There may be subtle or obvious signs that your loved one is struggling to get through their day.  We can miss some of the signs that someone needs additional support, especially when there is a gradual decline in daily functioning. Unfortunately, many people wait too long before they reach out for additional support, sometimes resulting in a crisis discharge from a hospital. The best time to reach out for additional support is at the first signs that your loved one may need some additional care. 

A 75-year-old divorced gentleman has been living in his home for over 50 years.  He likes his freedom and wants to stay in his home as long as possible. He has two children who live nearby but both are busy with their families and work but check on him weekly. This gentleman has type 2 diabetes as well chronic back pain and high blood pressure.  His back pain gradually prevents him from getting to the store regularly and cooking healthy meals.  He starts using meal delivery apps and inadvertently ordering high carbohydrate, high sodium food in large portions.  When he does make it to the store, he purchases mostly prepackaged meals and snacks with high sodium levels and poor nutritional content.  His high blood sugar levels cause him increased confusion, lethargy, and blurred vision. He has a non-injury fall but downplays the fall to his kids. His loved ones are unaware of these subtle changes and this gentleman eventually ends up in the hospital with an episode of extremely high blood sugar and is in the hospital for 3 days.  The hospital suggests that he get some care assistance at home or move to a community that can help him manage his diabetes, he states that he can manage everything on his own so does not engage in any kind of support. Two months later this gentleman has another high blood sugar episode, resulting in another hospital stay.  The hospital now states that they will not discharge him until he has caregiver services set up at home or moves into a community that can support his diabetic needs. His kids now must drop everything in their lives to do a crisis placement for their dad.  The first major medical crisis was the opportunity to at least get some in-home caregiver services started.

• Repeated falls- When someone has their first fall the chances that they will fall in the future increases dramatically, especially if there are no safety adjustments to the home or care support doesn’t increase
• Decrease in cognition-this can be evidenced by increased forgetfulness, inability to track important information, difficulty tracking time/day, dangerous mistakes (leaving stove on, leaving doors unlocked, etc.)
• Significant medical event- this may include stroke, heart attack, cancer, diabetic episode, etc. 
• Decreased ability to complete daily tasks- things such as cooking, dressing, housekeeping, grooming, and bathing can gradually 
• Increased difficulty tracking daily medications- missing important medications is a major sign that someone needs increased support in an effort to decrease the likelihood of a medical event
• Wandering from the home- leaving the home while confused, often getting lost
• Repeat urinary tract infections- these infections can leave people confused and doing/saying things that are uncharacteristic of their personality. It can also indicate poor bathroom hygiene, especially if these infections are a pattern
• Caregiver burnout- if you are regular caregiver for your loved one, you may need additional support as well. 

• Increased likelihood of injury fall
• Increased risk of other serious medical emergencies 
• Going through the placement process from the hospital in a crisis, rather than being able to strategically plan choosing care for your loved one
• Loved one is in the hospital and are unable to be a part of the decision-making process
• Loved one has declined to the point where they aren’t able to help in the decision-making process for placement

• Paid in-home care services
• Increased support from family, friends, or other community members
• Day treatment program (local program that provides activities, care support and a meal)
• Assisted living or residential care community
• Memory care community
• Adult care Home
• Caregiver support groups

Referral agents, in combination with doctor recommendations and your loved one’s needs and preferences, will help develop an action plan to find the most appropriate level of support. Local referral agents understand what is happening in the senior living industry and work hard to make the safest, best-fitting long term plan.

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