Home for the Holidays

According to Luise Warren, a Geriatric Care Manager (GCM), it happens every year just after the Thanksgiving, Hanukkah and Christmas holidays - a spike in calls to her offices in the western suburbs of Chicago.  The reasons for the calls are simple – adult children coming home for a holiday notice their parents are struggling either physically, cognitively or both. These changes are not easy to miss especially if it’s been a long time between visits.

The cognitive difficulties may result in financial problems as the parents become forgetful or begin to lose their ability to plan their finances. This may raise financial abuse fears as the parent becomes susceptible to scams. Physical problems include a drastic loss of weight. The children may also have noticed that their parent shuffles more than before and appear unsteady when walking, increasing the risk of a fall.

Of course, going home for the holidays can be traumatic enough without layering on issues related to the parents’ apparent loss of physical or cognitive abilities.  Families also differ in their willingness to talk about the issues raised here. Many parents refuse to talk about their finances with their children or admit they are having physical problems. But many of these challenges can be severe enough that they cannot be ignored. Rather than raise concerns during the visit, the adult child may merely note them for later discussion. Some children will take the extra step of calling a GCM to discuss their concerns and ask that an assessment be done to ascertain what the next steps should be.

But what should the adult child look for when he or she is home? What other issues should they raise while home? While not exhaustive, there are signs about the parent’s physical or cognitive condition that can be seen if the child looks carefully.

Telltale signs of Physical Problems

  • Has your mom or dad lost or gained weight? In addition to your observation, check the refrigerator – are the foods newly purchased or old and moldy?
  • What about their energy level? Is it the same or have they slowed down? Are they shuffling when they walk?
  • Ask about the last time they have seen a doctor. If willing, ask about the results.
  • Are they having a hard time hearing you? Does the adult child have difficulty getting their attention? Is the TV volume on much louder than necessary? Do their eyes glaze over during a conversation? Dr.  Sheri Billing, an audiologist in Wheaton, Illinois points out that if the parent lives alone it is often difficult for the parent to know there is a problem with hearing. She points out that often adult children fear their parent has Alzheimer’s Disease when the real problem may be hearing difficulties. The problem may also be something as simple as ear wax build up. Seniors, Dr. Billing points out, will often go “seven to ten years before having their hearing checked. Unfortunately, that may be too late to do anything about the problem.” Having a hearing problem increases the chance that the parent will be isolated from the community.
  • Are they squinting to help them see even though they are wearing their glasses? When was the last time they had their eyes checked? Medicare does not cover hearing tests or regular eye exams – many seniors will go without rather than asking their adult children for financial help.
  • Finally, at the dinner table, notice if they spend time just pushing food around the plate while eating very little. While seniors do tend to eat less, lack of interest in eating may be indicative of other physical problems.


Signs of Cognitive Problems

Recent research has found that “Impairment of financial capacity usually occurs very early in the course of cognitive impairment at a time when both patients and family members may be largely unaware of encroaching deficits in financial skill.” (Finances in the Older Patient With Cognitive Impairment Journal of the American Medical Association, February 2011). On a visit home, adult children should check to see if there are stacks of unopened mail on the desk. A large stack may indicate that bills are not being paid on time. To approach the topic, the children can raise, for example, the topic of the ease of bill paying online.  If the parent usually gives checks as gifts, look for any errors there may be on the check itself.

Other tips include:

  • Discuss recent events. Alzheimer’s Disease patients maintain their long term memories well into later stages of the disease. It is their short term memory they lose first. If they have trouble recalling recent events that may be an early warning of problems to come.
  • If the parent still has his or her driving license, the child will want to observe the parent driving. Poor driving may be a sign of physical and/or cognitive problems. If there is a concern, many rehabilitation facilities offer special driving tests and assessments for seniors. This is a very sensitive topic since the senior will see it as a blow to their independence. If the child suspects that mom or dad has a dementia (the best known being Alzheimer’s Disease) a tremendous resource is The 36-Hour Day 5th edition 2011. The symptoms of AD are wide ranging and professional assistance should be sought. Keep in mind, however, that non professionals can misdiagnose dementia – poor hearing, drug interactions, urinary track infections, and other causes may create dementia like symptoms in a patient.


Being home for the holidays may also give you a chance to discuss or observe:

  • Wills, advance directives, trusts, final wishes for burial, powers of attorney, whether beneficiary designations need to be updated, etc.
  • The type of Medicare Supplement programs the parents own. An analysis may show they have too little protection or the plan is more than they can afford and a change may be required.
  • Whether the home is in need of repairs.
  • One of our clients uses her home visits to make sure the smoke detectors in her mother’s home have fresh batteries.

The objective here is not to ruin the holidays or create family tension (well, any more tension than is already there). The goal here is to increase the adult children’s awareness of their parent’s well being. Dealing with one or two of the issues raised during a trip home may be as much as the adult child and parent can handle. The important thing is for the adult child to observe and note any problems they see. They can wait until later to raise the topic – unless it is an urgent matter - during a less hectic time of the year.

Written by James Sullivan, CPA/PFS.