Our elders love their independence, for the most part. Perhaps over time, their chronic health conditions start to erode their abilities to do some things independently. In the absence of a sudden event, like a fall, the slow decline in physical ability may not be obvious when family visit their loved ones. And at some point, the activity your elder has always done on their own becomes dangerous. But how can we tell when they reach that point?
The “Activities of Daily Living” and Safety
The medical community and home care providers often refer to how well a person can do at home by looking at six activities, which are referred to as ADLs, or activities of daily living. These include walking, bathing, dressing, toileting, eating and transferring from bed to chair and back. There are many more things a person does in any given day, but these six measures are frequently used for numerous purposes to determine whether a person needs help, with what and how much. Here I’ll address just two of these six, as very common areas of risk for aging loved ones.
Walking
Elders often resist the idea of any assistive devices to help them walk safety. A cane, a walker or wheelchair are symbols of being dependent that they don’t want to face. My late mother-in-law illustrated this perfectly for us. She was 90 years old at the time. We visited her at a shared vacation spot. She was teetering and holding onto things as I observed her on our arrival. I quietly gasped! Soon after we settled in I suggested that she consider a walker, just to keep her from falling. “I don’t want anyone to think I’m a cripple!,” she said. Right. It was about her image of herself, not about safety. We did rent a walker for her and it was amazing how much better she did. Eventually, she came to accept this, but not without a long period of refusal. We were grateful that she did not fall during the stubborn refusal time. We had to keep after her to get her to agree. Renting one to try it out was a good way to get the conversation going. We were there, showed her how to use it, and could point out the difference in how she looked walking without the walker and walking with it. That helped.
Bathing
Many, many falls for aging parents and other loved ones take place in the bathroom. Wet floors, slippery rugs, lack of grab bars, loss of balance getting into the tub or shower, arthritis, and vision issues all can contribute to fall risk. In addition, the proximity of hard surfaces, like walls, sinks, toilet, etc. to where the aging person needs to go add to the danger. When one falls in a bathroom, they may hit something hard and fracture a bone or knock themselves out.
An illustration
As a retired home health RN, I am sometimes asked to help families with assessments of the elder’s safety at home. In a recent case, I watched a 77 year old show me how she was getting in and out of her tub every day. The purpose was to help her loved ones plan for what would help her remain in her home. The danger was quite obvious. No grab bars, no rail on the tub, a slippery rug, and no one to help her. She did not wear a personal emergency response device. She had arthritis in her hands and could not grip anything firmly. She was an accident waiting to happen!
This family was urged to act immediately to get help, improve the bathroom with safety devices, such as bars and rails and to get her to agree to have a home care worker come at bath time every day. Fortunately, she was willing. We also urged her to get a wearable device that would call for help in the event of a fall. She agreed. There are plenty of devices to choose from now, including smart watches. She was open to the idea.
What Family Can Do
With about 27% of people over 60 living alone in the U.S. in 2020, the risks to safety loom. According to the Pew Research Center, this number is expected to increase as Boomers age. What does this mean for families? It can mean that you need to pay closer attention to how your aging parents and other loved ones are actually managing at home with their ADLs. We can’t afford to ignore the passage of time.
Is is not unusual for an aging parent to tell you they’re fine even if they’re not. They don’t want to worry you. They don’t want to face their declining ability. They may be embarrassed at the idea of needing help. They secretly fear you’ll “put them in a home”. The key to their safety may lie in communication and in doing your own observations. We can only recommend a personal observation to get a clear picture of how the elder is actually managing if they live alone and have no help. Their words might not match what your eyes can tell you.
How Can You Assess Safety Yourself?
With a respectful request, you can get your aging parent’s permission to watch them get to the bathroom, walk for you while you observe, get dressed, etc. Whatever may be your concern is the place you need to focus upon. If your aging loved one doesn’t have any chronic health problems, great. They are unusual. Most elders do have multiple health conditions, and take medication. The medications can affect balance, which is part of the overall need for close observation to see for yourself if your loved one is safe at home alone.
If you don’t feel inclined to do this sort of observation yourself, you can hire a professional care manager, or home care agency representative to do this for you. Their initial purpose is to assess what the aging person needs and to offer you their services to provide it. They normally provide a written suggestion for a Plan of Care, as it’s called. Be aware that Medicare does not pay for home care of this kind, when a person does not need skilled nursing. The ADLs described above are considered part of “custodial care”, not a Medicare covered service, as no skilled, licensed person is required to help someone with these activities.
The Takeaways
Family and friends can help prevent falls and hospitalizations by being proactive and arranging for your own personal observation of your aging parents. We can’t ignore that a fall in an elder can create a downward spiral that has no good ending. We suggest:
- Learn about your aging parent’s diagnoses, medications and whether they appear to be struggling with any of their ADLs. You may have to ask them directly if they are experiencing any problem with any of the six mentioned here.
- Do your own observations of how they perform those ADLs or hire someone to do it for you. Accept recommendations from professionals.
- Plan on how to pay for help at home if that is going to keep your aging parent or other loved one safe there. Not everyone will accept the idea of moving to an assisted living facility. Aim for respecting your loved one’s wishes in a way that avoids the dangers, especially of falling.