20-year-old, life can be overwhelming and full of worries. Individuals who are depressed may not eat well, may neglect personal hygiene and the upkeep of the home, may withdraw from what few outside activities they formerly enjoyed, may not take needed medications appropriately and may neglect other health care needs. They may even become suicidal. Is your loved one lonely or depressed? Can you help him find more companionship and activities? Can you help him seek medical treatment for his depression; medications can sometimes help. Can you visit more? Would a pet help (or would it increase the burdens)? Would a different living situation with more social interaction make for a healthier life?

OKAY, YOU HAVE A LIST OF ISSUES, BUT HOW DO YOU GET HELP? If you have an idea of what type of help you need, please read through the listings below to learn more about the types of services available. It is very common to use a combination of services, and to change the types of services over time, in order to meet specific needs. Please follow the larger categories through to their subheadings to learn more about specific services and to find the directories of local service providers.

1. Independent Living. For older adults who have few difficulties with the activities of daily living, but who could use some help with housekeeping, transportation or meal preparation, or for those who could benefit from spending time with other adults of a similar age and sharing meals and activities, see our section on Residences for Older Adults, Independent Living (services, but no health care). You might want to start there, but also browse through the categories of services under this current section.

2. Geriatric Care Manager. If you are really have trouble determining what type of assistance would help you or your loved one, if you aren't sure of the medical condition or how to identify medical needs, and if you perhaps could use help in making those determinations and in finding appropriate services, you might find a geriatric care manager of great assistance (please see section under Medical Specialists, Geriatric Care Managers). Geriatric care managers are typically nurses or social workers with experience in helping older adults; they advise and assist individuals and their families in obtaining diagnoses, developing care plans, finding and hiring services and monitoring health status and services on an ongoing basis.

3. Services when the Adult Lives at Home (see section). An older adult often wants to stay in his or her own home, or may wish to live with family (as opposed to a care facility). That can work well, but it may be necessary to hire some additional services to help the family provide appropriate care for the older adult. For adults who live in their own homes, or who share homes with family, home care services are available, both non-medical (companion services who assist with activities of daily living, but do not provide hands-on care) and medical services (various levels of nursing services). Adult day care services can provide a safe and fun place for the older adult to spend time while family is at work or school. Respite care can provide breaks for family care givers, ranging from a few hours to a few days. Depending on the older adult's medical condition, these services may make it possible for the adult to stay at home, or at home with family, permanently.

4. Residences that Offer Health Care (see section). If it is no longer safe or medically feasible for the older adult to remain at home, there are several levels of residences that offer health care. Assisted Living provides low-level assistance with the activities of daily living and still allows the older adult a great deal of independence. Dementia care residences specialize in the care of adults with dementias, such as Alzheimer's disease or vascular dementia. These facilities may be licensed as assisted living (low-level health care) or skilled nursing facilities (a higher level of care, such as we would consider a traditional nursing home). They should be secured (meaning no one can wander away) and staff is trained to deal with individuals with cognitive difficulties (memory loss, confusion, impaired judgment). Residential care homes may be licensed as assisted living and/or Alzheimer's care homes; these are usually regular ranch homes in normal neighborhoods where the staff cares for a small number of adults (usually no more than 8 to 10) in a very home-like atmosphere. Skilled nursing facilities provide the highest level of ongoing health care. They can care for bedridden patients and others with severe mobility problems, those with feeding tubes or constant IV's (and sometimes ventilators or respirators), and those who need a large amount of hands-on assistance. Many skilled nursing facilities have dementia units to care for residents with severe levels of dementia, many of whom will have physical difficulties, as well as cognitive challenges. Many skilled nursing facilities also contain rehabilitation units (see section on Rehabilitation Services under Medical Specialists) where residents recover from heart attacks, broken hips or other illnesses or injuries, with the plan being that those residents will recover and return home. Hospice care provides gentle, reassuring assistance for individuals who are terminally ill (often defined as those expected to die in the next six months) and for their families. Hospice care can be brought into the individual's home, or the family's home, or into care facilities, as needed. Continuing care retirement communities may have options for independent living, assisted living, skill nursing care and hospice, all on the same grounds.

5. Senior Housing Locators: If you know what level of care residence you need (assisted living, dementia care, skilled nursing care, etc.,) a senior housing locator can search for open beds or apartments for you. These services are typically paid for by the facilities and not by the individuals or families asking for assistance. This is good and bad. It is a helpful, time-saving and free service for you (ask up front to be sure who pays for the service), but it also means that the locator service is likely to recommend one of the facilities with whom it works regularly.

OTHER NEEDS: Please also see the sections of our web site for Medical Specialists, Hospitals and Medical Equipment/Supplies, Legal/Financial/Moves, Convenience Services, Government Programs, Social Services and Support Agencies, Transportation and Unique Services for other services or products that may be of help to you.