When a parent can’t live alone anymore

Maybe Mom fell, or Dad’s fridge is empty, or the bills are piling up. This guide helps you spot the signs, talk about it kindly, compare the options from a little help to full-time care, and check out a place or agency before you sign anything.

Signs your parent may need more help

The NIA says the best way to know what someone needs is to ask them. But a phone call or text doesn’t always show the whole picture. These are signs the NIA lists:

• Changes at home: trouble cooking safely on the stove, not bathing, wearing clothes that don’t fit the weather, a home that has become dirty or cluttered, or not taking needed medicines.
• Mood changes: the NIA notes that depression in older people is sometimes confused with normal aging, and a person may brighten up for a short call or visit. Serious mood problems are harder to hide during a longer visit.
• Health changes: big weight gain or loss, poor hygiene, confusion, falls, loneliness or isolation, and trouble walking or getting around.
• Memory problems: the NIA says occasional forgetfulness is normal with aging, but bigger memory problems, changes in thinking or personality, or poor decisions could mean a serious condition that needs a doctor.

Live far away? The NIA suggests that, with your parent’s permission, you ask people who see them often (neighbors, friends, doctors, or nearby relatives) to call you if they notice anything.

How to talk about it

Most people want to stay independent. The NIA’s advice for starting the conversation:

1. Mention your worry without sounding critical. The NIA’s example: “Mom, it looks like you don’t have much food in the house. Are you having trouble getting to the store?”
2. Follow their wishes as much as you can. If they want to keep cooking at home, you might offer to set up regular grocery delivery.
3. Offer practical, specific help, not just general concern.
4. Suggest a doctor visit if you’re worried about their health. Offer to make the appointment, drive them, or go along.
5. Plan before there’s a crisis. The NIA says the best time to plan is before a person needs a lot of help, while they can still make their own decisions.
6. Talk through the choices together. The NIA says some families find a family meeting or conference call helps, and the goal is a plan that works for everyone, especially your parent.

This is also a good time to make sure the legal papers are in place: a power of attorney and health care directive, and a paperwork binder so you can find things.

Care options, from least to most help

The NIA describes a range of help. Many families use more than one at the same time, and needs often change over time.

1. Help from family, friends, and neighbors. The NIA says much long-term care is given at home by family and friends: rides to appointments, errands, chores, meals, or company.
2. Community services. Meals, transportation, senior centers, adult day programs (activities, meals, and personal care during the day), volunteer visitors, and respite care that gives a family caregiver a break. Your parent’s local Area Agency on Aging knows what’s nearby. Find it through the Eldercare Locator (below).
3. A safer home. The NIA suggests fixing hazards like loose rugs and poor lighting, and asking a doctor about a medical alert ID or an emergency alert system. The NIA has a free aging in place guide with a home safety checklist.
4. Paid help at home. This can be personal care (help with bathing, dressing, and eating), household help, or home health care from nurses and therapists. Medicare covers some home health care for people who are homebound and need part-time skilled care, but Medicare says it doesn’t pay for 24-hour care at home or for personal care when that’s the only care you need. See what Medicare covers.
5. Living with family. The NIA lists living with a family member as one housing option to talk through.
6. Assisted living or another residential community. The NIA says some facilities offer only housing and housekeeping, while many also offer personal care, meals, activities, and medical services, and some have special programs for dementia. What’s included differs from place to place, so ask.
7. Nursing home. The NIA says that when someone needs more help than family or friends can give, it may be time to consider a residential facility such as assisted living or a nursing home. Medicare covers only short stays for skilled care after a qualifying hospital stay, not long-term custodial care.

Need someone to help coordinate? The NIA mentions geriatric care managers, who help families arrange and coordinate care. Ask about fees and qualifications before hiring anyone. usaBob doesn’t recommend specific providers.

Paying for it: see paying for long-term care (Medicare limits, Medicaid, PACE, VA Aid and Attendance, and long-term care insurance) and our care savings calculator.

Finding and checking providers

• Eldercare Locator: a free public service of the U.S. Administration for Community Living (ACL). Call 1-800-677-1116 or visit eldercare.acl.gov to find your parent’s local Area Agency on Aging and services near them.
• Medicare Care Compare: at Medicare.gov/care-compare you can find and compare nursing homes, home health agencies, hospice, and other Medicare providers. For nursing homes, Medicare’s checklist says to look at the star ratings (overall, health inspections, staffing, and quality measures) and the inspection reports. Care Compare’s list of provider types does not include assisted living.
• State licensing and inspections: The NIA says to look for state licensing when you visit. Medicare says a nursing home must post its most recent inspection (survey) report, and most state survey agency websites have these reports too. Ask each place which state agency licensed it, then check that agency’s website.
• Long-term care ombudsman: ACL says every state has a long-term care ombudsman program that works to resolve problems with the health, safety, welfare, and rights of people who live in nursing homes, assisted living, and similar places. Many programs can also explain options and share what they know about a facility. Use the state list below.

Your state’s long-term care ombudsman

Questions to ask on a tour

The NIA suggests visiting several places, meeting key staff, and then visiting again without calling ahead, at a different time of day and at a meal. Medicare has a full nursing home checklist (PDF). Many of the same questions work for assisted living. These come from the NIA and Medicare:

Before you sign: the NIA says to get detailed costs, find out if Medicare, Medicaid, or long-term care insurance will pay for any of it, and read the contract carefully. Ask about anything you don’t understand, and read it again before signing.

Next steps

• Free Medicare help: your parent’s State Health Insurance Assistance Program (SHIP). See Medicare basics.
• Paying for care: paying for long-term care, with every state’s Medicaid agency.
• Legal papers: power of attorney and health care directives.
• Scams: set up your parent’s phone with our parent phone checklist.