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When my father came to live with me almost 4 years ago, I thought he was completely self-sufficient and would just be sharing a residence with me. Little did I know how much care he actually needed. Looking back, I should have seen the signs - they were there; I just neglected to process them well.

For instance, when he visited me, he often brought a travel mug of coffee with him. As he continued drinking it throughout the morning, I asked him if he wouldn't want some hot, fresh coffee. "No", he replied "I'm used to drinking cold coffee" - this from a man of Swedish/Canadian decent, who always loved good coffee. As I questioned him further, I found that he didn't know how to use the coffee maker and so only drank coffee if there happened to be some in the pot. Since he was living with my sister at that time, I assumed that she must have had some fancy espresso machine or something similar. I was wrong.

Another clue should have been his weight loss. He chalked it up to the stress of living with my sister and her four kids. In reality, he didn't know how to prepare meals for himself when she was unavailable and so just didn't eat.

When considering whether or not your loved-one needs extra help, look carefully at some of the following signs.

Are his or her clothes clean and well-kept. Has he forgotten to add a belt; has she forgotten to change out of her slippers and passes it off as "being comfortable" or is he or she wearing the same outfit over and over again?

Does your parent or loved one show signs of deteriorating hygiene such as body odor, bad breath, unkempt hair?

Is his/her home as tidy as it should be? Of course, as seniors age, their surroundings won't be as neat as they once were, but they should still be clean. One woman I know was surprised to find tiny cockroaches scurrying to the corners when she opened her mother's pantry. Her mother had formerly been what she called a "neat freak". Changes in behavior are what matter most.

Speaking of pantries, check the cupboards to see if there is a good supply of nutritional food items. You might also check the trash to see if any of them are being used. Look in the refrigerator and note the expiration dates on perishable food items. I once found a package of cold cuts that had expired 2 months previous.

Are the bills being paid? This isÂ often difficultÂ to assessÂ because parents rarely wish to discuss their finances and it may require some detective work. One clue: if there are stacks of unopened envelopes on the desk, especially ones marked "overdue" or that have red outlines, this might be a concern. If available, glance through the checkbook.

Is your parent becoming socially isolated? Has he/she been attending church less frequently, avoiding social situations with excuses of fatigue or "other plans"? You parent may be fearful of driving or even fearful of being in a uncomfortable situation. Early dementia patients are especially prone to fears of socialization. Does she seem sad, anxious, confused ?

Are medications being taken correctly? This, too, is difficult to ascertain without some effort. Encourage the use of a compartmentalized medication container and then check to see if they are being taken each day at the correct times. I had thought my father had a good handle on his meds because he could tell me the name of each pill and what it was for but when I looked carefully, the medications were not always correctly placed and on some days, the medications were not taken at all!

Is there evidence of your parent falling prey to a phone or mail scam? My friend, Mindy, upon noticing her mother had numerous silver (colored) chains with crosses on them, commented to her mother on them. "O, they keep sending me those and I send them money, and they send more. Isn't that nice??" My own father bought a roll of "un circulated, soon-to-be-retired" nickels for $250.00. They were not what they were advertised to be. (And he did this WHILE living with me on a day that I was working.)

Lastly, are there bruises on his/her body? Some medications, like Coumadin or other blood thinners can cause some bruising, but bruising can also be a sign of falls. Elders will often make excuses such as "O, I was working in the garden" and not admit to the falls.

It's estimated that more than ten million senior citizens require some level of help in their daily living, ranging from simple chores to more complex caretaking.Â Always be aware that while it may be time for your aging parent or loved one to receive some type of help, they will probably be too embarrassed to ask for it.Â It's up to us as loving children to begin to discuss and determine what those needs are.

Shelley Webb has been a registered nurse for almost 30 years, with experience in the fields of neonatal intensive care, dialysis, case management and eldercare. When her father came to live with her in 2005, the advantages of her medical experience became clear. Due to his dementia and congestive heart failure, her father was not able to care for himself alone any longer and so she took over these duties.

Having experienced the helplessness, frustration, overwhelm and even loneliness that caregiving for an aging parent brings, Shelley is well aware of the emotional and educational support that caregivers need and so she began The Intentional Caregiver web site. With its weekly newsletter, daily news updates and monthly audio interviews of experts in eldercare and supporting services, Shelley strives to encourage and educate caregivers so that they can be empowered to provide the best possible care for themselves while caring for their aging loved one(s).

Please see: http://www.IntentionalCaregiver.com