Mom is 75 years old. She likes living in her own home, the same home she has lived in for 30 years.  You live miles away and can’t visit as often as you would like.  But when you do visit her, you wonder how she is really doing?  She loves living at her home, and you want her to stay there.  She has told you of her wish to live there as long as possible.
Five potential problems in the home can cause elderly people to fail.  These are nutrition, medicine, hygiene, unaddressed medical problems, and safety.  Home care can help the elderly remain at home by evaluating and providing solutions to these five problems.
Nutrition
Forty-five percent of older Americans do not get enough sound nutrition in their daily diet.  Physical disabilities, isolation, poverty, mental disorders or ignorance may cause this problem.  They may not be able to digest food as well as before.  In our work we see elders at risk for poor nutrition.  They have problems preparing meals and getting to the grocery store.  Poor nutrition leads to anemia, constipation, dehydration, and generalized weakness.  Many elderly people eat alone and miss the social pleasure of dining with others.  Home care services can help the elderly with meal planning and shopping.  A trained home care aide can prepare meals and help maintain a special diet.
Medication
The elderly person living at home alone often over uses or under uses medication.  They may take more than one medication to treat the same diagnosis.  They may no longer be able to understand their medication prescription due to diminishing cognitive and sensory functions.  To assess independence in medication, our client must be able to take the correct dosage at the correct time and to anticipate refills before they are needed.  These underlying functions or abilities are impaired in many elderly people living at home alone.  Reasons for non-compliance are varied.  One of the reasons include taking multiple medications for the same health problems.  An RN care manager can monitor medications to see that dosage is coordinated and safe.

Safety
Accidents are the 5th leading cause of death in older adults, with falls constituting two thirds of these accidents.  We hear this all the time: “Mother is not safe.  She will not call us.  She has a hard time with the stairs, and in getting out of the tub by herself.  She may fall and can’t get to the phone for help.”
As we age we have changes in vision, changes in our sensory process and hearing. Our reaction time slows and we lose our balance. People living alone need someone to monitor their daily activities.  An older person’s gait is often stiffer, less coordinated and more dangerous than that of younger persons. Muscle strength and tone decline with age. It is hard to avoid falls after an unexpected reach or bend.  Gait problems are a common cause for falls and a common cause of muscle weakness found in stroke, Parkinson, fractures, and arthritis.
A caregiver in the home will recognize the problems of recurring falls or the existence of high risk for falls.  They look for safety problems in the house and conduct a search for hazards, which could cause future falls.  Home safety assessments are done for the purpose of making recommendations to prevent future falls.  
These recommendations include grab bars, a shower bench, rubber bath mat, nightlights, removal of throw rugs, removal of doorway thresholds, and many other minor changes to reduce the risk of falling.  Also the presence of a home caregiver can give the client greater control, security, and independence and reduce the chance of disability from home accidents.

Hygiene/Home Maintenance      “Dad just isn’t taking care of himself, and the house is dirty.  He doesn’t shave and his clothes are dirty.”
Elders who live alone are less likely than those who live with others to consistently keep up an ongoing schedule of dressing, bathing, and grooming.  Older persons who lose a spouse may lose their motivation for cleanliness. A few hours of home care a week can remedy this problem. A home care aide can assist the elderly client in establishing a routine for daily bathing, dressing, and grooming. They improve the client’s outlook with a fresh start each day. Household tasks such as cleaning the kitchen, mopping the floors, taking out the garbage, and straightening up the house will help prevent the spread of germs and provide an organized environment in which the client can reside.

Unaddressed problems
Irregular medical care may result from physical or mental impairment that reduces the elder’s ability to recognize and seek treatment for persistent medical problems.  Sometimes it is difficult to get to the doctor.  
When they do get to the doctor, they may give incorrect information. Then they are reluctant to return because the problem is not resolved. They fear seeking help because they do not want to be a burden to others. They do not want to risk losing their privacy or independence.  In preparation for their doctor’s visit, the RN care manager can make a priority list of problems.  
Problems such as joint pain, incontinence, confusion and weakness should not be passed off as symptoms of aging. A home care aide can accompany the elder to the doctor to keep his/her “problem report” to the doctor on track. Information about treatment and instruction can be written down to follow at home.  
The elderly can benefit from a carefully planned home care program. People with back or spine problems, arthritis, heart, and stroke conditions may need help with housework and meal preparation.
Other physical limitations include difficulty in lifting objects, trouble climbing stairs, and problems with vision or hearing. In general, elders who cannot get around easily or need help getting into or out of the tub or bed are likely to benefit from home care.

Mary Peters is founder and president of Care For Life.  The goal of Care For Life is to enable aging individuals to remain in their homes with their memories and possessions safely and securely for as long as possible. For more information, Peters or Sheryl O’Neal may be reached at 852-9090 or www.careforlifecharleston.com.