How to Tell If Your Parent Is Managing at Home: What a Nurse Looks For

Thanksgiving is one of the few weekends in the year when adult children sit in their parents' kitchen for more than an hour. It is also, for a lot of families in British Columbia, the weekend they notice something.

Nothing dramatic. The fridge has three open jars of the same thing. There is a scorch mark on the counter that was not there last year. Your mother has always been slim, but her rings are turning on her finger. Your father, who used to phone every Sunday, has started letting it ring.

Most people drive home with a vague worry and no idea what to do with it. Here is what is actually worth looking at, and what a Registered Nurse checks when a family wants a second opinion.

What to look for while you are there

None of these are diagnoses. They are the things that tend to show up first, and every one of them is visible to someone who is simply paying attention.

• The fridge and the rubbish bin. Expired food, very little food, or a lot of food bought and not eaten. Duplicates of the same item usually mean someone could not remember what they already had.
• The pill organiser. Whether it is being filled and emptied on schedule tells you more than any answer to "are you taking your tablets?" Half-full compartments from last week are worth noticing.
• The mail. Unopened envelopes, anything official left in a pile, or a final notice for a bill that has always been paid on time.
• How they get out of a chair. Watch the first three seconds. Pushing off hard with both arms, or a pause to steady before the first step, is a change worth remembering.
• Bruises on the forearms and shins. These are the marks of catching yourself on furniture and door frames. People almost never mention them.
• How clothes and rings fit. Weight loss shows up here long before anyone stands on a scale.
• The volume of the television. And whether conversation in a room with background noise has become hard work. Hearing loss can look a great deal like confusion, both to families and to the person living with it.
• Whether they are still going out. Someone who has quietly stopped driving, or stopped going to something they used to enjoy, has usually made that decision for a reason they have not shared.

Why "they seem fine" is so hard to check

Two things make this difficult.

The first is that people rise to a visit. Your parent has known you their whole life and would rather be your parent than your patient. An afternoon of good conversation is not evidence of much, and both of you know it.

The second is that the usual route to an answer is not built for this. A ten-minute appointment, arranged by the person you are worried about, at a clinic they need a lift to reach, with a doctor who sees them already seated in a chair, will not catch most of what is on the list above. That is not a failing on the doctor's part. The information is back at the house.

What a Registered Nurse checks during a home visit

A home health check is a licensed Registered Nurse coming to the house and spending real time in it. A visit covers:

• Blood pressure, heart rate and oxygen saturation
• A medication review — what has been prescribed, what is actually being taken, and anything duplicated or out of date
• Mobility and balance, watched in their own rooms, on their own stairs
• Appetite, sleep and mood
• A written summary that you and their doctor can both read

Cholesterol screening and A1C can be added if you want numbers rather than impressions. And because our nurses are often in the house anyway for ear wax removal, the two are frequently booked together — worth knowing if the television has been getting louder.

A nurse does not diagnose and does not replace a family doctor. What the visit produces is an informed, written account of how someone is managing at home. That is a far more useful thing to bring to a GP than "I think Mum has gone downhill."

What it costs

$250 per visit, or $220 for seniors, plus GST. Cholesterol screening is $60, A1C is $60, or both for $100. If a nurse is already booked for ear wax removal, adding a wellness check to the same appointment is $150.

Where we visit

We visit private homes and senior residences in Vancouver, Surrey, Burnaby, Richmond, Coquitlam, Langley, Delta, White Rock, Abbotsford, Victoria, Nanaimo and Kamloops.

If the weekend leaves you uneasy

Trust that. The people who know someone best are usually right that something has changed, and usually wrong about what it is — which is exactly the gap a proper assessment closes.

Many families book a single visit simply to get a baseline, then repeat it quarterly so that any change is measured against something rather than guessed at. Others book once, get a clean report, and stop worrying. Both are good outcomes.

If you are concerned about someone's immediate safety, contact their doctor, or call 911 in an emergency.

Clear Health Group provides in-home health checks by Registered Nurses across British Columbia. Phone: 1-888-886-1210 | Website: clearohs.com