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Spoiled food that doesn't get thrown away
Missing important appointments
Unexplained bruising
Trouble getting up from a seated position
Difficulty with walking, balance and mobility
Uncertainty and confusion when performing once-familiar tasks
Forgetfulness
Unpleasant body odor
Infrequent showering and bathing
Strong smell of urine in the house
Noticeable decline in grooming habits and personal care
Dirty house, extreme clutter and dirty laundry piling up
Stacks of unopened mail or an overflowing mailbox
Late payment notices, bounced checks and calls from bill collectors
Poor diet or weight loss
Loss of interest in hobbies and activities
Changes in mood or extreme mood swings
Forgetting to take medications – or taking more than the prescribed dosage
Diagnosis of dementia or early onset Alzheimer's
Unexplained dents and scratches on a car
I think it's good to add help before it it absolutely essential. My mom said she didn't really need a cane, and I told her to get used to using it now, so that she would be comfortable with it when she did need it.
As far as putting someone into the NH, I would consider that when the physical care of a full-grown adult becomes unsafe for either party, it's time. When sleep issues do not respond to every treatment, it's time. When incontinence is unending, it's time. We endure what we can. I think children with kids of their own should give up earlier, because they should preserve themselves for their own family. As a spouse, I don't intend to martyr myself to keep my husband home when his care starts to destroy my health. Who knows what will happen in 5 to 10 years, though?
During the worst times my Mom says she's ready to look at nursing homes. The next day she changes her mind and wants to keep Dad at home as long as she can. She says she feels guilty for thinking of placing him somewhere. Her health is suffering along with his. I know that the point where her health becomes the top priority is the time when he'll have to go to a nursing home, and she knows this also.
I know several people who have placed spouses in assisted living or nursing homes even though they can still take care of themselves in some ways. I know others who've kept their spouses at home until death. I suppose it really just depends on the couple, on the health of both of them, and how they feel they can deal with everyday life. Either way, whatever the decision, it's not easy.