THE SENIOR YEARS: Several factors determine need for nursing-home care

What are the indicators that an elderly person needs in-home services or a move to a nursing home?

Connie Suderman, Marion County case manager for the North Central Flint Hills Agency on Aging, does dozens of assessments each year.

She identified several factors she considers when determining whether a person needs assistance. Adult children with elderly parents should be looking for tell-tale signs.

n Nutrition. Are the parents or loved ones getting adequate nutrition living by themselves? Are they eating safely? Are they getting groceries? Is the food being stored properly, such as refrigeration? Are they getting sufficient fluids on a daily basis?

“That’s always a big issue,” she said. “The Area Agency on Aging works through the senior centers in Marion County and will do home-delivered meals up to seven days a week if we can. But in some cases, it just isn’t safe even with those kinds of intermittent interventions. If that’s the case, that person more than likely will need to go to a nursing home.”

n Cognitive issues. Do parents or loved ones have difficulty remembering to take medication? Are they taking medication in the proper amounts and intervals?

“Medication is a huge issue, and that’s connected with memory.” Suderman said. “One of the things that happens with older people, if their medication is out of whack, is that it can have a huge impact on them cognitively and physically.

“How can you tell? In some cases a person becomes gravely ill. But in other cases, a neighbor might notice some confusion. Sometimes we don’t see the medication issue until after I’ve gone in for the assessment.”

n Hygiene issues. Are the parents or loved ones keeping themselves clean? Are they forgetting to shower? Can they still bathe themselves? Do they have good bladder control? Is the housekeeping as thorough as it should be? Do they have the physical strength to clean and dust their house?

n Socialization. Are they becoming more reclusive then they used to be? Are they avoiding social situations uncharacteristically? Do they have adequate social support-family members, friends, neighbors-who can help fill the gaps at home?

“Surprisingly, people often have existed in that state for quite a while when I get a call,” Suderman said. “Folks generally like to cover that and they do a pretty good job of it. They try to give the impression they’re doing better than maybe they are-nobody wants to give up their independence.”

n Seeing the doctor. Are they making and keeping regular appointments with their physician?

“A lot of times those folks are not seeing their doctor regularly,” she said. “If a family member is noticing their loved one isn’t having regular doctor visits, they might encourage more frequent visitation and maybe even go with them.”

n Mobility issues. Can they walk without assistance? Even with a cane or walker, are they able to get safely around the house on their own or have they fallen? How many times have they fallen in a six-month period? Can they still drive safely? If they can’t drive, is support available if they need transportation?

All of these things are clues to an elderly person’s well-being, Suderman said. The availability of informal support from family and friends can fill many of the gaps if needs are identified.

“If there’s not good support, generally that person will head to a nursing home sooner than someone who has some support in the area,” Suderman said.

As a case manager, Suderman said she often can help find the necessary support through existing agencies and services if family members cannot do it themselves.

She said every person and every situation is unique and must be considered individually.

“Different people function at different levels,” Suderman said. “Their memories can be good about certain things and bad about others-and not even be consistently the same from day to day.

“So we have to assess just how impaired they are on a regular basis.”

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