Holiday Visit Checklist: Signs Mom or Dad Needs More Help
Holiday visits have a way of filling in what phone calls leave out. You talk with Mom every week, and she always says she’s doing fine. Then you spend a few days with her and notice small things. The fridge is emptier than usual, a couple of lightbulbs have burned out, and she’s slower getting up from her chair.
Noticing changes like these is very common. Every year, from Thanksgiving well into January, I hear from families who saw something during a holiday visit and aren’t sure what it means. Some of what they notice can be handled with a little extra help. Some of it means it’s time for more support.
Below, I’ll share what I look for as a geriatric nurse, how to tell what’s worth watching from what needs attention, and how to keep your parent safe if they’re coming to your home for the holidays instead.
Why don't phone calls tell the whole story?
Most seniors tell family they're fine on the phone, and many believe it. Small changes around the house are easy to hide, and easy to miss, during a short call.
"Oh, I'm fine. Just puttering around here, taking care of things." That's what most families hear. But it may not be quite like that.
Some parents don't want to worry their children. Others honestly don't notice what's changed. Here's one example I see often: lightbulbs burn out one at a time, and as eyesight fades, an older person may not realize they're living in the dark. They're walking in the dark, and falling in the dark. Nobody would ever mention that on the phone, but you'll notice it right away when you walk in.
Is it a big deal, or is Mom just tired?
In my experience, families are more likely to overreact than to brush things off. What helps is knowing which changes actually point to a safety problem.
What families find can vary a lot. Sometimes it's a few small things that a housekeeper or a weekly check-in can solve. Other times it's more serious. I've talked with families who hadn't seen their mom in two years and walked in to find green mold in the fridge and garbage that hadn't gone out in six weeks.
Worrying when you see something new is a natural response. It means you're paying attention. The goal isn't to panic. It's to sort out what's normal aging and what's a sign that your parent needs more support.
These are the changes that catch my eye as a nurse, even when they look small to family:
Spoiled food in the refrigerator that your parent doesn't seem to notice
Weight loss
A home that's much less clean than it used to be
Clutter everywhere
Clutter is one of the biggest telltale signs. It creates tripping hazards and fire hazards, and it can make it hard to get out of the house quickly in an emergency.
When it may be time for more than a little help
Some signs tell me a person may not be safe living alone anymore:
Falls, or near falls
Problems with their feet that they can't feel. When I do an assessment, I look at a person's feet. Open sores between the toes that someone doesn't even notice are a pretty big problem.
Soiled undergarments left in the bathroom because they're not sure how to dispose of them
Confusion. A person who is confused and living alone is simply in danger.
What should you quietly notice during a holiday visit?
Look at the fridge, the bathroom, the path to the bedroom, the car, and the medications, and notice how your parent seems later in the day.
You don't need to inspect the house with a clipboard. Most of this you can take in naturally while you're there.
The kitchen
Open the fridge. Asking "What do you have to eat, Mom?" or "Can I make you something?" gives you a natural reason to look. Spoiled food, empty shelves, or the same item bought over and over can all tell you something.
The bathroom
Look for soiled items left sitting out. It can be hard to tell whether someone is bathing, but if you suspect they aren't showering, that's a good sign they need help. One clue is what's in the shower. If it's being used to store things, like extra pots and pans, it probably isn't being used for showers.
The bedroom
Most older adults get up at least once in the night to use the bathroom. Is there a clear path from the bed to the bathroom, and is it lit? Small battery-operated motion lights are an easy fix you can add during your visit.
The car and garage
If your parent is still driving, take a look at the car. New dents, scratches, or damage to the garage are serious signs and worth paying attention to.
Pets
If your parent has a pet, make sure it's being fed and looks healthy. Watch for accidents around the house. I've walked into homes where the floor was covered in pee pads, and the owner thought that was just fine.
Later in the day
Many people cover very well for early dementia. Their social graces stay intact, especially in the morning. Confusion often gets worse in the late afternoon and evening, a pattern sometimes called "sundowning."
Here's a simple tip: if you usually call your mom in the morning, try calling around 3 or 4 in the afternoon. Is the conversation as clear as it is in the morning?
You may also hear stories that don't add up, such as a neighbor spying on them or trying to harm their pets. These are often confabulations, meaning the mind fills in gaps with stories the person truly believes. But not always. Every now and then, there's real truth behind a story like this. So listen carefully and gently explore what's going on before you dismiss it.
Medications
This is the one area where I'd skip the subtle approach. Sit down together and say, "Mom, show me exactly what you take and when you take it." Then compare what she tells you with what's on the labels.
If she doesn't already use a weekly pill organizer, setting one up is a great first step. If you can visit every week or two, it also lets you see whether she's remembering to take everything.
If you live farther away, an electronic medication dispenser is worth considering. You load it with pills for a couple of weeks at a time. It sounds an alarm when it's time for a dose, and some models can alert a family member if a dose hasn't been taken.
What if one parent is caring for the other?
When one spouse is fully caring for the other, the household is on thin ice. Regular outside help with everyday tasks protects them both. This is one of the hardest situations, and it happens all the time. If something happens to the healthy spouse, the whole arrangement falls apart.
Even if the caregiving spouse seems capable day to day, having someone come into the home to help with certain tasks can make a big difference. That might include:
Laundry once or twice a week
Grocery shopping, restocking the kitchen, and throwing out old food
Taking the garbage can to the street, which is a huge job if there's a long driveway
Bringing in the mail and keeping an eye on things
Many couples turn this down. "We're fine. I don't want anybody in my house." If that's where your parents are, keep the door open and keep checking in. Sometimes, despite everyone's best efforts, change only comes after a fall or another crisis. That isn't a failure on your part. It's a reality many families face.
Do you need to decide anything on Thanksgiving Day?
No. The holiday is for being together. Take note of what you see, and talk it through in the days afterward. Respect your parent's independence while you're there. Enjoy the meal, and save the bigger conversations for later. When the visit is over, these are sensible first steps:
Compare notes with your siblings. Each of you may have noticed different things.
Talk with your parent's doctor about what you saw.
Consider bringing in a little help. A reputable care company that is licensed, bonded, and insured can provide companionship, rides to appointments, and light housekeeping. They can also handle small things that make a big difference: taking out the garbage and bringing the can back, collecting the mail, putting away grocery deliveries, and changing lightbulbs. Don't count on the garbage company to help, either. Here in the Issaquah area, our garbage service no longer brings cans out to the curb for residents with disabilities. If you're not sure where to start, you'll find the in-home care company I recommend on my FAQ page.
Expect to hear "I don't need anything." That's normal. Many times, a little help at home is just the ticket, and it lets your parent stay in a home they love. Other times, what you saw means it's time to start looking at a different living situation. Knowing which one fits your family is where a second opinion can help.
What if your parent is coming to your home for the holidays?
Your home is unfamiliar territory for an aging parent. Clear pathways, good lighting, a safe bathroom, and a ride home after dark go a long way. The holidays can be risky for older adults even when they're the guests. A few things to keep in mind:
Point out changes in floor level. If you have a sunken living room, make sure Mom or Dad knows there's a four-inch step down, and walk with them for a bit.
Plan for the dark. Holiday meals are often in the late afternoon, so it may be dark by the time they leave. Offer a ride home, and help them in and out of the car.
Clear your walkways. Wet leaves and sticks on a sidewalk can be very slippery, so sweep them away and make sure the path is well lit.
Think about the bathroom. Yours probably doesn't have grab bars. You don't want to invade anyone's privacy, but if Mom has been in there a little longer than she should be, go check on her.
Move the throw rugs. They're a common cause of trips and falls.
Take stairs seriously. Even a few steps can be hard if they're wet, if it's dark, if your parent is tired, or if they've had a glass of wine. Be ready to hold on to them on the way down.
Not sure what your holiday visit means?
If something you noticed this season is still on your mind, you don't have to sort it out alone. I offer a free 30-minute consultation for families who aren't sure yet what they need. We can talk through what you saw together and figure out what's wait-and-see and what means it's time to start looking. If you're already planning to tour homes, my elder care tour checklist can help you ask the right questions.
Flying home after the holidays? Distance doesn’t have to slow things down. I regularly help families who live out of town find the right care for a loved one here in East King County.
