Is it time to step in? Signs your parent needs more help.

I wish I had figured out the balance between assisting and enabling.

In my family, the dominant love language was always acts of service.

Every night, my dad would make lunch for my mom to take to work the next day, tucking in a little love note with her bologna sandwich. As they watched the Braves game on television, my mom would ask my dad to make her a cup of tea, or my dad would ask my mom to reheat the leftovers for him, and eventually one of them would cover the other, unbidden, with our scratchy but beloved 1970s crocheted blanket. They seemed to genuinely enjoy doing things for each other. That extended to me; they often joked that the reason they had a kid was so they could have a “gopher” — someone to “go for” snacks and drinks.

After my mom died, my dad began to ask me to do more and more.

“Would you mind throwing the clothes in the wash?”

“If you have time, could you swing through the drive-thru and get me the new chicken sandwich I saw advertised on television?”

“Could you do all the laundry?”

“Could you wash all the dishes?”

As he grew less capable, the requests became more frequent and more involved, and they eventually started to sound less like requests and more like obligations.

“The trash is ready for you to take out.”

“The sink is full.”

I began to resent these new responsibilities and wondered whether my help was allowing him to be independent or enabling him to be sedentary. It’s apparently a hard line to walk. In “How to Care for Aging Parents,” Virginia Morris says the job of the adult child is to help their parent help themselves.

“Of course you want to say, ‘Stay there; I’ll get it for you.’ But movement, any movement at all, is good for his body,” she says. And further, the ability to do things for himself is “good for his soul.” She adds:

“Your parent might welcome your help, but when elderly people are constantly catered to, when they no longer make their own decisions, when they are treated as needy and helpless, they only grow more needy and helpless, and often lose their spirit and drive.”

I wouldn’t have put it into those words, but I think that’s exactly what happened to my dad: he lost his spirit and drive. I tried to get it back by cajoling him into doing things I thought were good for him (and, if I’m honest, sometimes shaming him for not doing those things), but what I should have been doing all along is helping him help himself.

If you come in too hot—making a lot of changes and taking over—your parent will feel resentful and push back. But if you wait too long to intervene, it may be too late for you to take preventative steps. Something will happen and you might end up stuck just navigating the fallout.

In “A Bittersweet Season,” Jane Gross admits that with her mom, she waited too long.

“Today, the how-to books, websites, and blogs about elder care wisely advise pushing elderly parents to do as much as they can for as long as they can—not to infantilize them. ‘Use it or lose it’ is the mantra of healthy longevity. A regular routine of walking extends mobility. Weight bearing exercise fends off broken hips. Balancing the checkbook keeps the brain sharp. All of that, I have no doubt, is true. Indeed, many of my mother’s health problems…might have been avoided had I pushed her harder in her sixties and seventies. But long after that point had passed and the damage was done, I wanted her to be fine so badly that I pretended she still was.”

One of the hardest jobs, as the child of an aging parent, is to figure out how they’re doing and gauge how you can help without overstepping. It’s to find the middle place, somewhere between not providing enough help, soon enough, and jumping in too quickly and taking over. A way to find this balance is to consciously, intentionally, observe how your parent is doing in their everyday life before there are big problems.

The things your parent must do to move through life are called “activities of daily living,” and they include: bathing, dressing, toileting, and eating.

At some point, they may lose the ability to do some of those things. It may happen all at once, where they have a fall or a heart attack and can no longer care for themselves. Or it may happen slowly, like with my dad, where things deteriorate over time. There may be things you can do to make the activities of daily living easier, like adding bars in the bathroom to help with showering or adding tread to their stairs. But it may be that the activities of daily living are so out of your parent’s current capacity that you need to find a more intensive solution, like finding a new living situation, taking over these responsibilities, or hiring a caregiver.

If your parent is like my dad, it may be fairly easy to see the decline in their ability to do the activities of daily living. If your parent lives farther away, or is more secretive about the decline in their health and independence, it may take some detective work.

We’ve talked in the past about taking small steps to observe your parent in their environment, addressing safety hazards and fall risks, and getting organized for the task of taking care of your parents as they age. But now let’s say that you’ve started to notice some things are off. Below, I’ve listed some questions to ask and things to observe as you evaluate whether your parent might need more help. When you identify an area where they are starting to struggle, make note, and then think strategically about how to tackle it (even if your parent’s love language isn’t acts of service).

You’ll find all these questions, and a templated table to keep track of them, here.

Eating

• When you visit your parent, is there food in the fridge? Is anything spoiled?

  • If you find barbecue sauce from the Obama administration, try to figure out why. Do they not use it often? Was it on a shelf they can’t reach?

• Is your parent eating a normal, healthy diet? Are they meeting their own nutritional needs? Can they follow diets recommended by their doctors?

  • There are so many reasons someone might not follow a diet they’re prescribed. Approach this with curiosity, not judgment.

• Is your parent burning food on the stove or avoiding using it?

• Is your parent ordering food out often?

• Is your parent relying on meal substitutes, like nutritional drinks?

• Do you notice your parent losing or gaining weight? Does your parent’s doctor mention their weight or level of dehydration?

  • Weight gain or loss isn’t necessarily about eating a lot of KFC or skipping breakfast. It might be a symptom of something else, like my dad’s congestive heart failure or my mom’s difficulty in swallowing.

Hygiene

• How does your parent look and smell? Are they bathing often enough?

• Can your parent still cut their nails and toenails?

• Can your parent shave or groom themselves to an appropriate degree?

• Is your parent wetting their underwear or sheets?

• Is your parent able to use the bathroom without assistance and to clean themselves up?

• Do you notice a messy bathroom, indicating accidents or trouble getting to the toilet?

• Is your parent appropriately caring for their teeth and/or dentures? Are they going to the dentist for cleanings and fittings?

  • Many seniors neglect their dental health (dental care isn’t covered under Medicare unless it rises to the level of a medical emergency!) but dental health can affect so many other things, it’s worth paying attention to.

Dressing

• Can your parent get dressed, including putting on their shoes and socks?

• Are they wearing outfits typical of their style?

• Is your parent wearing clothes that are appropriate for the situation and weather?

  • My dad was wearing sandals no matter how cold it was, and I realized he could easily do the Velcro straps but had trouble with laces on sneakers.

• Do your parent’s clothes fit? Are they in good condition?

Management

• Is your parent keeping up with their home maintenance? Are they cleaning, changing batteries and lightbulbs, shoveling snow, clearing leaves, mowing the grass (or continuing to pay the landscaping crew), keeping clutter under control?

• Is your parent paying their bills on time?

• Is your parent keeping up with taxes, payments, and insurance?

• Is your parent able to manage email and phone?

• Does your parent have subscriptions to media or monthly payments to charities? Are they aware of everything that’s paid automatically each month?

  • As he grew older, my dad began to send money, small amounts, to more and more charities. $10 to SmileTrain, $10 to the ACLU, $40 to Planned Parenthood. Keep an eye out for new subscriptions or donations.

• Does your parent miss appointments?

• Is mail piling up?

  • One sign for me that my dad was struggling was when I would arrive after work and the newspaper would still be at the front door. He started each day reading his beloved Tampa Bay Times; why would it still be outside at 6 p.m.?

Medication

• How are your parents’ medications organized? Are they taking their medications when and how they are prescribed? If you have two parents, how do they keep their medications separated?

  • My dad saw his prescriptions as suggestions. He kept bottles in the kitchen, bathroom, living room, and bedroom, and it was impossible to tell if or when he had taken something.

• Do you see any pills on the floor or loose on tables?

  • When I would bring my dog over, I always had to do a floor check first. Westley would dive under my dad’s recliner to look for chicken wing bones and cookie crumbs. I didn’t want him to also wolf down some blood pressure medicine.

• Does your parent keep a list of medications?

  • Eventually, my dad got to a point where he used a local pharmacy¹ that delivered his monthly medications in blister packs for AM and PM and came with a complete list that we could tear off and bring to appointments. Check in your area to see if this is an option. Another option is to log into your parent’s patient portal, if they have one, for their doctor or health system, and navigate to the medication list.

Social

• Is your parent still seeing friends and family? Are people comfortable visiting your parent at their home?

• If your parent has a hobby, are they keeping up with it?

• Does your parent have any new friends, online or in person?

Personality

• Your parent has always been sarcastic and independent. Are they acting more sullen or compliant?

• Your parent has always been kind and quiet. Are they combative and irritable?

Transportation

• Does your parent often get lost while driving?

• Do they avoid driving at night or during rush hour?

• Have they gotten speeding or traffic tickets?

• Does your parent keep up with their car maintenance, payments, insurance?

• Do you feel safe driving in the car with your parent? Do you feel safe having your children in the car with your parent driving?

• Walk around your parent’s car. Are there any scratches or dents?

Movement

• Does your parent seem to be avoiding going up or down stairs? Are they winded when they go up or down steps?

• Does your parent seem steady on their feet? When they walk beside you, do they hold on?

• Do they need help getting out of a chair or out of the car?

• Observe your parent’s gait. Has it changed? Are they shuffling or wobbly?

What’s next?

• Download the checklist and tables by clicking the image below. Make a copy, and start going through the questions. When you feel ready, add to the table.

• If you don’t have any possible solutions or roadblocks, that’s okay! You’ll think of some in future weeks as we cover more topics related to caregiving, and then you can revisit this resource.

• Take a look at the table you’ve completed, and consider talking about it with others who know your parent well, such as siblings, friends, or medical professionals.

A quick note–I’m not a doctor, and these resources aren’t intended to diagnose an illness. Their purpose is to help you identify where your parent is having trouble, how you might be able to help, and where you need more guidance. As always, I recommend encouraging your parent to talk to their doctor to see if there’s a medical reason for their struggles.

1. St. Pete folks, it was Gulfport Pharmacy.