A picture of an elderly couple and their grand daughter.

When we don’t see our elderly loved ones as frequently as we’d like, it can be difficult to know how they’re really doing living independently at home.

If you’re planning to visit older relatives this holiday season, it’s important to observe them in their home environment and gauge whether it’s time to have a conversation about getting help. Watch for these physical, emotional and social signs:


  • Gradual loss of vision and hearing
  • Difficulty with steps, getting in or out of bed, on or off the toilet seat or other activities of everyday living
  • Increase in falls at home or out in public
  • Overall decrease in energy
  • New physical problems that arise in addition to existing ones


  • Increase in forgetfulness or confusion
  • New or different agitation
  • Feelings of guilt or shame
  • Withdrawing from social settings they would usually enjoy
  • Changes in mood
  • Increased paranoia and fixation
  • Poor recall


  • Poor hygiene, inability to shower or practice good self-care
  • Difficulty with misplacing things such as meals, medication, etc.
  • Missed billing and payments
  • Gaps in basic home security (locking doors, no fire extinguisher/smoke alarm, no clear emergency plan)
  • Concerned neighbors or loved ones
  • Wandering unattended (in worst-case scenarios)

It’s important to notice these aspects of your loved one’s home living situation because, if getting help could make a real difference in their safety or well-being, it’s time to have the care conversation.

However, when well-meaning children or other relatives bring up their concerns or suggest moving somewhere they could have more assistance, they’re often met with pushback by their older loved ones. Most older adults (77%, according to the AARP) would overwhelmingly prefer to stay independent in their own homes as they age, but this puts their family members in a difficult spot as they face mounting age-related health challenges, especially if their families live out of the area and are trying to coordinate care from afar.

Gary and Mary West PACE Social Worker Matt Vasile recently shared some helpful suggestions for handling this important care conversation with your older loved one, being gracious yet direct.

  • Use “I” statements and factually observe what has changed. (“I notice there are a lot of past due bills stacked on the table. You were always so good about paying things on time when we were growing up, have you been able to keep up with paying them?”)
  • If commenting on their appearance or hygiene, ask open-ended questions. (“I’ve noticed you don’t like to style your hair as much lately, has anything changed?”)
  • Try to restate what they are saying to you back to them to make sure you convey that you understand their wants, needs, and fears. (“It sounds like you’re concerned about people not respecting your privacy, is that accurate?”)
  • If your loved one acknowledges they need help, don’t tell them what to do. Instead, ask what their priorities are and ask how they might prefer to solve a given problem. (“I can see that it’s hard for you to keep all your medications straight, but it’s really important to stay on top of that. What do you think you need the most help with?”)
  • Give your loved one choices when talking about care. (“It sounds like you could either add a chair lift to help you get upstairs, or you could move your bedroom downstairs and have someone come in a few days a week to help you around the house. What sounds more feasible to you?”)
  • Emphasize the idea of “interdependence” to older loved ones afraid of losing their independence, and that you’re on their side. Acknowledge that people need one another from childhood to older age, and encourage your loved one to remember that by accepting help, they are in turn helping the person providing the help.
  • Be patient, and give your older loved one time to adjust. This will likely be an ongoing conversation unless there is a serious emergency or health hazard. In this case, contact your local PACE program, which can help point you in the right direction and even send an expert to help assess your loved one’s home and situation.

West PACE is part of a national network of PACE (Program of All-inclusive Care for the Elderly) programs, which provide wrap-around medical, social support, transportation, physical therapy and other services for Medicare/Medi-Cal-eligible older adults, helping them age independently in their own homes even if they have multiple cognitive or physical health issues. PACE has been proven to reduce emergency room visits and hospitalizations among seniors, and lead to improved mental and physical health outcomes for enrolled participants.

We hope these suggestions are helpful as you prepare to visit your older relatives during the holidays. If your visit with your elderly loved one leaves more questions about their independence than answers, it might be time to consider getting help (or more help) for them at home. If you or a loved one are 55 or older, live in North County San Diego, and meet state requirements for nursing home level of care, contact West PACE today to see if enrolling in our program is right for you. We can also answer any questions about the recent Medi-Cal expansion and can coordinate a tour of our center. Call 760-280-2230 or email us today.

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