How to Know if Aging Parents Need Assistance When You Live Far Away

Lucy would call her mom at least once a week, and usually more. Lucy had moved away from Daly City a few years ago, taking a job just outside Seattle. She liked it there, but the 12-hour drive meant she couldn’t get back to see her mom as often as she would like. Her parents were divorced, had been for years, and Lucy’s mom lived alone. She had always seemed fine, but lately Lucy had started to worry.
Their conversations were more stilted, and her mom would repeat questions more than usual. She wouldn’t always answer some questions, either, unless asked over and over, even simple things, like “Did you have a good dinner last night?”  Lucy wasn’t sure if this was normal, if her mom was just distracted, or if she needed help. When you live far away, and don’t have regular interaction, it is hard and can be confusing to know if your aging parents need assistance. When you are distant, you have to work harder to understand—it requires you to keep a sharp eye (or ear) out for some specific clues. Knowing what to look out for is key to helping you understand what your aging parent might need.

Gleaning Information From a Phone Call and Skype

When calling a loved one you are worried about, you will want to focus on more than just the vague and superficial. We’ve all been there—conversations where most of the answers are “fine” (work is fine, my boyfriend is doing well, I’m fine, everything is fine). When you have a conversation like this, it can be too easy to think that things are OK (“mom’s fine”). People in early stages of mental illness are good at hiding symptoms, from others and from themselves. They will avoid difficult subjects and specific questions to avoid having to talk about things they are unsure of.
This is why, when on a phone call, you need to ask questions with specific answers. In Lucy’s case, it can’t just be “did you have a good dinner last night?”, but needs to be “what did you have for dinner last night?” Avoid “yes or no” questions. Ask about times and dates.
If you have a routine for when you normally call, or when they are supposed to call you, switch it up. Arrange a different time for them to call you, to see if they remember. This tests mental flexibility and the ability to break out of routine. Be wary of over-diagnosing mental illness, of course (people are quick to take any confusion and ascribe it to dementia), but if forgetting becomes a pattern, it may be time to take the next step. Another benefit of altering the schedule is that it gives you a more rounded picture of their schedule, including irregularities. If you call unexpectedly on a Sunday and they are out to post-church lunch, you know they are getting out and engaging with the world. If they are still in bed at 1:00 PM, you can tell if they are sleeping too much, or are sick, or if something is wrong.
One great development for long-distance communication is Skype (and similar video chatting programs). In a Skype call, you can see your parent’s face, and get a gauge of how they are actually reacting to things. You can also judge if they are dressing themselves well, or if they have stopped caring about appearance. Ask to see the house through the camera so you can see if normal chores like cleaning are being taken care of. A failure or unwillingness to handle tasks can be a sign of early dementia or depression. Skype (or Facetime, Google Hangouts, or any video chat) is a great way, literally, get a more complete picture.

What to Ask and Watch for When You Visit

Visiting home when you’ve been gone for a while is a good way to see if something has changed. In this way, your distance is actually an advantage—people living close by and interacting often don’t notice subtle small changes, but you might notice a lot. When you visit to see if an aging parent needs assistance, there are ways to tell if something is wrong.

• Ask specific questions about doctor appointments, such as who their doctor is, where the office is located, and how often they go. This is both for your knowledge and to see how well they remember.  
• Where do they keep their medications? Are they organized? Can they read the labels? How do they obtain prescription refills? Are there contraindications with food or other medications?
• Peek in the cupboards. Do they have adequate groceries or specific foods required for a special diet?
• Is their car receiving adequate maintenance? Take a ride with them to evaluate their driving skills. If they no longer drive, do they have manageable transportation for their needs?
• Study the floor for loose rugs, cords, and clutter that could cause a fall.
• Examine the electrical appliances for faulty wires and make sure the smoke detectors have batteries.
• Are the porch, yard, and driveway free of debris? If so, it could show that they are mobile enough to clean up, or invested in it enough to have someone else do so. If there is clutter—beside being a hazard—it might be a sign that they don’t get out very often.
• Check for stacks of unopened mail. Are they paying their bills correctly and on time?
• Look at the bills themselves. Are there unexplained charges or unusual expenses? This is often a sign of elder financial abuse.
• Have they fallen? Do they have unexplained bruises or an unstable gait?
• Do they forget things or appear confused?

If there are issues with several of these areas, it is important to get involved. Talk directly to your parent’s doctor. Explain the situation—you are far away, and concerned about what you have observed. Ask about medication, what your parent needs, and if there is anything specific to your parent you should be on the lookout for in future phone calls or visits. Ask if the doctor thinks your loved one needs a caregiver, whether that is home care, support services, or anything else. Above all else, of course, maintain communication with your loved ones. Talking together frankly and honestly is always the most important step.
You can’t always physically be there. We understand—life takes us in different directions. But even if you are far away, there are ways to tell if your aging parents need assistance, and there are people who can help them find it.
At Institute on Aging, we work with families to find the best care for our aging loved ones so they can live with dignity and independence in the comfort of their homes. Connect with us today to learn more about our work in the Bay Area.