Facing the possibility that a parent may be in mental decline isn’t easy — especially during the holidays.
Once joyful, fun-filled holiday visits can turn into alarming wake-up calls for many people when their parents are in their senior years.
According to the Alzheimer’s Association, around 32 percent of people over age 85 develop Alzheimer’s disease. For family members living far away, the early signs can be difficult to detect until they see their loved ones in person.
It’s a heartbreaking reality that many people face — like Rena Hyman, a mother of four who lives in New Rochelle, New York, and who’s worked in the senior living industry.
From all appearances, Hyman’s 83-year-old mother was living a good life in Toronto. She’d remarried at age 70 and after 12 years together, her new husband passed away.
“Only at the end, after he died, did we find out he’d had Alzheimer’s [for about the last year]. They’d kept it a secret,” Hyman explained.
Being a full-time caregiver was a difficult, physically exhausting, and emotionally draining job for Hyman’s mother. “When he passed away, she was very debilitated,” she said.
When Hyman or one of her four siblings would suggest their mother consider moving into a senior living center rather than continue living alone, she would tell them, “I’m not ready.”
The option of having live-in help was quickly nixed as well, with Hyman’s mother saying, “I don’t want somebody looking at me all day.”
Soon thereafter, Hyman’s family began noticing concerning changes in their mother’s appearance and behavior when they’d visit.
Once when Hyman’s brother went to visit, he discovered their mom hadn’t paid her bills.
When Hyman went on another occasion, she noticed her mother had lost an alarming amount of weight and was behaving oddly.
“She’d drive to the store, [come back home], and say, ‘They moved the store,’” Hyman said.
Worried for her mother’s safety, Hyman worked together with one of her siblings. They devised a plan to move her mother to a senior living center in New York. Their mother agreed to go, but on moving day, she refused to get in the car, telling her children once again, “I’m not ready.”
Though it was heartbreaking, they knew this was a decision they had to make for their mother, despite her protests.
Hyman’s experience with her mother is all too frequent and “holidays are when reality often sets in,” said Debbie Drelich, LMSW, who founded and runs New York Elder Care Consultants. “It’s one thing when you speak to somebody on the phone, they put their best foot forward. You don’t get a sense of what’s what, especially at a distance.”
The signs of mental decline aren’t always easily visible on the surface either.
Jennifer FitzPatrick, MSW, who teaches at Johns Hopkins’ Certificate on Aging program and is the author of “Cruising Through Caregiving: Reducing the Stress of Caring for Your Loved One,” says holiday gatherings can give adult children a chance to check for less obvious signs that their parent may need help.
Even if a holiday gathering isn’t held at an older parent’s house, FitzPatrick stresses the importance of going into their home if you’re concerned about the current state of their mental well-being.
“Does it look as if your loved ones are spending a lot of time in one room? [If] it’s a two-story home, [have they] set up camp in the living room and are [they only] using the first-floor bathroom?” FitzPatrick asked.
Drelich added other common warning signs that an older parent may not be well enough to continue living on their own may include “spoiled food in the refrigerator, clothing that is stained or ripped on a parent who was typically fastidious, weight loss, and unpaid bills.”
Finding unused daily medications is also a sign that a parent may be having more trouble than they appear to be.
If your parent is still driving, suggest running to the store together to pick up a pie or some wrapping paper to see how well they can operate an automobile.
“Look at what’s normal for this person; it doesn’t have to be something huge,” FitzPatrick said. “One example you often hear is, ‘Dad’s very gentlemanly and now he’s using bad language in front of the grandchildren.’ Are there memory problems? An infection?”
What should you do if you arrive for the holidays and find your parent’s living situation may not be sustainable for much longer?
Drelich advised against doing “anything in the heat of the moment.”
“Start a gentle conversation,” suggested Drelich. “‘Mom, I’ve been worrying about you. Let’s talk about options. It’s hard for people to stay alone in a big house.’ [Then] let that sink in.”
However, if you find the situation is direr, it may be time for a family intervention.
“The big thing you have to determine is [whether or not] your loved one [is] able to have a reasonable conversation,” said FitzPatrick. “I see families make this mistake all the time. They say, ‘Mom said no, she’s not ready.’ Well, Mom thinks Ronald Reagan is president.”
If you live a great distance away from your parent, FitzPatrick suggests hiring a care manager through an organization such as the Aging Life Care Association while you sort through options.
An elder law attorney may be needed to help with finances and facilities as well.
Other options include organizations like the Home Care Association of America, which will send a manager out to the home of your loved one to help assess what needs to be done.
“Work with an organization that is bonded and licensed,” FitzPatrick advised, pointing out there are many horror stories of people who believed they were getting a better deal, only to later discover their parents were receiving terrible care. “The bonded organizations are training people, licensing them, and there’s a nurse that does supervisory checks periodically.”
If your parent needs 24-hour care, tour several facilities before making any decision about moving them into an assisted living center.
If you’re unsure of where to begin, organizations such as The National Association of Area Agencies on Aging and Argentum, which is the nation’s largest senior living association, can be a good place to start.
Facing the possibility that a parent may be in mental decline is never easy — and it can be particularly emotional during the holidays.
Be ready to have open and honest discussions with siblings and other family members about the true state of a parent’s cognitive decline, what should be done, and which caregiving roles each family member can fill if they wish to do so.
Taking the time to fully assess the situation and devise an actionable plan can make a big difference for your aging parent’s future health and give you peace of mind as well.