As a caregiver, you may have to decide if it is still possible to leave an elderly person in your care alone for an hour, an afternoon or an entire day. Will they be safe? Will they wander off? Will they let strangers into the house? Will they turn on the stove and forget to turn it off?
Making this decision can be a complicated and emotionally wrenching experience for you and the senior. For caregivers, it can be heartbreaking to recognize that the strong, self-sufficient adult they have known for years is no longer capable of taking care of themselves. It also means a real loss of freedom and flexibility and may require you to develop creative strategies to accomplish daily errands and tasks. For the elder, it can be equally difficult to acknowledge and accept that physical, emotional or mental changes have reduced their independence.
Checklist on Being Home Alone
There are numerous factors to consider when making this decision. But first, recognize that loss of sight, hearing loss, memory loss, confusion, incontinence and depression are not normal aspects of aging. In many, if not most cases, these are treatable conditions. Failure to identify them as being treatable could place elderly patients at risk of unnecessary functional decline. Have you or the elder discussed the elder's problems with a physician? And, if the first physician dismissed them as being due to old age, did you see another physician for a second opinion? (A surprising number of doctors don't have the training to help elders overcome their problems.)
It is important to balance the safety of the elder with the needs of both elder and caregiver to retain as much independence as possible. As a result, you should include as many people as you can in the decision-making process, even the elder. You may also want to consult with other caregivers, such as family members and friends; paid caregivers who know the elder's abilities and limitations; and elder care professionals such as doctors, nurses, and social workers.
The following questions can guide you in making the decision. If the answer to any question is "no," it may no longer be possible for the senior to be left alone, even for a short period of time. Instead, hiring 24 hour care in the home may be appropriate.
• Do they understand how to leave the home if necessary? Do they know where the door is located and how to exit the building?
• Will they stay home or near the house rather than wander off?
• If they go outside, do they know where they live and how to get back inside?
• Can they identify signals, such as smoke from the kitchen or fire alarms, that would alert them to potential dangers?
• Do they know how to access emergency services? Do they know how and when to dial 911? Would they be able to communicate over the phone? Can they physically get to a phone no matter where they are?
• Do they have frequent life-threatening medical emergencies that require immediate intervention? Do they know where any medication they might need is located? Can they reach it? Do they have the capacity to select the right medicines in the correct amounts?
• Do they have the judgment to identify who they should and should not let into the home? Will they know to allow family, friends and emergency personnel into the home?
• Can they prepare themselves something to eat if they get hungry? Do they know how to use the stove, and will they remember to turn it off?
• Can they get to the bathroom and use the toilet on their own? If not, have alternatives been worked out?
• Are they afraid to be alone for an hour or more? Do they become clingy when caregivers depart and make frequent telephone calls if they are alone?
If you decide that it is still safe to leave your elder at home alone, you should regularly reassess the situation. Caregiving is a dynamic process — you need to be aware of any and all changes in the elderly person's condition and abilities. Even if you think they can be left home by themselves, pay attention to their desires; if they fear being alone, it could be a sign that at some level they know they are not capable of coping with any emergencies that might arise.
Gail Freeman-Campbell, is the C.E.O. of Daughter On Call, Ltd.