Countless times I encounter families that are surprised, if not horrified, by what they find when visiting Mom and Dad's during the holidays. The resounding message heard is that Mom or Dad seemed fine during long-distance chats with them on the phone. However, it turns out to be a very different story when seeing them in person over the holidays. This revelation accounts for the big surge in calls to home care agencies after holiday visits with parents.
It is common for unintended stretches of time to occur between visits. Living far apart, demanding work schedules, juggling child-rearing and other responsibilities often lead to phone calls becoming the main form of communication. While serving to check up on parents, these conversations can be very deceptive. I have witnessed well-meaning but pre-occupied children often kept in the dark and unaware of the decline in their elderly parents' condition. Often, the children's ignorance of their parents' self-neglect can be credited to parents who are quite skilled at concealing problems that they and/or their spouses may be experiencing. Avoiding unwanted attention, fear of sounding alarms that hiring caregivers may be needed, or the dreaded conversation of relocating to an assisted living further prompts the parental cover-up.
Self-neglect comes in different forms and is often caused by depression, dementia, and/or isolation. A lot has been documented about red flags to watch out for if you suspect that your parents are showing signs of self-neglect. Obvious red flags are finding your parent's home terribly unkempt or noticeably poor personal hygiene. Odd, atypical behavior such as unfounded paranoia may be discernable and the inability to move around safely are also signs that your parents may have issues with self-neglect. However, in my experience, many signs of self-neglect are less recognizable thereby creating a need for closer scrutiny. Pointing out more subtle changes to look for when visiting your parents may alert you to take necessary action and hopefully evade a crisis.
While enjoying holiday visits with your parents, take advantage of this ideal time to observe for difficulties your parents may have with activities of daily living. Voice your concerns openly with your parents, as they may be unmindful of their diminished capabilities. Discuss practical solutions such as hiring a caregiver to help with bathing, cooking or housekeeping. Encourage your folks to work together as a family to find answers that will enable them to remain at home safely and comfortably. Consider using the services of a home care agency as a sound and practical solution.
1) Minor bruises, scratches or scrapes on various body parts
2) Unfinished, empty, or outdated prescription bottles
3) Expired food or minimal food supplies in refrigerator and cupboards
4) Overgrown or dirty nails (particularly toe nails)
5) Poor fluid intake and dry scaly skin
6) Unexplained weight loss or gain
7) Unwashed hair or ungroomed hair (if atypical for parent)
8) Missed customary hair appointments
9) Missed dental appointments
10) Poor condition of teeth and lack of oral hygiene
11) Same clothes worn repeatedly or inappropriate to weather
12) Missed scheduled doctor check-ups
13) Reports by neighbors not seeing usual activity outside
14) Indoor and outdoor home maintenance needed
15) Home repairs unaddressed or unattended to
16) Late notices or unpaid bills piling up or tucked away in drawers
17) Bounced checks and reports of utility shut-offs
18) Unexplained dents and scratches on cars; expired registrations or inspections
19) Missed meetings, clubs, or other missed group activities usually attended
20) Newspapers, magazines, or other trash stacked up in piles
21) Old, soiled musty towels and unwashed laundry
22) Odor of garbage or smell of urine in home
23) Inability to move safely in home without holding on to items
24) Shuffling gait or unsteady balance
25) Refusal to use prescribed walker/cane to prevent falls
Clare Absher is a Registered Nurse with 45 years of experience. Most of her experience is in home health serving as a caregiver, educator, patient advocate, and liaison between families and community resources. She has also worked in acute care, assisted living, and retirement settings. She is passionate about helping families care for their elderly loved ones at home.
