How to Know When a Loved One Needs Help at Home

The need for extra help at home rarely shows up all at once. More often, it's a set of small changes that build up over months, easy to explain away individually, harder to explain away together.

Why these changes are easy to miss

I spent most of my career as a nurse practitioner in long-term care. In my experience, older adults are very good at hiding that they're declining, and they'll isolate themselves to keep people from seeing it.

A parent may start refusing certain medications or “forgetting” meals, and families may not recognize it until it's too late. Notice I wrote “forgetting” in quotation marks. When they haven't eaten, most of the time they'll tell their family they decided to skip lunch or dinner, when really they forgot to eat.

Hospital trips get explained away, too. One change that often happens as people get older is that they start utilizing hospital-level services more often. They get sicker quicker, and the signs of being sick often don't show up until they're really not feeling well. Your parent may be lying in bed, unable to feed or care for themselves, and the family ends up bringing them to the hospital. As those trips become more frequent, families often think they're normal with aging. They are not.

If you're visiting a parent or loved one and something feels different, these are some of the areas worth paying attention to.

Personal Care & Hygiene

• Wearing the same clothes for several days in a row
• Noticeable changes in grooming, bathing, or personal hygiene
• Strong body odor or an unusually messy bathroom
• Difficulty with tasks like buttoning clothes or managing zippers

The Home Itself

• Unopened mail piling up, or unpaid bills sitting out
• Spoiled food in the refrigerator or expired items in the pantry
• A noticeable decline in cleanliness compared to how they used to keep things
• Laundry piling up or the same dishes sitting unwashed
• Clutter or tripping hazards where there used to be clear paths

Nutrition & Health

• Noticeable weight loss
• An empty or sparsely stocked refrigerator
• Missed medications, or medications that seem to be taken incorrectly
• Missed doctor's appointments
• New or worsening chronic health conditions

Mobility & Fall Risk

• New bruises they can't clearly explain
• Unsteadiness getting up from a chair or out of bed
• Avoiding stairs, or visible difficulty with them
• Refusing or forgetting to use a mobility aid like a cane or walker
• Holding onto furniture or walls to get around

Mood, Memory & Behavior

• Withdrawing from friends, family, or activities they used to enjoy
• Repeating questions or stories more than they used to
• Getting lost or confused in familiar places
• Increased irritability, agitation, or anxiety
• Leaving the stove on, misplacing items often, or forgetting appointments

When someone is developing dementia, families will often give them a pass for a while at first. They tell themselves maybe they're just getting older, or maybe they're just really stressed right now, and they let it go on. Then, as the symptoms get worse, they suddenly realize it's something more than a phase or just aging.

What to Do With This List

What matters most is the pattern. Any one of these changes may have a simple explanation. Several appearing together, or becoming more frequent over time, can be a sign that daily life at home is getting harder. Families are often in the best position to catch that pattern before it becomes a crisis.

But if you live out of state and depend on caregivers in the home, you won't always see these changes yourself. Often our caregivers are the first ones to notice. When that happens, we first ask the family whether they're seeing the pattern too, and then we have a neutral conversation about what we're observing. If someone else is in the home, ask them what they're seeing and compare it with what you've noticed.

If a few of these sound familiar, don't think twice about seeking help early. With the right support and interventions, many older adults can keep living well at home.

If you've already brought up home care and met with resistance, we have a separate guide on what to do when your parent says no to help at home. If you want a doctor to look at what you're seeing, see how to advocate for an aging parent or loved one at the doctor.