When Seniors Can No Longer Live Alone

My mother was 80 when my father died. She still drove, was relatively healthy, had an active social life, and had good friends nearby and a supportive church community. With a little help from her children and hired helpers she was able to manage the household and handle all the tasks of daily living. Two years later she voluntarily stopped driving. Then she had some health problems. Gradually her friends left the neighborhood. Then she fell a number of times, suffering minor injuries.

Friends and family did everything we could think of to improve her situation. We encouraged her to hire more help. We called and visited more often. We made small changes in her physical environment to make it safer: installed grab bars, removed throw rugs, signed her up for a medical alert response service, moved the microwave so she could reach it easier, etc. Still, she fell and fell again.

When she went into the hospital for a pacemaker, we started thinking about whether it made sense for her to return home after rehab. Over the years she had told us emphatically that she wanted to stay in her own home, and asked us to help her make that happen. How could we suggest to this fiercely independent woman, that maybe it was time to move? We tried to find more ways to ensure her safety and a good quality of life at home, and eventually decided to talk to her about our concerns.

How do you know when an elderly person can no longer live alone? Of course, there's no easy answer to this problem that is increasingly common as people live longer. There are, however, signs that families, caregivers, and the seniors themselves can look at in order to assess the situation, including:

• Uncharacteristic behavior
• Mental confusion
• Forgetfulness
• Falls
• Weight loss or gain
• Social isolation
• Depression, lack of interest
• Acute changes in appetite, energy level, sleep patterns, social interactions, housekeeping, or appearance
• Difficulty taking medication correctly and performing other health-related tasks

Evaluating a senior's situation and making a list of concerns makes it easier to take a rational look at this emotionally charged issue. Caregivers and seniors can go down the list and figure out if anything can be done about each concern. Social isolation might be lessened by time at a senior center, for example, where activities keep seniors engaged and active. A walker, handrails and "grab bars" in important places like bathrooms and hallways can reduce the risk of falling.

A list of concerns lets you take an orderly approach to the problem. When you can no longer match each concern with a viable solution, it may be time to consider other "aging in place" accommodations or moving to a fully supportive environment, like an assisted living community. It goes without saying that the senior needs to be an active participant in the process. Just because an elderly person is having difficulty performing certain tasks does not mean he or she is unable to think, reason, and make decisions.

The end of independent living is a major life transition; it's a process that takes time. Respectful communication between family members, caregivers, and the senior will help bring the discussion to a positive conclusion-but don't expect it to happen overnight.