The holiday season brings families together and gives loved ones a chance to catch up with the changes in their family's lives. Unfortunately, some of these changes bring additional stress to some, particularly adult children. Have you noticed a change in your parents' abilities to care for themselves or their home?
Objectivity is essential if you are concerned about changes in your parents' ability to complete basic daily tasks. Being concerned about a loved one is expected, particularly if you feel something isn't quite right. To help your parents, view their behaviors and abilities as if they are any other person on the street or in the grocery store.
Honest answers to questions like "Have your parents' appearance or behavior changed in any way?" or "Is their house in disarray when it is normally clean and organized?" can be a start to getting your aging parents the help they need. There could be changes in your parents' activities of daily living (ADLs) or instrumental activities of daily living (IADLs). Look for other signs that may show something isn't quite right. If a parent has uncharacteristically lost weight or their refrigerator and food cupboards are bare or generally lacking edible food, it may be best to observe your parents' new habits.
It's important to remember that even if your parents have to spend more time completing ADLs and IADLs, they can still finish the tasks. It is usual for an aging person to slow down when completing specific tasks, so do not underestimate someone's true abilities because of speed changes. Consider whether your parents are fighting an illness, what time of day it is, and when your parents are at their best. Suppose your parents have abandoned their tasks entirely, or they are incapable of adequately completing them, such as bathing or toileting. In that case, it is time to look further into assessing their situation.
Remember, it is difficult for a once-independent person to accept that they may not be able to live without assistance or are losing their independence, so approach the subject and observations with discretion, empathy, and patience.
Activities of Daily Living and Instrumental Activities of Daily Living
Activities of daily living (ADLs) and instrumental activities of daily living (IADLs) are different types of tasks, but they are all essential to maintaining a person's functional status. ADLs include:
- Basic personal hygiene
- Dressing independently
- Maintaining continence
- Toileting independently
- Independent mobility
- Feeding oneself
Instrumental activities of daily living (IADLs) are required to care for yourself, your home, and the occupants of your home. IADLs require more complex cognitive skills and organizational skills than ADLs. Examples of IADLs include:
- Medication management
- Housecleaning and home maintenance
- Meal preparation
- Shopping and restocking the home of necessities
- Managing communication with a phone or computer
- Paying bills on time and managing financial assets
- Transporting oneself and dependents without assistance, whether that be driving or using public transportation
You know your parents best, but it helps to have the input of siblings, other family members, or others close to your parents, such as friends and neighbors. A few questions, like whether your parents have needed more assistance lately or if they have kept appointments and scheduled visits, could clarify whether your concerns are warranted. It is crucial to find out if anyone else has noticed changes in your parents. If someone has seen a difference, what examples can they provide? These observations are imperative for helping your parent's doctor recommend an appropriate treatment plan.
Including Health Care Professionals
A family member or caregiver should accompany your parents to their medical appointments. Concerns about changes in ADLs and IADLs often trigger medical evaluations to find any underlying causes. It is best to be thorough in medical evaluations so treatment options are appropriate for the level of assistance your parents may need.
Your parents' doctor may assess your parents' ability to complete ADLs and IADLs. The most common ADL assessments are The Katz Index of Independence in Activities of Daily Living or Katz ADL, The Barthel ADL Index or BI, and the Functional Independence Measure or FIM. These assessments can provide an accurate view of a patient's dependency needs, though the tests are administered based on differing medical diagnoses. The Katz ADL is the most popular test for aging seniors with mostly adequate physical and mental capabilities.
The IADL assessment is the Lawton Instrumental Activities of Daily Living Scale. This assessment is practical if the patient's functional capabilities aren't overestimated or underestimated as the patient completes the evaluation. A caregiver familiar with the patient may be able to complete the assessment, but burnout or personal feelings may make it difficult to provide objective answers.
Healthcare professionals understand how difficult it is to bring concerns to their attention. It may mean significant changes to your parents' lives. They may want to continue to live independently, but that isn't always the most viable option.
Developing an Appropriate Care Plan
Medical treatment could solve your parents' decline by including new medications, working with physical therapists, or regularly visiting occupational therapists. Difficulty with IADLs could be solved using different service providers. Consider hiring a money management professional to pay bills and protect finances, a housekeeper to clean and maintain the home, and a home delivery service for any shopping and grocery needs. A home care professional can check in a few times weekly to help manage medications and other small necessities.
Problems with ADLs may require more extensive care plans. Your parents may need to consider a home care service to assist with ADLs, moving in with a loved one for full-time assistance, or the most effective long-term solution may be an assisted living community.
Home Care Services: Home care can provide excellent services helping with ADLs and IADLs for each patient. While home care services might be the most comfortable option, and home care aides may be available twenty-four hours a day, the cost is exorbitant, and the services may be less consistent. Plus, a lack of programming, socialization and additional stimulation beyond care services can accelerate physical and cognitive decline. As your parents' physical and cognitive abilities decline, home care will be less effective, and living at home will become more hazardous.
Moving Into a Loved One's Home: Moving in with a loved one for full-time assistance is an attractive solution if your parents are physically and cognitively capable of independently completing most ADLs and IADLs. However, as your parents become less independent, their caregivers become more burdened with caring for one or two additional people.
Caring for an elderly loved one is a rewarding experience but can be physically, mentally, and emotionally exhausting. Most caregivers need to work to financially make up for the extra people to feed, clothe, and assist. Caregiving may lead to resentment between the loved ones being cared for and other household members. The caregiver's other relationships inside and outside the home may also suffer. Caregiving is a full-time job, so caregivers often begin to neglect other loved ones or even themselves.
Caregiver burnout can approach quickly as other stressors increase. Therefore, if moving in with a loved one is the best option, caregivers should take frequent breaks to care for their mental and physical health and to catch up on other parts of their lives that need attention.
Moving to an Assisted Living Community: Moving into an assisted living community is the most beneficial long-term option for anyone facing challenges completing ADLs and IADLs independently. As seniors age, physical and cognitive abilities decline. Living in an assisted living community will provide the support needed to complete all ADLs and IADLs.
Luckily, the necessary IADLs tend to decrease after moving into assisted living. Caregivers and aides can take care of the laundry, there are very few bills to pay, and medication technicians can distribute the correct medications as needed. There are also meal programs for residents, so they no longer need to cook for themselves. Assisted living communities like Clearwater Living offer transportation services for residents to shop or enjoy themselves outside the assisted living community.
Moving to an assisted living community allows seniors to focus on themselves and their well-being. The staff takes care of chores and housework so residents can focus on their health, social relationships, and activities they enjoy. It is also healthy for seniors to set goals for themselves. For example, they may want to learn a new hobby within a month or two. Goals help everyone to feel relevant and have meaning in their lives.
Senior living communities provide more than long-term assisted living options. If one or both parents have a debilitating cognitive diagnosis, Clearwater Living offers opportunities for their residents to transition from assisted living to their memory care neighborhood with minimal disruption. This option allows residents to stay in the same community regardless of increased care or support typically required for individuals with Alzheimer's or dementia.
Care and Support
Many options and resources are available to ensure your parents receive the best care possible when they lose their independence. Regardless of your parents' diagnoses or treatment plans, you want what is best for them. It's essential to have open and honest communication with your parents' medical team to solve their problems with ADLs and IADLs and any underlying medical problems that may have developed. Once the doctor establishes a treatment plan, your parents will need all the support they can get.
If the doctor establishes the immediate treatment plan is to provide short-term solutions, finding the most adaptive assistance is ideal. As your parents' needs change, you will already have services in place to adapt. Check in frequently to ensure the services your parents receive are adequate for their needs. Observing their living situation is also necessary to assess whether their needs have changed.
If assisted living is the best solution for your parents, Clearwater Living supports residents and their families during their moving process. Clearwater Living believes achieving optimum support for residents also means providing support for their loved ones.
We know choosing to live in an assisted living facility is an emotional process, and we are prepared to provide any assistance to make moving as seamless as possible. Clearwater Living offers open communication with residents and their families to be sure the care plans are appropriate for each resident.