The short answer
- Write down what you saw, and whenNote the thing itself, the room and the day. That gives a GP, the council and your parent something specific to answer, which a general worry does not.
- Confusion that came on suddenly is an emergencyThe NHS says to go to A&E or call 999 if someone suddenly becomes confused. Forgetfulness that has built up over months is a GP appointment instead.
- A care needs assessment is free, and anyone can ask for oneYou ring your parent's council and ask social services. It does not depend on savings and it does not commit your parent to accepting anything.
- Paid help can start with one hour a dayAn hour every morning covers getting up, washed, dressed and fed. You can add a lunchtime or evening visit later if it turns out to be needed.
Hourly visits on PrimeCarers cost £18 to £25 an hour with our fee included. An agency charges £28 to £35 an hour for the same visit.
The twelve signs
Twelve things to look for in your parent's house
They are grouped here by where you would come across them, because that is how you will notice them. One of them on its own is rarely a reason to change anything. Several together, and going on for weeks rather than days, usually means the week needs some help in it.
The house
What the kitchen, the post and the heating tell you about how the last few months have gone.
- 1
Food in the fridge well past its date, or the same meal every day
Shopping or cooking has become harder than it was. People over 65 are particularly at risk of malnutrition, and the NHS is clear that losing weight is not an inevitable result of old age.
- 2
Unopened post, a pile of bills, or letters from the bank left where they landed
Opening post and acting on it takes concentration, eyesight and energy. A pile of it is where a missed renewal, an unpaid bill or an unanswered hospital letter starts.
- 3
The house is colder than you would keep it, or only one room is heated
This can be money, a boiler nobody has looked at, or no longer feeling the cold. Government winter guidance is to heat the rooms you spend time in to at least 18C.
Their body
The changes that are easy to miss on a video call and hard to miss across a weekend.
- 4
Clothes hanging loose, a belt on a new notch, or a wedding ring turning
Losing 5 to 10 per cent of body weight over three to six months is one of the main signs of malnutrition, and the NHS asks people to see a GP about weight loss they did not intend.
- 5
A hand on the furniture between rooms, or a bruise they cannot place
Around a third of people aged 65 and over, and around half of people aged 80 and over, fall at least once a year. A fall or a run of near misses is a reason to see the GP.
- 6
Unwashed hair, the same clothes for several days, or a bathroom nobody has used properly
Getting into a bath or a shower can become difficult or frightening. The step over the side, and the stairs up to it, are often the obstacle rather than any reluctance to keep clean.
Their mind and mood
Memory, words and company. Pay attention to how fast a change arrived, because that decides who you ring.
- 7
The same question three times in an afternoon, or a word that will not come
Memory loss, struggling to follow a conversation or find the right word, and confusion about time and place are listed by the NHS among the early symptoms of dementia. It advises talking to a GP sooner rather than later.
- 8
Confusion that arrived over hours or a day rather than over months
The NHS says to go to A&E or call 999 if someone suddenly becomes confused. An infection, and urinary tract infections in particular, is a common cause in older people.
- 9
They have stopped going out, or given up something they used to look forward to
Withdrawal and low mood are worth raising with the GP alongside anything physical, and they can have a treatable cause of their own.
The shape of the day
Medication, appointments and the car. These are the jobs that assume somebody is keeping track.
- 10
Tablets still in the blister pack, doubled up, or loose on a worktop
Medication has to happen at a particular time of day, which is why a booked visit answers it better than a phone call does.
- 11
A missed appointment, or a repeat prescription nobody has collected
Appointments, prescriptions and reviews all assume a person is tracking them. When nobody is, they get missed one at a time rather than all at once.
- 12
New scrapes along the car, or on the gatepost and the garage frame
Some medical conditions have to be reported to the DVLA, and the fine for not reporting one that affects driving goes up to a thousand pounds. Check the condition on gov.uk before anyone argues about the keys.
None of this is a diagnosis, and a list of 12 signs is not a verdict on how your parent is coping. It is a way of turning an uneasy feeling into specific things you can describe to a doctor or to your parent. The rest of the elderly care guide goes into each area in more depth, and three pages are worth having open alongside this one: what happens when an older person does not eat enough, medicines in later life and how to deal with a fall.
Doctor or carer
Which of these needs a doctor before it needs a carer
Some of the twelve are medical and some are practical, and it saves a lot of time to separate them before you start looking at care. A carer cannot treat an infection, and a GP cannot get somebody washed, dressed and fed every morning.
| Who to contact | What the guidance says | |
|---|---|---|
| Confusion that arrived over hours or a day | A&E, or 999 | The NHS says to go to A&E or call 999 if someone suddenly becomes confused. An infection is a common cause in older people, and urinary tract infections in particular. |
| Forgetfulness or confusion that has built up over months | The GP surgery | Memory loss, losing the thread of a conversation and confusion about time and place are listed by the NHS among the early symptoms of dementia, and it advises talking to a GP sooner rather than later. |
| Weight loss that nobody intended | The GP surgery | Losing 5 to 10 per cent of body weight over three to six months is one of the main signs of malnutrition, and the NHS says weight loss is not an inevitable result of old age. |
| A fall, or a run of near misses on the stairs | The GP surgery, and ask about a falls assessment | Around a third of people aged 65 and over, and around half of people aged 80 and over, fall at least once a year. The falls guidance published for the health service lists loss of confidence and loss of independence alongside the injury itself. |
| Hardly any fluids in a day, dizziness on standing, dark urine | The GP surgery, or NHS 111 the same day | Older adults are more at risk of dehydration, and the NHS lists tiredness, dizziness and dark urine among its signs. |
| A cold house, or only one room heated | Not the GP, but do not leave it | Government winter guidance is to heat the rooms your parent spends time in to at least 18C, because cold housing carries its own health risk for people aged 65 and over. |
| Washing, dressing, meals, shopping and the housework | The council, or a carer | These are the things a daily visit is for. They are not a medical problem and a GP has no way of fixing them. |
Confusion that arrived over hours or a day
- Who to contact
- A&E, or 999
- What the guidance says
- The NHS says to go to A&E or call 999 if someone suddenly becomes confused. An infection is a common cause in older people, and urinary tract infections in particular.
Forgetfulness or confusion that has built up over months
- Who to contact
- The GP surgery
- What the guidance says
- Memory loss, losing the thread of a conversation and confusion about time and place are listed by the NHS among the early symptoms of dementia, and it advises talking to a GP sooner rather than later.
Weight loss that nobody intended
- Who to contact
- The GP surgery
- What the guidance says
- Losing 5 to 10 per cent of body weight over three to six months is one of the main signs of malnutrition, and the NHS says weight loss is not an inevitable result of old age.
A fall, or a run of near misses on the stairs
- Who to contact
- The GP surgery, and ask about a falls assessment
- What the guidance says
- Around a third of people aged 65 and over, and around half of people aged 80 and over, fall at least once a year. The falls guidance published for the health service lists loss of confidence and loss of independence alongside the injury itself.
Hardly any fluids in a day, dizziness on standing, dark urine
- Who to contact
- The GP surgery, or NHS 111 the same day
- What the guidance says
- Older adults are more at risk of dehydration, and the NHS lists tiredness, dizziness and dark urine among its signs.
A cold house, or only one room heated
- Who to contact
- Not the GP, but do not leave it
- What the guidance says
- Government winter guidance is to heat the rooms your parent spends time in to at least 18C, because cold housing carries its own health risk for people aged 65 and over.
Washing, dressing, meals, shopping and the housework
- Who to contact
- The council, or a carer
- What the guidance says
- These are the things a daily visit is for. They are not a medical problem and a GP has no way of fixing them.
Sources: NHS guidance on sudden confusion, dementia symptoms, malnutrition and dehydration, the government's falls guidance for the health service, and its winter advice on keeping warm and well.
If memory is the part that worries you most, the signs that dementia is getting worse sets out what changes as a diagnosis progresses and what care it needs. If your parent is drinking very little, the symptoms of dehydration in older people explains what to look for and how quickly to act.
While you are there
What a few days in the house shows you that a phone call cannot
On the phone your parent gives you the version they have prepared, and they are not being dishonest when they do it. In the house you see the fridge, the bathroom, the thermostat and how they get out of a chair. Tick anything that is true while you are still there and able to check.
Worth looking at before you go home
0 of 12 ticked
The kitchen
The bathroom and the bedroom
Around the house
Watching them move
If you live a long way away and most of the year is phone calls, caring for a parent from a distance covers how to keep an eye on things between visits. If you are in the house at the same time as brothers and sisters who see it differently, when siblings disagree about a parent's care is written for that argument.
What to say
Raising it before you go home
It is tempting to say nothing while everybody is together and ring them about it in January instead. Saying one small, specific thing in the house, where you can point at what you mean, is easier than starting the whole subject on the phone a fortnight later.
Tends to help
- One thing you have seen, named plainly, such as the food in the fridge or the tablets left in the pack
- A quiet moment with one person your parent trusts, rather than the whole family at the table
- Offering to ring the GP surgery yourself, if the worry is medical
- Framing it as one hour a day to take a job off them, not as moving out or giving up the house
- Leaving the subject open, so it can be picked up again in January without starting from nothing
Tends to make it harder
- Waiting until everyone has had a drink and the day has already been long
- Listing six months of worries in one go on the last evening, as you are leaving
- Arriving with a decision the family has already made without your parent in the room
- Turning it into a discussion about the house or the money before anybody has agreed help is needed
- Accepting the first "I am fine" and never coming back to it
How do you tell someone they need care? goes through the first conversation in full, including the phrases that tend to land and the ones that start an argument. If your parent has already said no, how do you get someone to accept care? picks up from there, and dealing with an irrational elderly parent is worth reading if the resistance comes with suspicion or a change in personality, since some of that has a medical cause.
What to do next
Four things to do in the week after you get home
These four steps turn what you noticed into help. None of them commits your parent to accepting anything, and the first three are free.
- 1
Write the list down while it is fresh
The same dayWhat you saw, which room, and roughly when. Keep it to things you could describe to a stranger. This one page is what the GP, the council and your brothers and sisters will all end up working from. - 2
Ring the GP surgery about anything medical
This weekWeight loss, a fall, memory changes and drinking very little all belong here. Ask for a medication review at the same time, since several tablets together can cause dizziness and falls. - 3
Ask the council for a care needs assessment
Free, and anyone can askYou ring adult social care at your parent's own council. A social worker or occupational therapist works out what help would cover and writes it down. The assessment itself does not depend on savings, and the financial assessment comes afterwards. - 4
Look at carers near your parent
Free to searchYou can look at who is available in their area and what they charge before anyone has agreed to anything, so that when your parent does say yes you are not starting from a blank page.
The assessment is the easiest step to put off, and it is the one that opens the door to council funding, to equipment and to an occupational therapist. What a care needs assessment is, and how to ask for one walks through the call and the questions, and local authority funding explains what the council may pay towards afterwards. If your parent is over State Pension age and needs help or supervision, Attendance Allowance is worth checking on its own: it is not means-tested, it is currently about £77 or £115 a week depending on the help needed, and the money can be spent on a carer.
When you are ready to see who could do the mornings, you can search for carers near your parent and compare their rates and reviews without signing up to anything. How many visits a week does my parent need? turns the list you wrote down into hours a week, which is what the cost and the rota are worked out from.
PrimeCarers is an introductory service rather than an agency, so you search, message and choose the carer yourself and agree the visits directly with them. Before a carer's profile appears we check their identity and their right to work, confirm an enhanced DBS on the Update Service, and interview them online. We do not check qualifications, training or references, so ask the carer about those yourself: their references sit on their profile for you to follow up. Carers are insured while they work.
Questions
Questions families ask after a visit home
The earliest ones are usually practical rather than dramatic: food going off in the fridge, a pile of unopened post, tablets left in the pack, the same clothes for several days, and a house colder than you would keep it. Changes in the body come next, such as clothes hanging loose or a hand on the furniture between rooms. One on its own is rarely a reason to act. Several together, and lasting weeks rather than days, usually means the week needs some help in it.
Say one specific thing you saw rather than making the case again, because a specific thing is much harder to argue with than a general worry. Leave the subject open rather than pressing for an answer that day, and come back to it. How do you get someone to accept care? sets out the stages families move through and what tends to help at each one.
Yes. The NHS says to go to A&E or call 999 if someone suddenly becomes confused. Infections are a common cause in older people, and urinary tract infections in particular, so it is often treatable once it is found. Forgetfulness that has built up gradually over months is different, and that is a GP appointment rather than an emergency.
You ring adult social care at your parent's own council and ask for one, or request it on the council website. The assessment is free, anyone can ask for one, and it does not depend on savings. A social worker or occupational therapist looks at what your parent can and cannot manage day to day. If help is needed, a separate financial assessment then works out what the council will pay towards it. Local authority funding explains what happens after.
Carers on PrimeCarers charge £18 to £25 an hour with our fee included, against £28 to £35 an hour through an agency. Companionship visits are usually a little lower, at £15 to £20 an hour. Under the contract between client and carer, bank holidays are charged at one and a half times the carer's rate and Christmas Day at twice the rate, so a week that includes them costs more than an ordinary week.
You can search carers, message them and speak to them on the phone within a couple of days, so a good deal of it can be done while you are still in the house. Whether a carer can start that week depends on their own availability over the holidays. Once visits are agreed, either side can end the arrangement on 48 hours' notice for hourly care. A visit the client cancels is still payable to the carer in full, apart from unplanned hospitalisation, illness, or another reason the carer agrees to.
Bring it back to the written list of what you saw and when, rather than to who is right about how your parent is doing. A care needs assessment helps here too, because it puts an independent professional's account of what your parent can manage in front of everybody. When siblings disagree about a parent's care goes through the argument and the ways families get past it.