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When to consider long-term care Add to ...

Question: When is it time to consider long-term care for my aging parents?

Answer: It's normal to worry about elderly parents. Maybe you notice that your father has trouble with the stairs or that your mother often forgets things. You may have been thinking for a while: "Is it time to sit down for a serious family discussion about the future?"

Before you do, the first thing to ask yourself is whether something has changed with your parents' health -- or whether they are simply getting older. Aging is a natural process and there may be nothing to worry about. The truth is most seniors in Canada live at home and consider themselves generally healthy.

But you should watch for signs your parents need help. Before you automatically think this means a retirement or nursing home, consider that there are other types of long-term care.

Physical issues

How do your parents manage with basic daily activities such as bathing, dressing, eating and using the bathroom? It may sound simple, but it's a barometer used by experts to make an assessment. Basically, if your parents can do these things on their own, it's likely they can continue to live independently.

But they still may need help, especially if they have conditions that limit mobility. If family or friends can't provide this, consider in-home care. This can mean just an extra pair of hands for a few hours a day or week to help with things like meal preparation and home maintenance.

Find out about home care and community support services: Your parents may qualify for assistance. Your doctor can tell you where to get more information, since agencies often differ between provinces.Paid caregivers are an option for some.

If you are uncertain about your parents' physical capabilities, contact their family physician. Ask the doctor to set up an in-home safety assessment by a home occupational therapist (or, in some places, a specially trained nurse). This person will observe how your parents function in their own environment. Often, simple and inexpensive modifications will make the home safer, such as grab bars in the bathroom or a second handrail on the stairs.

If changes to the home aren't enough, the therapist may recommend long-term care outside the home. The prospect of losing cherished independence can be wrenching. It's often helpful to have the discussion in the family doctor's office, where the doctor can be a neutral voice and make recommendations.

A retirement residence (also known as "assisted living") may well be the best choice. These are places where seniors can live in their own apartments, but meals, medical supervision and other services are provided. Many now offer comfortable, hotel-like accommodation. Extra help can be tailored to your parents' needs. For example, if your mother needs 15 minutes of assistance to get dressed, you only pay for 15 minutes. By comparison, it's hard to get someone in the home for such a short period of time.

Then there's the nursing home (or long-term care facility) for people who require a lot more help, such as assistance with getting out of bed and eating. A nursing home can provide elderly people with improved health and safety, social activities, and a sense of community, largely subsidized by government.

Mental issues

Ultimately, if your parents are of sound mind, it's up to them to decide what's best for them. The picture changes if there's evidence of mental decline.

Watch for signs such as:

asking the same questions repeatedly;

missing appointments and getting lost frequently;

forgetting to take medications;

difficulty paying bills;

changes in personality and personal hygiene;

mood swings;

apathy.

If you observe these, contact their family doctor. The diagnosis may be dementia, which is a cognitive disorder. This doesn't necessarily mean institutionalized care is required. About half of those with dementia live in the community, according to the Canadian Study of Health and Aging.

There may be things you can improve in the home so that parents with cognitive problems can still function in their own environment. Familiar settings, people and routines are better for those with dementia.

If judgment is impaired and your parent is no longer deemed capable, a decision about long-term care will fall to others, usually a family member. Unless you're able to provide care 24/7, long-term care outside the home is often the solution.

No matter what your parents' situation, remember that long-term care is not an all-or-nothing proposition. Different options can make sense at different times. And you may be able to have that "serious family discussion" in a less emotionally charged atmosphere.

Dr. Barry Goldlist is medical director of the Geriatric Rehabilitation Program at the Toronto Rehabilitation Institute. Dr. Goldlist is a University of Toronto professor and a past president of the Canadian Geriatrics Society.

Editor's Note:

This column marks a new addition to the Health page of The Globe and Mail. Leading medical experts from across Canada will answer selected questions from Globe readers. The column will appear every other Tuesday. E-mail questions to

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