Aging In Place

Not having to move from your present residence.

Aging In Place

It used to be that getting older meant moving in with family or heading to a nursing home. No longer! The idea of “Aging in Place” has gained traction nationwide. Gerontologists have said that as 77 million baby boomers reach retirement age, staffing at senior facilities will become a critical issue. If homes can be made suitable for seniors, Aging in Place will likely be the most pleasant alternative for aging Americans.

What is it?

Aging in Place is not having to move from your present residence in response to the changing needs associated with aging. The Aging in Place trend refers to living where you have lived for many years, or to living in a non-healthcare environment and using products, services and conveniences to enable you to not have to move as circumstances change. Continuing Care Retirement Communities (CCRC’s) tend to use the term in marketing to reference the multi-stage continuity of their campuses. Of course you have to move there first. Aging in Place can also mean the modifying of your long-term home to accommodate your changing needs. It often references a longer term strategy for readying your home for retirement.

Why do it?

A recent AARP survey found that most American seniors desire to stay in their homes for the rest of their lives – 80% in fact. Reasons cited for the Aging in Place preference are:

  • Comfortable environs
  • Familiarity and memories
  • Convenience to known services
  • Feelings of independence Safety and security
  • Proximity to family and friends

What is a NORC?

A Naturally Occurring Retirement Community is a neighborhood where residents remain for years and age as neighbors. It might be a specific apartment building or a particular street where residents have just stayed put. About 27% of seniors live in a NORC.

It’s possible to band together and develop access to (and perhaps preferential pricing for) services such as:

  • Social and recreational programs Information and counseling
  • Continuing education programs
  • Outside maintenance and referral services
  • Heavy cleaning
  • Home Care
  • Emergency and preventive health care programs
  • Meal programs
  • Transportation


Successful aging in place requires identifying and correcting any safety pitfalls. The major safety issues are:

  • Preventing falls
  • Fires and Emergency situations
  • Balance and coordination problems
  • Limited reach
  • Limited vision
  • Limited strength
  • Wheelchair accommodation

Most purpose-built senior communities are designed with these accommodations in mind, but it’s usually possible to modify your current home to suit your particular needs.

Home Remodeling

Even if you’re years away from retirement, any remodeling projects should be designed with consideration of possible senior needs. Even if you don’t end up staying there, you’re most likely broadening the net for potential buyers. You may wish to consult a professional early in your evaluation process. “CAPS” are contractors who are recognized by the National Association of Home Builders as being Certified Aging in Place Specialists. Some home remodeling considerations:


  • Adapt ground floors for one-level living
  • Better lighting and task lighting especially in bedrooms, baths, closets & hallways
  • Easy garage/parking access
  • Good lighting in transition areas
  • At least one entry without steps
  • Doorways 36” wide with off-set door hinges Levers instead of knobs
  • Electrical outlets at 18/24” instead of 12”
  • Easy open/lock patio doors Light switches at 42” instead of 48”
  • Rocker light switches Lower window sills, especially for windows on the street
  • Contrast colors between floor and walls
  • Rounded counter edges
  • Color borders around floor and counter-top edges
  • Non-skid and smooth flooring
  • Low-pile and firm pad carpeting
  • Non-glare surfaces and glass
  • Strobe light or vibrator assisted smoke and burglar alarms
  • Automatic garage doors


  • Lever faucets and mixers with anti-scald valves
  • Stall shower with a low threshold and shower seat
  • Hand-held shower
  • Grab bars for shower/tub/toilet (or wall reinforcement for later installation)
  • Turn-around and transfer space for walker or wheelchair (36” x 36”)
  • Higher bathroom counters
  • Elevated toilet seats
  • Telephone jack or medical response device


  • Cabinets with pullout shelves and lazy susans
  • Shelves no more than 10” deep
  • Easy to grasp pulls
  • Sink controls on the side
  • Under-counter task lighting
  • Cooktop with front controls
  • Side by side refrigerator
  • Variety in counter height – some as low as table height (30”)
  • Gas sensor near gas cooking (as well as gas heaters)
  • Color or pattern borders at counter edges
  • Ultra-quiet dishwashers to reduce background noise

Living Room

  1. Seating at least 18” off the floor
  2. Chairs with sturdy arms

Caregiver Burnout

It’s real…and its effects can be devastating.

Caregiver Burnout

Does any of this sound familiar?
  • You feel a sense of constant fatigue.
  • You’ve experienced a change in appetite or sleep habits.
  • You feel helpless, trapped and defeated.
  • You’re starting to feel resentful of the person you’re looking after.
  • You’ve been withdrawing from friends, family and activities you used to enjoy.
  • You’ve started taking your frustration out on others.
  • You have frequent headaches, back pain, muscle aches.
  • You’re relying more on food, drugs or alcohol to cope?

Caregiver burnout is a state of emotional, mental, and physical exhaustion caused by excessive and prolonged stress. It occurs when you feel overwhelmed and unable to meet the demands put on you. Much like Post Traumatic Stress Syndrome, the symptoms of burnout can begin surfacing months after a traumatic episode. It’s not “just the way life is now”. There are ways to recover from it and prevent it from happening again.

Causes of Caregiver Burnout

Caregivers are often so busy caring for their loved one that they neglect to look after their own needs. As the stress piles up, emotional, physical and spiritual exhaustion build, frustration and despair take hold and burnout isn’t far behind.

Caregiving involves many stressors

Changes in the family dynamic – Role confusion can result when a caregiver is also spouse, child or friend.

Household disruption – You may not have time to do the things you’d like to do with or for your own family, or maybe you can’t entertain as you’d like because your dining room has become a sickroom.

Unrealistic expectations – It’s natural to expect your loyalty and hard work to be appreciated by the person you’re caring for and for it to have a positive effect on their happiness, but this isn’t always the case. Sometimes your expectations may be unrealistic if the patient is depressed themselves or perhaps suffering from a progressive disease like Parkinson’s or Alzheimer’s. Also, there are limits to what anyone can handle; you shouldn’t expect yourself to do it all.

There are also financial pressures, lack of control, lack of resources, and the sheer amount of work involved.

Preventing Caregiver Burn-out

Being able to cope with the strains and stresses of being a Caregiver is part of the art of Caregiving. In order to remain healthy so that we can continue to be Caregivers, we must be able to see our own limitations and learn to care for ourselves as well as others

Adopt healthy eating, exercising and sleeping habits. Research proves a healthy, well-rested body is better able to absorb the rigors of stressful times.

Be realistic about the situation and accept your feelings – Caregiving can trigger a host of difficult emotions, including anger, fear, resentment, guilt, helplessness, and grief.

Talk about it – Don’t bottle up your feelings. Caregiver support groups are invaluable, but trusted friends, co-workers, neighbors and family members can help too. Often, just talking about it can relieve the stress.

Maintain a sense of humor – Stuff happens; try to laugh it off.

Be flexible – Staying easy going will help you maintain your sanity.

Give yourself a break – Set realistic goals and accept that you may need to turn to others for help with some tasks. Enlist friends and family who live near you to run errands, bring a hot meal, or “sit with” the care receiver so you can take a well-deserved break. Caregiving is a job and respite is your earned right. Taking care of yourself is NOT a luxury, it’s an absolute necessity.

The Signs of Dementia

Dementia is a general term that describes a group of symptoms.

Dementia Overview

Dementia is a general term that describes a group of symptoms such as loss of memory, judgment, language and other intellectual function. It is caused by the permanent damage of the brain’s nerve cells. Causes of dementia include disease (Alzheimer’s is the most common), vascular destruction, trauma and alcohol. Clinical symptoms and progression of dementia vary depending on the type of disease and the location and number of damaged brain cells. Some types progress slowly over years while others may result in sudden loss of intellectual function. Experienced clinicians can accurately diagnose dementia 90% of the time. Accurate diagnosis is critical.

When forgetfulness could be dementia

Dementia is a loss of memory that worsens over time, but is also associated with personality changes and an inability to care for oneself. Normal forgetfulness has no effect on day-to-day activities or personality. In the early stages of dementia, memory changes can mimic normal forgetfulness, so dementia becomes apparent over time. Some memory loss – age-related memory impairment – can be normal as we get older, although this is by no means a universal experience. Unlike dementia, it can be helped by keeping the brain active. In dementia, the most recent memory tends to be the first to go, so sufferers remember childhood events but forget where they put their purse or why they went into a store. Dementia can cause disorientation, as well as personality changes. There can be mood swings and irritability plus an inability to concentrate or grasp new ideas. Self-care and personal hygiene can also be forgotten. A tendency to fall and unexplained weight loss may also be early signs of dementia. Memory problems are not always caused by dementia, so the earlier you see a GP, the more quickly these can be diagnosed. Depression can mimic dementia but resolves once treated.Other conditions such as hormone imbalance, vitamin deficiency and infections can also cause dementia-like symptoms. Certain medications slow the progression of dementia symptoms. Controversially, the medicines were previously not recommended until the disease was moderately advanced. This guidance from the National Institute for Clinical Excellence has now been reviewed and they say the drugs should be offered to those in the early stages of Alzheimer’s. Occupational therapy, physiotherapy, social services and voluntary support groups all have a role to play. Strategies to aid memory as well as exercise, reality orientation and cognitive stimulation have been proven to help.

Warning signs of Alzheimer’s

It’s hard to know to what extent memory loss is a normal part of aging. The Alzheimer’s Association says that memory loss that disrupts daily life is not a typical part of aging. It may be a symptom of Alzheimer’s Disease, a fatal brain disease that causes a slow decline in memory, thinking and reasoning skills. Every individual may experience one or more of these signs in different degrees. If you notice any of them, please see a doctor.

  • Memory loss that disrupts daily life:
    One of the most common signs of Alzheimer’s is memory loss, especially forgetting recently learned information. Others include forgetting important dates or events; asking for the same information over and over; relying on memory aides (e.g., reminder notes or electronic devices) or family members for things they used to handle on their own. What’s a typical age-related change? Sometimes forgetting names or appointments, but remembering them later.
  • Challenges in planning or solving problems:
    Some people may experience changes in their ability to develop and follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before. What’s a typical age-related change? Making occasional errors when balancing a checkbook.
  • Difficulty completing familiar tasks:
    People with Alzheimer’s often find it hard to complete daily tasks. Sometimes, people may have trouble driving to a familiar location, managing a budget at work or remembering the rules of a favorite game. What’s a typical age-related change? Occasionally needing help to use the settings on a microwave or to record a television show.
  • Confusion with time or place:
    People with Alzheimer’s can lose track of dates, seasons and the passage of time. They may have trouble understanding something if it is not happening immediately. Sometimes they may forget where they are or how they got there. What’s a typical age-related change? Getting confused about the day of the week but figuring it out later.
  • Trouble understanding visual images or special relationships:
    For some people, having vision problems is a sign of Alzheimer’s. They may have difficulty reading, judging distance and determining color or contrast. In terms of perception, they may pass a mirror and think someone else is in the room. They may not realize they are the person in the mirror. What’s a typical age-related change? Vision changes related to cataracts.
  • New problems with speaking or writing words:
    People with Alzheimer’s may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with vocabulary, have problems finding the right word or call things by the wrong name (e.g., calling a “watch” a “hand-clock”). What’s a typical age-related change? Sometimes having trouble finding the right word.
  • Misplacing things and losing the ability to retrace steps:
    A person with Alzheimer’s disease may put things in unusual places. They may lose things and be unable to go back over their steps to find them again. Sometimes, they may accuse others of stealing. This may occur more frequently over time. What’s a typical age-related change? Misplacing things from time to time, such as a pair of glasses or the remote control.
  • Decreased or poor judgement:
    People with Alzheimer’s may experience changes in judgment or decision-making. For example, they may use poor judgment when dealing with money, giving large amounts to telemarketers. They may pay less attention to grooming or keeping themselves clean. What’s a typical age-related change? Making a bad decision once in a while.
  • Withdrawal from work or social activities:
    A person with Alzheimer’s may start to remove themselves from hobbies, social activities, work projects or sports. They may have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby. They may also avoid being social because of the changes they have experienced. What’s a typical age-related change? Sometimes feeling weary of work, family and social obligations.
  • Changes in mood and personality:
    The mood and personalities of people with Alzheimer’s can change. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, at work, with friends or in places where they are out of their comfort zone. What’s a typical age-related change? Developing very specific ways of doing things and becoming irritable when a routine is disrupted.


Again, if you think you notice any of these signs in your loved one, take him/her to a doctor. An accurate diagnosis is essential. Once you know what you are dealing with you can begin to get educated about it. Carolyn McIntyre’s article A Careful Look at the 3 Stages of Caregiving offers some interesting insights via her family’s experience.

The Signs of Changing Needs


How to tell when an aging relative might need extra help.

Aging relatives, particularly those who live alone, increasingly face medical and mobility issues, and questions relating to their physical, social and psychological well-being arise. So how do you know if a relative’s needs have changed and more care is necessary?

Healthy aging and signs to expect

The aging process will slow down even healthy adults to some degree, though how much and to what extent depends on the individual. As we age, we won’t be as quick and our energy reserves won’t be what they were when we were teenagers.  Even with normal aging, a parent may not be able to get through the day without some help. That said, the aging process should not necessarily cause problems in basic functioning. Outside of slowing down physically, people should still be able to balance their checkbook, maintain personal hygiene, and conduct routine tasks. If these activities of daily living are being successfully accomplished, you probably don’t need to worry too much.

dementiaHealthy aging and signs that need evaluation

If you see signs beyond some general slowing of physical function, it’s important to take an aging parent to a doctor – if possible, a geriatric medicine specialist – for an evaluation. Any number of illnesses could be behind worrisome symptoms. Increased fatigue and reduced energy may not seem like urgent health issues, but they should still be evaluated. For instance, fatigue and weakness can be caused by anemia, common in older adults, and can be treated. Weakness and shortness of breath can be signs of heart disease, even if you parent isn’t complaining of chest pain. A normal condition in aging adults is having a less steady gait, a common result of the loss in muscle mass that naturally occurs with age. But that unsteadiness can lead to falls, which can be dangerous for aging adults who may easily break a bone or suffer a head injury. Signs of instability should be evaluated by a doctor, and the aging parent’s home environment should be carefully checked for hazards that could cause trips and falls. See our Home Safety Checklist.

The challenges of recognizing health problems

It can be difficult to know when aging parents are experiencing health problems. Part of the problem is that aging parents often won’t admit that something might be wrong. They are afraid of being “put somewhere”, or perhaps of being a burden to anyone. An adult child might miss the signs of health problems if she sees a parent all the time. If you live close by and visit often, health problems may be tough to spot because some conditions such as dementia can occur slowly over time. It’s a good idea to ask regularly about current events going on in the world. Also, take notice and appropriate action if the response is uncharacteristic. Adult children who do not see their aging parents often will be more likely to observe problems right away. Some family members may talk on the phone regularly, but then when they come to visit for the holidays they realize that all is not okay. Confusion or memory problems can be caused by medications. Many aging adults can have trouble keeping track of the many prescriptions and an overdose can easily lead to mental and physiological problems.

Following are some clear warning signs that some type of intervention is needed:

Mail and bills are left to pile up. The simple act of opening and filing mail can become overwhelming. Paying bills on time and managing a checking account can also become too much for a parent to handle, or can be a sign that they are not thinking clearly. The house is cluttered or unkempt. Lack of interest. This should be of special concern if the parent has always been neat and orderly. Losing weight. This can happen especially after the death of a spouse. Shopping, preparing food and cooking become too much trouble. Food in the refrigerator is uneaten or spoiled. Shopping, cooking, and cleaning become too much trouble A parent might eat just enough to get by, but suffer nutritionally. Losing weight can be another sign that a parent is not eating a nutritious diet. Signs of scorching on the bottoms of pots and pans. A result of short-term memory loss, this is a dangerous sign that parents are forgetting about pots left on the stove, causing a fire hazard, and threatening both the individual and the surrounding neighbors’ safety. Look for other signs of confusion in the kitchen such as water stains and mildew under the sink and in other places because water was left on and forgotten about, dishes that are unwashed for long periods, food left out, etc. Declining personal hygiene as indicated by unkempt hair, dirty or lengthy nails, poor oral hygiene, body or urine odor, unshaven, and wearing same clothes over and over or wearing night clothes during the day. Especially common when the washing machine is in the basement. Or there may be a fear of falling in the tub or shower. Missed doctor’s appointments. Sometimes this is simply a product of not having transportation and not knowing how to access ride options. Getting up and down stairs and in and out of home becoming difficult. Walking unsteady on level ground and/or complaining of dizziness. Falls are likely or have already occurred. Forgetting to take medication. A sign of short-term memory loss or depression, this is not just a quality of life issue, but a real risk factor. Inappropriate behavior, clothing or speech. You may hear about this from a neighbor, someone who has noticed that your parent is not dressing appropriately for the weather, for instance. That’s a sign that he or she might be confused. Not recognizing need for, arranging, or scheduling necessary household repairs and maintenance. Lawn not mowed, trash not disposed of, and mail retrieved with irregularity. Just acting strangely or out of character. Odd conversations, signs of paranoia, accidentally taking too much medication, phone calls at odd hours, unusual fears and nervousness, all of these things may be signs that a parent needs help.

Now what?

If you see any of these signs in your parents, discuss it with them. Share your concerns and see what they say. Try to get them in to the doctor, but if you can’t, make an appointment with the doctor or a geriatric care manager yourself and discuss your concerns. The professional can point you to various agencies that can help.

Legal Considerations


While you’re in the process of organizing long term care for your loved one, it’s a good idea to look into some legal considerations that are specific to seniors. Addressing these issues now will help reduce stress when critical life decisions need to be made and will ensure that a senior’s wishes are met.

Wills and Trusts

Wills – Enable a person to specify who gets his or her personal possessions when they die. They are useful in preventing potential family conflicts. In the absence of a will, the law will determine how personal property is distributed.

Trusts – A trust is a legal arrangement where one person (called the “trustee”) holds and manages property for the benefit of someone else (the “beneficiary”). The trust “property” can be cash, CDs, stocks, or real estate. The terms of the trust document control what the trustee may do with the trust property. It will set forth specific instructions for how the property can be invested as well as who can receive distributions from the trust and under what circumstances.

Some estate planners say it’s possible to use trusts to reduce your assets in order to qualify for Medicaid. Others say trusts can disqualify you for Medicaid. It’s important to seek the help of a good and experienced elder law attorney in the patient’s state when structuring your estate to meet specific goals.

Advance Health Care Directives

In the event that an individual is unable to make decisions due to illness or incapacity, Advance Health Care Directives are legal documents through which someone expresses their preferences for medical intervention and long-term care.

The 2 types of advance directives are:

Living Will – Provides instructions for the types of health care treatment that should be provided.

Durable Power of Attorney for Health Care – Appoints a person to make decisions on the individuals’ behalf when the individual is incapacitated.

Both forms of advance directives are advisable. To ensure they are followed, you should discuss them with everyone involved and give copies to responsible family members, a personal physician, and other trusted individuals. Advance Directives are recognized nationwide, but the detail in them may vary from state to state. Check with an experienced elder law attorney in your state.

Spouses do not have legal authority. Just because you are married does not mean you have legal authority over the property and person of your spouse. It’s important to give your spouse or someone you trust Power of Attorney. If your spouse becomes incapacitated and you don’t hold his or her power of attorney, you cannot sell the home you own jointly, cannot make withdrawals from your spouse’s IRA or other retirement plan, and cannot act for your spouse in any other legal capacity. If you don’t have a power of attorney, the only other alternative is a court appointed guardian.

Guardians and Conservators

If an individual becomes incapacitated without having completed a durable power of attorney to specify who he/she wants to act on his/her behalf, a court can appoint a guardian or conservator. Terminology varies from state to state and sometimes the terms are interchangeable. In Pennsylvania, the court procedure is termed a “guardianship”.

Guardian – An individual appointed to make health care, personal and financial decisions for someone in the event that person becomes physically or mentally incapacitated. A guardian would have the legal right to decide where the person will live and the medical treatment they would receive.

Conservator – Someone appointed to oversee the financial affairs of someone unable to do so themselves. The conservator takes control of the person’s assets and must handle them for the welfare of the protected person. Once a conservator is appointed, a dependent person may not liquidate his own assets or determine how the money will be invested without the consent of the conservator.

The court appoints a guardian/conservator after hearing evidence that a person is incapacitated and deciding that there is a need for a guardian. The law requires due process for the proposed ward. The proposed ward, or alleged incapacitated person, must be given formal legal notice of the proceeding, has a right to be present at the hearing, and has the right to be represented by a lawyer.

Court appointed guardianship can be very expensive and can take a considerable amount of time to get. Making a power of attorney is much less expensive and much less stressful than the court-appointed guardian process.

Starting the Conversation


Conversations about the effects of aging and plans for the future of an aging loved one can be tricky. Here are some suggestions for tackling such issues as long term senior care, finances, driving, household safety, and end-of-life choices.

Some things to consider before you begin:

Don’t think of your changing relationship with your parent as “role reversal”, think of it more as becoming a peer or friend. Chances are, if you become the “parent” by ceasing control, they’ll become the “child” and rebel.

Don’t think of it as “The Big Talk”, but rather as a series of conversations. It’ll be easier to get started if there’s not a huge list of things to accomplish. And it’ll be easier for your parent not to feel overwhelmed. Be sensitive to their level of comfort and stamina.

Sooner is better – talk before a crisis occurs and when your parent’s health allows them to fully participate.

Remember that while most kids assume their parents will resist having this conversation, the fact is that many parents want to share their thoughts but think their kids don’t want to hear it!

Try to ask questions and then listen carefully. You’re trying to find out what your parent wants. DO NOT give ideas, suggestions or input unless asked. If you jump in with a bunch of plans and solutions before asking what they want, you’ll likely meet with resistance. Ask what, where, who, how and when… but avoid asking “why”. If you do you’ll likely meet an emotional and defensive response.

Pick a time for the conversation that’s not rushed. And don’t do it during family occasions such as holidays or birthday celebrations.

Educate yourself before you start. It’s important to know what needs to be discussed, ie, living arrangements, outside help, power of attorney, when to stop driving, etc. Understand the options available. The more you know the better you’ll be able to ask the right questions.

It’s possible you’ll get some resistance. Remember that resistance is usually the response to fear. You can reassure them that the reason you’d like to discuss things is so you can help them live the life they want, even if in the future they can’t do certain things for themselves.

Remember that decisions made today can be changed tomorrow. Especially after having had the time to think about them more and from various perspectives.

Try to keep it light, involve only immediate family, don’t make it an intervention, and limit your initial expectations.

Some conversation starters

Hopefully one of the following examples will give you an idea:

Use an experience you’ve had or that of a friend. For example, “My friend’s mom broke a hip and is in the hospital. My friend has to make decisions for her and is unsure what to do. It got me thinking that I should know what you’d want me to do if that happened to you. Can we talk about it?”

“I read an article about how seniors often lose control as they age because others’ have to make decisions for them. I want to make sure you never feel that way. Can we talk so I’m clear about how to help if you need it?”

You can share an experience such as your own retirement or estate planning as a way to gracefully transition into a conversation about your parents’ thoughts regarding the future.

If you are unsure what sort of documents you might need, see the Legal Considerations section.

Ask about records and documents. Explain that you want to be prepared to help them when needed. Ask where they keep important documents such as insurance policies, wills, trust documents, investment and banking records, tax returns, living wills and durable powers of attorney. This approach could also serve as a way of finding out what plans he or she have already made and what needs to be done.

Some signs of a looming problem might be if you notice damage to an older driver’s car, or if you notice that they’re reducing driving at night due to vision problems. “Let’s figure out a plan for how you can get around town if you no longer feel safe driving.”

If the house is a mess… “Mom, I have some extra cash. What do you say we find someone to help you with the heavy stuff?”

Even if the house isn’t a mess, you can help open the discussion by inquiring whether there are any responsibilities – such as home maintenance, yard work or bill paying – that they’d like some help with to make life easier.

If you see medication bottles everywhere… “How the heck do you keep all these pills straight, Dad?” There might be good reasons such as, some are in the kitchen because he takes them with food. Some are on the nightstand because he takes them before bed. On the other hand, if the response is something like, “I don’t know. I do my best. I’m not even sure what some of them are”, then the situation probably needs more attention. A pill organizer might help, or perhaps a trip to the doctor or pharmacist together to get it sorted out.

Household clutter is a little-known cause of senior stress. Perhaps offering to help a parent sort through a cluttered home will give you the time together to broach a tougher subject and busy hands to make it seem less onerous.

If you notice bruising… Pay special attention. It could simply be a result of certain medication (though if extreme the doctor should be consulted), but it could also be due to falls, malnutrition, or elder abuse. “Mom, that’s a nasty bruise, where did you get it?” If she tries to pawn you off with a generic response such as “I’m just clumsy”, dig further. “Sure Mom, our whole family is clumsy but we aren’t all walking around with big bruises on our arms. So how did it happen?” If you notice empty cupboards or spoiling food in the fridge… “Boy, there’s not much food around the place – what are you guys eating?”

Involve third parties. If your parent resists your efforts to begin the discussion, he or she may be more open to the guidance of a respected non-family member. Doctors, clergymen, geriatric care managers or trusted friends who have already helped a loved one in a similar situation might be possible resources.

Approaching a parent about giving up the car keys

We typically consider driving a significant part of independent living, but the fact is that the ability to drive safely decreases with age. Response times slow, manual dexterity decreases, peripheral vision and depth perception decline, concentration ability declines, hearing loss, and decreased flexibility to look around for problems are just a few. Many people are able to drive safely into their 70s and even their 80s, but people age differently. Knowing the risk factors and warning signs of an older loved one who has become unable to safely operate a vehicle will help you gauge when it’s time to hang up the keys.

According to the National Institute on Aging, there are several critical indications that a senior may be losing the judgment or ability to drive:

  • Incompetent driving at night, even if competent during the day.
  • Drastically reduced peripheral vision, even if 20/20 with corrective lenses.
  • Struggling to drive at high speed even if he or she drives well locally at slow speeds.
  • Erratic driving, such as abrupt lane changes, braking or acceleration, hitting curbs, missing turns or scaring pedestrians.
  • Getting lost frequently, even while driving on familiar roads.
  • Trouble reading street signs or navigating directions.
  • Frequently startled, claiming that cars or pedestrians seem to appear out of nowhere.
  • At-fault accidents or more frequent near-crashes or scrapes on the car or mailboxes, garage doors, and curbs.
  • Failing to use turn signals or keeping them on without changing lanes.
  • Drifting into other lanes or driving on the wrong side of the road.
  • Range-of-motion issues, such as failing to look over the shoulder, trouble shifting gears or confusing pedals.
  • Increased traffic tickets or “warnings” by traffic or law enforcement officers.

Talking to a relative about his or her need to stop driving is one of the most difficult discussions you may ever face. However, it’s better if it comes in the form of advice from you or someone he or she knows rather than by an order from a judge or the DMV. One of the main reasons seniors are reluctant to give up driving is that it is one of the few ways they can continue to feel self-sufficient. The discussion becomes even more difficult when the person still maintains most of his or her faculties, just not those that enable safe driving.

Be empathetic. Imagine how you would feel if you were in your parent’s place. Ask others to join in the meeting. It helps to involve other family members in the discussion to help, but not to confront.

Keep the conversation non-accusatory, honest and between “adults,” not “child and parent.” Say things like, “We’re concerned,” “We care” or “We don’t want you to get hurt or to hurt others.” Once you’ve both come to an agreement, you can continue to support your loved one in ways beyond just offering rides.

Help the senior make a schedule. He or she can plan activities and combine trips on days when a caregiver can drive.

If all else fails, they might have to hear the news from a doctor.

Fall Prevention Checklist


General Precautions

  • Is there an emergency plan in place?
  • Are working smoke detectors installed?
  • Is there a “ready-to-use” fire extinguisher(s) on the premises?
  • Are inside halls and stairways free of clutter/debris?
  • Are throw rugs removed?
  • Are there sturdy handrails or banisters by all steps and stairs?
  • Are electrical cords unfrayed and placed to avoid tripping?
  • Are electric outlets/switches overloaded (e.g. warm to the touch)?
  • Are rugs secured around the edges?
  • Are hazardous products labeled and kept in a secure place?
  • Is there a need for a stool to reach high shelves/cupboards?
  • Is smoking paraphernalia handled safely (e.g. cigarettes put out)?
  • Does anybody smoke in homes where oxygen is in use?
  • Are all animals, on site, controlled?
  • Is the home free from bugs, mice and/or animal waste?
  • Are materials stored safely and at a proper height?
  • Does the occupant wear an emergency response necklace/bracelet?


Entrance to Home

  • Are there outside lights covering the sidewalks and entrance ways?
  • Are the steps & sidewalks in good repair and free from debris/material?
  • Are the railings on the steps secured?
  • Is there a functional peephole in the front door?
  • Does the door have a deadbolt lock that does not require a key to open it from the inside (unless there is a tendency to wander


Living Areas

  • Are doorways wide enough to carry loads through and get a wheelchair/walker through?
  • Are light switches accessible so they can be turned on/off without walking across a dark room?
  • Are sofas & chairs high and firm enough for easy sitting and rising?
  • Is there a telephone in the room that is easily accessible?
  • Is a list of emergency telephone numbers by the telephone?
  • Do telephone cords/electronic wires run across walking areas?
  • Are there castors or wheels on furniture?
  • Does sitting furniture have armrests which are strong enough for getting in and out?



  • Are there glass doors on the bathtub/shower?
  • Is there a non-skid surface/mat in the bathtub/shower?
  • Are there grab-bars on the bathtub/shower and adjacent to the toilet?
  • Is there a raised toilet seat (if trouble getting on/off toilet)?
  • Is the water temperature below scalding (e.g. below 120°)?
  • Does the bathroom have a night light?
  • Is there a shower bench/bath seat with a hand-held shower wand available?



  • Is the floor waxed or otherwise slippery?
  • Are there any flammable items near the heat source?
  • Do the “ON” buttons work on all appliances?
  • Are items used the most stored between eye and knee level?
  • Is there an uncluttered work space near the cooking area (to avoid having to carry items)?



  • Is there adequate lighting in all stairways and hallways?
  • Is there a light switch at both the top and bottom of stairs?
  • Is there a light switch by the doorway of each room?


Medical and Medication

  • Are used needles placed in a sharps container?
  • Is oxygen tubing kept off the walking path?
  • Is medical equipment properly stored?