Whether you live near your aging parent or miles away, you probably worry about them more and more. Every visit tells you that your once-robust mom or dad is starting to become frail or forgetful. Is it your imagination, or is it really time for “the conversation” about the need for assistance? And how can you know what signs to look for?

Because this dilemma is being encountered by millions of adult children every year, we appreciated reading this recent article from US News that briefly describes some of the warning signs that your parent might need either in-home care, or possibly relocation to a senior care facility. The writer, reporter Elaine Howley, also provides some helpful next steps to guide you into what is sure to be uncharted territory.

Does Your Aging Parent Need Additional Support?

Recognizing the point when a parent goes from living independently without issue to needing more help can be a really difficult process for seniors and their loved ones, especially adult children. For her US News article, Howley consulted with a handful of experts, including Dr. Paul Chiang—medical director of a nonprofit organization that makes house calls to homebound seniors—for some solid advice about how to recognize the signs that your aging parent may need more help, and how to go about finding that support.

According to Chiang, changes in behavior are the first warning signs that your parent might be declining. Howley adds that these changes tend to fall into several broad categories, including personal care, safety concerns, household management, and health management.

Personal Care: Look for Clues

Adult children of aging parents need to “be a detective when visiting the aging parent,” says Jennifer Avila, executive director of Chicago-based Custom Home Care. Avila recommends starting with the fridge for obvious clues: old, expired food—or no food at all—could be clear indications that your parent needs immediate help.

Many aging seniors, less interested in cooking, rely on the convenience of food delivery services, or else they eat a lot of frozen meals. But Chiang says this is far from ideal. “While [these meals] are easy to obtain or easy to make, they’re not necessarily the healthiest foods for seniors, especially if they have a heart condition or diabetes or kidney problems,” he says.

Weight loss could be another sign to keep an eye on. Heather Prinzel, director of nursing at the Orlando Health Center for Rehabilitation in Florida, explains, “Weight loss doesn’t necessarily mean that (your) parent needs to move, but it does mean that they may need some help in order to stay in their home longer.”

If food-based help is needed, you might consider enlisting the help of other family members or friends to support your parent with purchasing healthy groceries, meal prep and cooking, or even setting up a Meals on Wheels type of service.

Some Seniors Find Personal Hygiene More Difficult

Another signal that your parent needs help is personal hygiene. Some older adults may struggle with showering regularly, washing their clothes, and keeping their home clean.

Namrata Yocom-Jan, president of Seniors Helping Seniors, says that a change in sleeping patterns can also signal an issue. Poor sleep could point to a medical condition or anxiety, and both of these can affect both behavior and general health.

Yocom-Jan says that all these can be compounding issues, because for some seniors “ordinary tasks might start to feel absolutely impossible,” leading to mood swings. “Either they get cranky or angry. It’ll have an impact on how they behave,” she adds.

Safety Concerns Increase as Mobility Declines

“Every 19 minutes in the United States, an elderly person dies from a fall,” says Francine Hwang, CEO and founder of FrannyCares, a caregiver placement company. It’s a terrifying statistic, but one that can be mitigated with some basic safety modifications in the home. Simple examples can include:

• Removing area rugs.
• Installing grab bars in the bathroom.
• Making sure your parent is using the railings when navigating stairs.
• Investing in a fall detection monitor.

Hwang also recommends scheduling an appointment with an occupational therapist, who can do an assessment of the home and your parent’s medical history to spot fall-risks early. Your loved one’s medications should also be taken into account, especially if they have dizziness as a side effect. (See the article on Polypharmacy also posted on the blog this week.)

Certainly, not all falls can be prevented. But applying non-skid strips in showers and tiled areas, as well as moving items from high shelves or cabinets to eliminate the need of a step stool, are just further common-sense ways to get ahead of the danger.

Safety Concerns and Cognitive Decline

Some safety concerns are more obvious and immediate than others. If your parent is regularly confused, or wandering away from home and into danger, or getting lost while driving normal routes, then it is unlikely they should be living alone anymore. Howley writes, “That could mean 24-hour care every day at home or moving into a memory care unit sooner rather than later. In cases where dementia could be developing, family caregivers may start to notice personality changes too.”

Chiang adds, “Sometimes, the needs of the patient really stretch the ability of the family members to take care of them at home. Whether it’s a patient who’s becoming agitated or wandering outside of their home, that’s taxing the family members to the extent that they are no longer able to safely care for their loved ones.”

Can Your Parent Manage the Household?

Finances and general resource management are another canary in the coalmine, alerting family that there might be something wrong. Mail, bills, and other paperwork involved with maintaining the home might pile up, go unanswered and unpaid, or get misplaced altogether.

Prinzel tells the story of her own grandfather, who was normally a very organized man. The family knew he was in decline when the state of his desk—and the piles of checks scattered all over the place, made out to different scam organizations in varying amounts—told them that he was struggling. “He had not only lost his sense of judgment, but his ability to problem-solve, both of which are also symptoms of early dementia,” she says.

This is a sadly common tale, so keep an eye on your loved one’s finances, either by checking in regularly or even setting up bank alerts from their accounts on your own devices so you can keep tabs from a distance.

Staying on Top of Health Care Needs

“As we get older, many of us suffer from multiple conditions, and we need help from other people to support us,” Chiang says.

Because of this, your parent’s ability to keep on top of their medications is very important to keep track of. Howley writes, “[Chiang] recommends asking whether they’re able to take their medications as prescribed and to ensure that they have access to medications and medical care when they need it. If your parent already has in-home care, that caregiver can be critical in helping you assess when it’s time to consider moving your parent.”

Talking With Your Parent About Moving to an Elder Care Facility

If enough worrying trends have piled up about your parent’s ability to live alone, it’s time to look for support of some kind. Daniel Jan, chief operating officer of Seniors Helping Seniors, suggests starting locally, especially if you yourself don’t live nearby.

Partnering with a home care agency or your loved one’s pre-existing social support network, like a church or a local senior center, is ideal. This helps to combat loneliness as well as get them the support they need, and it can give you a better insight into how your parent is doing from the perspective of their local community. Your local Area Agency on Aging might also have support and programs available.

But if it truly seems that living at home isn’t a viable option anymore, it’s time to have the tough conversation about a change in living situation. Hwang says, “The conversation about moving into a senior care facility can often be distressing because your parent may feel as if they’re losing their freedom. It also can be emotional because of a reversal of roles where the child becomes the ‘parent’ and the loss of authority, no matter how small or big, can be off-putting for a parent.”

Though the conversation has the potential to be difficult, Hwang suggests approaching it from a place of humility, “being frank and asking questions, such as ‘I know you don’t necessarily need care now, but how would you like to be cared for in the future? I want to be an advocate for you and your care wishes, so I would love for you to guide me.’”

Ideally, Avila suggests that you “start [these conversations] early before there is an imminent need. If you wait until there is a medical emergency, your options are immediately limited.” However, if you start early, “you can ensure the senior feels that they are in charge and making the decisions about how they want to age.” Hwang agrees, adding, “The key is to have the conversation early and often. Normalize the topic, and have your parent actively voice their wishes.”

Overall, keeping lines of communication open is healthiest. Jan says, “Being in touch with your family is super, super important for their healthy aging.”

Senior Living Can Be a Big Improvement

Moving into an assisted living or memory care facility can be a tough decision, but it often pays off in unexpected ways for your loved one, bringing new opportunities for friends and social engagement.

“Quality of life is one aspect that we have seen improve when a senior moves into a senior care facility,” Prinzel says. “When at home, a person with limited mobility may find it difficult to go to the store or join in the weekly bingo game at the rec center, and life can become very lonely.”

But living in community with other seniors can breathe new life into your parent’s later years. Howley concludes her article with a quote from Prinzel: “Senior care facilities vary in levels of care and activities, but they are all similar in that they bring an aging community together.”

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(originally reported at https://money.usnews.com)