I have been in the home care business long enough now to see the dangers that are so common to seniors. I would like to share with you some things to look for in your loved one’s life, and more importantly, how you can help.
In many peoples’ lives there comes a time when they can no longer maintain a healthy and safe lifestyle without the assistance of outside help. And more often than not, the real issue is about the loss of independence. For seniors, believing they might lose control over some of their independence if they accept outside help is a scary proposition. This is when a loved one needs to intervene with tact and help steer the senior toward a path of accepting help that can not only provide safety, but foster independence at home as well.
The first step however, comes before finding additional care at home: the assessment and identification of signs that care is needed. So, how do you know it’s time for help? According to the Mayo Clinic, the following are key warning signs that in-home care is needed:
√ Weight loss. Losing weight without trying could be a sign that something’s wrong. For the elderly, weight loss could be related to many factors, including difficulty cooking, loss of taste or smell, or other underlying conditions such as malnutrition, dementia, or depression.
√ Personal grooming and housekeeping changes. Failure to keep up with daily routines – such as bathing, tooth brushing, and other basic grooming – could indicate health problems such as dementia, depression, or physical impairments. Any big changes in the way things are done around the house could also provide clues to health.
√ Increased injury and safety concerns. Take a look around the home, keeping an eye out for any red flags. Does the senior have difficulty navigating a narrow stairway? Has she fallen recently? Is she able to read directions on medication containers? Is there adequate lighting for nighttime trips to the bathroom?
√ Mood changes. Note moods and significant differences in mood changes. Drastically different moods or outlooks could be a sign of depression or other health concerns.
√ Mobility. Muscle weakness, joint problems and other age-related changes can make it difficult to move around as well. If the senior has become unsteady on his feet, there may be a risk of falling – a major cause of disability among seniors.
In addition to the key signs above, there are other common warning bells that might go off and things to look for in the home.
√ Hoarding. Very little is understood about why older adults hoard; however, it is often associated with dementia. It will be obvious if the household contains large quantities of saved items like newspapers, old clothing, bags, books, mail, notes, lists – all of which have already been used and are no longer ‘necessary’.
√ Struggling to keep finances in order – The state of an elderly person’s finances is another indication that help may be needed inside the home. If mail is piling up unopened in her house, it can indicate that paying the bills and taking care of day-to-day finances is becoming overwhelming for her. Or, if she isn’t handling money the way she usually does (i.e., forgetting how much cash she has, spending recklessly, gambling, etc.) she may need help.
Tasks that once seemed mundane can become unmanageable if a senior’s physical or mental state is deteriorating. When approaching someone about these warning signs, keep in mind the following:
√ Remember to be sensitive.
√ Use motivational rather than judgmental language.
√ Consider consulting a professional to conduct an assessment. Using an outside party can make it less personal and threatening.
While the use of logic and persuasion makes intuitive sense, it is usually not effective for motivating a person to recognize that he or she has compulsive hoarding and to work on the problem. This is because individuals with compulsive hoarding often have mixed feelings about the problem. For example, they may both feel safe and comfortable with their possessions while also feeling shame and embarrassment about their number or their inability to invite others into the home. Attempting to persuade the individual that he or she has too many things and that this is leading to any number of problems (e.g., social isolation, inability to find things, safety and health problems, etc.), usually leads him or her to argue for the opposite position, namely that there is no problem and that he or she is quite comfortable and safe in the home. Instead, raising a person’s awareness and motivating him or her to work on the problem requires an approach in which the concerned family member or friend expresses empathy, elicits the perspective of the person with the problem, and helps him or her to articulate his or her values and goals. Buried in Treasures provides some guidelines for motivating change and Motivational Interviewing, Second Edition: Preparing People for Change, by William Miller and Stephen Rollnick describes in detail this approach to motivating change.
Where there is imminent danger to the person with hoarding or to others in the household and the person with compulsive hoarding is not willing or able to acknowledge this difficulty, it may be necessary for concerned family members and friends to seek outside help. Because compulsive hoarding often touches on many issues, such as mental health, personal safety, and protective issues, it is ideally handled by a coordinated effort among multiple agencies. Concerned family members or friends can find out if their area has a compulsive hoarding task force made up of multiple agencies. For areas without a compulsive hoarding task force, particular agencies can be contacted directly. If at-risk individuals are involved (i.e., children, elders, disabled people, and pets), the appropriate protective service can be contacted; where no at-risk individuals are involved, the local department of public health or the fire department can be contacted.
For individuals with compulsive hoarding who are ready to work in the home and wish the help of family members or friends, the following can be helpful:
1. Decide together on the goal of the assistance, e.g., clearing an area of the home or accompanying the person on trips to places where he or she usually acquires to help him or her to resist the urge to acquire.
2. Help the person remain focused on the task in front of him or her. People with hoarding problems often find themselves easily distracted, especially when they are trying to reduce clutter, make decisions about possessions, or resist the urge to acquire things. Family members or friends can be helpful by simply reminding the person what he or she is supposed to be doing at the moment.
3. Provide emotional support. Overcoming compulsive hoarding is hard work and many people with this problem feel misunderstood. Family members and friends can express empathy, with statements such as, “I can see how hard this is for you,” or “I understand that you have mixed feelings about whether to tackle this clutter.” Family members and friends can also be cheerleaders, for example, by praising the effort the individual is making to overcome this problem and expressing their belief in the person’s ability to make progress.
4. Help the person make decisions but do not make decisions for him or her. It is helpful to develop rules for discarding. Good questions to ask are: “Is it useful?” “Do you need it?” “Can you do without it?” “In the long run, are you better off keeping it or letting it go?”
5.Help the person with hauling. Many people with compulsive hoarding have accumulated so many things that they can become overwhelmed by the enormity of removing such a large number of items.
6. Accompany the person on non-acquisition trips. One way to overcome the urge to acquire is to encounter situations where the urge is invoked and not give in to the urge. This allows the person to experience what happens to the urge when no acquisition takes place. Usually, the urge drops off over time. A family member or friend can support the individual to not give in to the urge in the moment.
In addition to the above recommendations, the following “don’ts” are suggested:
1. Don’t touch anything in the person’s home without his or her specific permission. Individuals with compulsive hoarding have many thoughts and feelings about their possessions and often feel uncomfortable when another person — even a family member or friend — touches their things. Ignoring the person’s wishes and handling their things without their permission breaks trust and can damage the relationship with them. It can take considerable time before an individual with this problem will allow another person to handle their things.
2. Don’t argue with the person who has the hoarding problem as this produces negative feelings and slows progress. When conflict arises, take a break. Similarly, don’t work beyond your tolerance level. Overcoming compulsive hoarding is hard work for everyone involved.
3. Don’t tell the person with the hoarding problem how he or she should feel. While it can be hard to understand why the person is keeping particular things, that seem to be useless, the thoughts and feelings about these things developed for a reason. Respecting that items that appear useless in fact have great value to the person is instrumental in helping the individual to overcome this problem.
Be sure to share concerns, encourage regular medical checkups and address safety issues. Working with a professional caregiver such as the ones provided by Assisting Angels Home Care can also help to identify important issues and assist with daily activities such as bathing, dressing, and meals as well as companionship.