Shay Jacobson, RN, MA, NMG, LNCC, CNLCP
Martha Kern

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Many of us will be making the trek home to visit family for the holidays.  These holiday excursions represent important opportunities to see how the elders in our families are really doing. They always sound pretty good on the phone, but seeing how they live, how they keep the house, how they look, walk, and work through their daily routine, sometimes offers a new perspective on just how functional they are.

Our parents, perhaps owing to pride or fear or a hope that the situation will pass, may be prone to keeping small lapses and new deficiencies under wraps.

There are signs, however, that care is needed. In cases where care is already provided, there are signs that the care may not be of the right variety or size.  The possible scenarios in which these signs are offered are endless, but here are examples of the ways your loved ones might be showing you that they need more – or different – help:

  • Bills and taxes are unpaid, or paid incorrectly;
  • A change of subject in the conversation cannot be managed – your Mom routinely changes the subject back to something familiar or tells a joke when more complex topics are raised;
  • Your Dad repetitively asks the same questions or wants to review the same material;
  • A sudden uptick in charitable giving is seen, or checks are being written to unknown parties for unknown services;
  • Uncharacteristically risky behavior appears, such as gambling, excessive spending, inviting strangers into the house, etc.
  • Grooming and hygiene show a decline – odors are present, clothes are stained, your loved one appears in the same clothes three or four days in a row;
  • Weight loss is registered for no apparent reason;
  • There are bruises, abrasions and other minor injuries, the origins of which your Mom cannot recall or is reluctant to share;
  • Medical issues present that may stem from inaccurate dosing of medication;
  • Pills linger in various compartments of the pill box, or prescriptions that should last 30 days are gone too soon;
  • The credit card bill shows charges for unnecessary goods and services being purchased from telephone solicitors;
  • Neighbors are paid cash or given elaborate gifts for routine assistance, rides or small household chores;
  • The house appears unkempt – flyers are piled up on the sidewalk, the landscaping is overgrown, grass is uncut, mail is not retrieved from the box;
  • New “friends” have appeared and seem to take an influential role in decision-making;
  • The caregiver is there, but so are members of the caregiver’s family (who might also be living there);
  • The caregiver is NOT there, or your Mom reports the caregiver is often out of the house for repeated, unexplained periods of time (i.e. the caregiver has other revenue streams and is taking your Mom out to attend to business transactions, hair appointments or other self-serving interests unrelated to your Mom for whom they are paid to care);
  • Your Dad’s gradual loss of strength has made it impossible for him to participate in his own transfers. The caregiver is moving “dead weight” and has dropped your Dad more than once;
  • Grandpa has begun to wander and has escaped the home several times when the caregiver was napping or watching television. Vigilant neighbors or the police have found him and brought him back home each time;
  • Bed sores are beginning to form and the caregiver is not strong enough to reposition Grandma;
  • Dad can no longer accurately discern when it is time to take medication and the caregiver, who has difficulty reading English, has been guessing which pill to administer and when to do it;
  • The assisted-living community in which your Mom lives has asked that she leave or will not take her back after a hospitalization;
  • Meals are offered in the independent-living dining room, but your Dad forgets or refuses to go.

There are hundreds more such scenarios, each of which shares a common denominator: A change is noted, whether in behavior, ability, physical status, environmental status, social interactions or in any other sphere of life.  The change may or may not signal a larger problem, but only a thorough assessment by a skilled professional will properly tell the tale.  We have seen many cases wherein one change is noticed and at least five additional changes, all of them indicative of decline, are undiscovered until some investigation takes place.

Crossroads are inevitable for all of us, and are most acutely felt by our most vulnerable loved ones: the elderly, the psychiatrically impaired, individuals with disabilities and those who have suffered brain injury.  If we see signs of decline, there is every possibility that others have seen them, too, and these others may not have honorable intentions.

Exploitation always begins with the detection of weakness or vulnerability.  An assessment or audit of existing care limits risk, identifies areas of concern and develops a plan to strengthen safety and circumvent harm.

©Lifecare Innovations, Inc.