- Physicians generally consider two major factors when evaluating the appropriateness of independent living: (1) the ability to perform ADLs without assistance and (2) the presence and severity of unsafe behaviors
- Activities of Daily Living (ADLs) are the abilities that allow someone to function in daily life, like bathing or showering and getting dressed
- Even if your loved one is still physically able to perform all ADLs independently, an additional concern is safety
- Older adults who display unsafe behaviors can get into trouble quickly and often need 24/7 supervision
It’s a challenging predicament when a loved one wants to continue living at home independently, but you’re not sure they’re safe to do so. Your concern might have been precipitated by any number of “close calls.'' Some common examples include:
- A fall due to instability, poor vision, or an unsafe home environment
- Missed medications, leading to worsening medical problems or even hospitalization
- Injuries caused by poor memory or judgment (like leaving boiling water on the stove)
- Financial problems (like utilities not paid, vulnerability to scams)
- Weight loss due to the inability to shop or prepare foods
- Poor hygiene because of the inability to bathe, groom, or dress
- Paranoid or irrational behaviors like wandering, dialing 911, or getting lost
Unlike cut-and-dry medical decisions (you have appendicitis and it must be taken out in the operating room to save your life), decisions around whether or not someone can live at home independently can be subtle, especially when it’s a “close call.” Additionally, the availability of family, friends, and paid caregivers is a significant factor into one’s ability to stay in their home.
With that said, there are some clear red flags that indicate independent living is no longer a safe option if no additional home support is available. Physicians generally consider two major factors when evaluating the appropriateness of independent living: (1) the ability to perform ADLs without assistance and (2) the presence and severity of unsafe behaviors.
Understanding Activities of Daily Living (ADLs)
Activities of Daily Living (ADLs), sometimes referred to as geriatric vital signs, are the abilities that allow someone to function in daily life. These include:
- Eating (feeding oneself)
- Transferring (moving from a bed to a chair or vice versa)
- Bathing or showering
- Getting dressed
- Grooming (brushing teeth, combing hair)
- Walking (at least) short distances
If your loved one can’t do any one of these things without support, experts would recommend that they no longer live at home independently.
Note: these are the “bare bones” foundational activities for independent living. Even if your loved one can do each of these, they may still need assistance, but not in an ongoing, 24/7 way. For example, one may still be able to live at home if they can eat by themselves, but this will require someone to cook or bring meals.
Many other “higher function” abilities are also required to live at home by oneself — doing light housework, preparing a meal, handling finances, self-administering medications, shopping — but these do not require minute-to-minute assistance. These are referred to as iADLs (instrumental activities of daily living).
Even if your loved one is still physically able to perform all ADLs independently, an additional concern is safety. Older adults who display unsafe behaviors can get into trouble quickly, even if they have relatively good functional ability.
There are a few reasons why this might occur. One is that many neurological conditions more prevalent in older adults progress slowly. As they unfold, they can impact memory, judgment, and other areas of thinning reasoning. This decline in cognition can sometimes be difficult to spot at first but can lead to unsafe behaviors.
Patients who have safety problems often need 24/7 supervision. Unsafe behaviors are unpredictable, and it only takes a second to get into trouble.
Get Creative to Help Your Loved One Stay at Home Independently
As a first step, take inventory of which ADLs and iADLs your loved one can and cannot do independently.
If you identify an impairment, the next questions are: Can your loved one not do this at all, or do they require extra assistance for the task? When during the day does this occur? You can then think creatively about what might be the least invasive and restrictive alternative possible to preserve independence.
Here are some examples:
- Medication management: A person who cannot self-administer medication might be able to stay at home if someone helps set up a device like Hero Health. You can also utilize a service like PillPack that assembles all medications with the date and time of administration.
- Food prep: A person who can eat by themselves but needs assistance preparing food may be able to benefit from a local Meals on Wheels program, or by having a meal delivery service like Uber Eats or Seamless setup and explained by a tech-savvy loved one.
- Grooming: A person who has difficulty grooming and dressing in the morning may only need a home attendant for a few hours early in the day just to get them started, whereas a bedbound older adult requires 24/7 care.
If unsafe behavior is the concern, sometimes there are simple solutions to prolong independence. Smart technology has made it much easier for someone to stay at home for longer. We detail our favorite devices in our Home + Living section, but some of our top picks include the Apple Watch for its fall detection feature and the BurnerAlert or Ome Burners for ensuring a stove is safe.
After you’ve spent time assessing your loved one’s ability to perform ADLs and iADLs, you can go category by category and make a plan. Creatively problem-solving these issues can be challenging but also rewarding. While there are some situations that take staying at home independently off the table, it’s often possible to find a way by leveraging in-home help and local services and optimizing decor and devices.