Your parents worried about and cared for you the first couple of decades of your life – and probably still worry about you. Now that you’re an adult and your parents are aging, the roles may be reversed.

And that can come with a healthy dose of worry. You may be concerned about their eating habits and nutritional intake. Are they taking their medications? But, they may not want to be parented by their children or admit to needing help.

For most, it’s challenging to know when to step in and offer help, how much, and what kind of help to provide. Geriatrician Dr. Hillary Lum, an associate professor of medicine at the University of Colorado School of Medicine’s Division of Geriatric Medicine, recommends having an ongoing conversation with your parents, regularly checking in about their day and asking if they need help.

If your parents are not forthcoming with information, though, how do you know when it’s time to step in? How do you initiate the conversation?

When it’s time to step in to help your aging parents

Lum says that, broadly, the time is when you notice challenges with what medical professionals call the Instrumental Activities of Daily Living. The National Institutes of Health defines this term as “activities related to the ability to live independently in the community.”

“For example,” Lum says, “Are they having trouble managing finances, navigating transportation, keeping up with housekeeping, running errands, or making meals?”

Other signs that something has changed are, for example, when your ordinarily elegant mom stops bathing, or your gregarious father declines social invitations. These are signals that something may be going on that is preventing them from doing things they typically do. Perhaps your mother is worried about falling in the shower or is having trouble turning on the water. Your father may be reluctant to participate in social activities because he’s depressed, having trouble hearing or has cognitive impairment problems.

Michele Kuntz, a licensed clinical social worker at the UCHealth Seniors Clinic – Anschutz Medical Campus, says that often medication management is the most common concern she sees with her patients. “Medication management problems can be indicative of patients failing at home. So, for example, if they have heart medication that is life-sustaining and are not taking it as directed, at times, this can end up as a visit to the hospital.”

You’ll also know it’s time to step in when you hear from friends or neighbors that your parent is struggling or – your parents finally have the courage to tell you they need help.

How to have the conversation with elderly parents

Barring a severe illness or accident when it’s obvious your aging parents need assistance or your parents ask for support, you will most likely have to approach the topic with sensitivity and compassion. And, even when they do ask for help, you should still discuss the next steps with kindness and warmth. Lum recommends being patient with your parents and yourself.

“Recognize that this is going to feel overwhelming, so start slow and plan to keep discussing it over time,” she says. She also suggests bringing in trusted additional people, such as other family members and/or a social worker from a health care clinic or a case manager from a community organization.

A social worker or case manager can go over a checklist of assessments so you can figure out where there is a real need for help and then what types of support may be available. Every local area of the country, she says, has an Area Agency on Aging with resources you can tap into.

“These conversations may be emotional. Try not to accuse or blame,” Lum says. “Instead, ask questions like, how’s driving going for you? Or, tell me more about why you’re not going to book club like you used to.” Making your parents feel like they’re part of the decision-making is essential.

What are living situation options?

Everyone’s situation is unique. First, you need to assess your willingness and availability to step in, the finances available to pay for help, and your aging parents’ needs and wishes.

If your parents decide they want to stay at home with help, you can support them in many ways. There are also programs within the community that can keep your parents socially engaged and cared for during the day. And if it’s time to move them to assisted living or nursing care, there are ways to vet quality care to ensure your parents are safe and comfortable.

Home support

Again, it depends on your parent’s needs and situation, but a good place to start is with medication management. A simple pill box from the local pharmacy can help your parents track what they need to take every day, and an alarm on their phone or a stand-alone device can remind them when to take their pills. It helps if you or a neighbor can regularly fill the pill box and make follow-up reminder calls. If you are the medical decision maker (also known as a Medical Durable Power of Attorney) and have arranged to be able to access your parent’s health information, like through a patient portal, you can assist with coordinating requests for medication refills.

Next, you’ll want to make their home safer by clearing clutter and loose rugs to prevent falls, installing grab bars in the bathroom to help them get up from the toilet and bathe, and putting rubber guards on sharp edges. Additionally, you should make sure there is good lighting around the house and that items your parent uses every day are within reach (no step stool needed). Requesting a home safety evaluation by an occupational therapist through your parent’s primary care provider is a great place to start.

Lastly, a medical alert system can give you peace of mind, especially if you don’t live near your aging parents. “I tell all my patients (often those 75 and older), especially if they live alone, that having a medical alert is beneficial,” says Kuntz. But, she acknowledges, not everyone can afford one. Medicaid and the VA cover the cost but for others, it’s usually an out-of-pocket expense.

A life alert system is a device your parent wears or keeps in their home that can alert 9-1-1, a system monitor, or a designated loved one 24/7 that you need help with. Many wearable alert systems have fall sensor monitors. Most products have an activation and monthly fees.

Other home supports to help with independence and safety include meal delivery, housecleaning, home and yard maintenance to reduce the use of ladders and yard equipment, and installing cameras in or outside the house.

Bringing help in or sending your parents to an adult day center

Even if you can care for your aging parent or have them live with you, their needs may become so demanding that you will need help. And, if your parent lives alone, a home aide can provide needed support and care, including respite care.

Kuntz recommends consulting with an at-home care provider agency to help find quality care. Whomever you find, be sure they have references and can also provide backup care if they are sick or need to go out of town. Because there are many options, it can be helpful to meet with a social worker or care manager for general guidance on how to approach decision-making.

Another option is to use senior daycare facilities in your community. Some centers offer transportation to and from their facility; most offer full and half-day programs to keep your parent active and engaged. At-home providers usually cost between $36 to $45 per hour, and most of them have a four-hour minimum, while daycare facilities run between $65 to $90 per day with half-day options.

How to find a quality assisted living or nursing home facility

If your parent needs more help than you can provide, and their needs are too great to live at home, your next option is a senior care facility. Lum says, for example, if meals are being delivered to the house, but the older adult can’t prepare them, that’s a sign that a senior living facility may be appropriate.

“If someone is incontinent or unable to get to the bathroom or shower, that often suggests a nursing home level of care may be needed,” says Lum.

In her practice, though, she says she doesn’t use a checklist. Instead, she and her team perform a “whole person and whole family assessment” to understand the options available to the older adult in their particular situation.

When moving your parent to a care facility, Kuntz recommends working with a long-term placement company to find the right place for your parent, whether it’s an independent living, assisted living, memory care, or skilled nursing. Additionally, they can help you find a place within your budget or for other needs, such as a religious affiliation or a community that speaks a specific language. But you should still do your own due diligence.

“I encourage my patients and families to tour the facilities first and meet the staff. Are the staff friendly? Is the facility short-staffed? Will the patients like the food? Do they have outdoor space?”

Moving to a care facility can be a hard transition for your parent. However, working with a social worker or other health professional can help you and your aging parents adjust to the change.

UCHealth recently added information related to care for older adults and care partners who may have memory issues or dementia. You can explore it by going to https://www.uchealth.org/, clicking on the Livi chat assistant (lower right-hand corner) and entering “dementia.”