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The statistics are staggering: The number of caregivers of adults in the U.S. has increased by more than 8 million since 2015, according to a 2020 report from AARP and the National Alliance for Caregiving. The report also notes that 24% of caregivers are caring for two or more older adults at a time and that nearly 9 in 10 are caring for a relative.

As we age, we face steadily increasing odds that declining physical or cognitive health will affect our ability to function independently.

But how do we – and our family members – know when we have reached the stage where additional help is needed? And how do our family members decide where to turn to get the appropriate level of care?

Sometimes the need is obvious. A debilitating health event like a stroke or fall or a traumatic accident like a car crash can render someone incapable of self-care. In other cases, the signs may be subtle and accumulate gradually. Here are some indications it might be time for assisted living.

[ SEE: The Advantages of Assisted Living. ]

Warning Signs

The Mayo Clinic breaks the warning signs of decline into eight basic categories. Knowing these signals is helpful in determining when it is time for assisted living or a nursing home.

Is your loved one able to manage self-care?

Common signs of decline include poor hygiene, sloppy dressing and an unkempt appearance, says Maria Hood, director of admissions at senior care facility United Hebrew in New Rochelle, New York. “With my dad, we began to notice he wasn’t shaving, and his clothes were rumpled. This was a man who always took very good care of himself,” Hood says.

Also notice if the home is being kept up. Are the bills getting paid? Are the lightbulbs working? Are the appliances clean and the dishes put away? Is your loved one able to go to the grocery or drugstore? Any changes in household upkeep or personal care offer clues to someone’s health, the Mayo Clinic notes.

[ SEE: 9 Rewards of Caregiving. ]

Is there significant memory loss?

We all lose some memory as we age, and the occasional misplaced keys or disappearing remote control are nothing to worry about. What is worrying, though, is memory loss that affects bigger issues, such as where you are, how to drive and what you just said minutes ago.

The Mayo Clinic’s signs of this type of memory loss include:

  • Asking the same questions over and over.
  • Getting lost in familiar places.
  • Being unable to follow instructions.
  • Being confused about location, time and well-known people.

Is your elderly loved one safe in the home?

Check the home for clutter, loose rugs, exposed electrical cords and other dangers that could cause a fall. If your loved one seems in danger when climbing stairs or moving normally about the house, that is a red flag.

In addition, are they able to reach dishware, tools and other daily objects easily? Can they read and follow instructions on medication and other labels? Have you seen worrisome incidents, such as falls, dropped glasses or missed medication doses? A safe home is paramount to keeping your loved one well.

Lisa Dunlap, a geriatric and holistic nurse practitioner at Nurse Your Soul in Wilmington, North Carolina, says, “A lot of care falls through the cracks for seniors when living at home unless they have a person who is able, willing and devoted to their care 24/7.” If your loved one isn’t getting all their necessary care, it might be one of the signs they need a nursing home or an assisted living caregiver, depending on their health needs.

[ READ: Nursing Homes vs. Assisted Living. ]

Is your loved one safe driving a car?

We all make jokes about the old man driving too slowly in the left lane, but the reality is that 60% of older adults do drive with at least mild cognitive impairment, according to a 2022 study in Innovation in Aging. Hood noticed her father driving “white-knuckled” at 45 mph in a 65 mph zone and took it, appropriately, as a sign that he was no longer safe on the road. Slowed reflexes, diminished vision and hearing, and increasing confusion all make driving a challenge as we age.

In addition, if you notice more dents and dings in the car, or if your loved one has gotten a ticket or a warning for a driving mishap, those are signs of the need for an intervention.

Has your loved one lost weight?

Unexpected and unexplained weight loss could be a sign of either physical or mental health problems – or potentially both.

The Mayo Clinic says weight loss could be a result of:

  • Difficulty cooking. It may be hard to summon the energy or desire to cook, hold and manipulate cooking tools, read labels or follow directions and recipes.
  • Loss of taste or smell. Aging naturally causes diminishment in these senses, and when food doesn’t taste or smell good, eating becomes less enjoyable.
  • Socioeconomic issues. Your loved one might find grocery shopping physically difficult or too expensive if they have financial pressures.
  • Other health conditions. Weight loss can be a symptom of a serious underlying medical problem, such as malnutrition, dementia, depression or cancer.

Has your elderly loved one’s mood or spirit changed?

Everyone gets sad, and the elderly often have a lot to be sad about, with the loss of friends and family, chronic conditions and the everyday challenges of growing older. But clinical depression is not a natural product of aging. Many seniors maintain a happy outlook most, if not all of the time. If you notice a change in mood that lasts longer than you might consider normal, it could indicate clinical depression or another illness.

Is your loved one socially active?

Social engagement is one of the primary markers of good physical and mental health. The COVID-19 pandemic has made that difficult for everyone, and seniors can suffer from isolation like the rest of us. Check in on your loved one to see if they are staying as active as possible, connecting with friends, maintaining hobbies and participating in the activities they enjoy. If they have lost interest in being socially active, that is another red flag.

Is your elderly loved one walking safely and steadily?

Do you wince every time your aging mom or dad walks across the room? Do you hop up to help with even short walks from the table to the sink? Do they seem likely to fall?

Aging can lead to muscle weakness, stiffness and pain in the joints, balance problems and other issues that affect gait and steadiness on their feet. Falling is a primary cause of disability in the senior population, so any sign of walking difficulty should be addressed immediately.

Making the Choice

If your loved one needs more help than you can provide, there are different levels of care available, including home health aides, assisted living facilities and nursing homes. Experts recommend you familiarize yourself with the differences among these options long before you need to make a choice so that you are prepared in the event of a health crisis.

Talk to your loved one’s doctors, or case manager if they have been in a hospital, to determine what level of care is best to improve quality of life. Another option is to hire a geriatric care manager, who can help you navigate the options in your community.