At 92, Ellen has lived alone in her little house much longer than many. Now she's been hospitalized for dehydration and congestive heart failure. Her family is trying to figure out the next step. Since she probably won't be able to live alone any longer, can she live with her daughter and son-in-law, who have to be out at work every day? Is this a situation of "can't live alone," or is she at the point of "can't be left alone?"

No one has the funds to afford to pay for someone to stay with her for the 10 or so hours she would be alone every day, so that's not an option.

Ellen's daughter and I brainstormed a bit:

First, when Ellen leaves the hospital, will she be able to get in and out of bed and walk without assistance? Right now, she can't. But she still has a few days before she is discharged. If she can't safely move around, then she will not be safe alone for so many hours every day.

Because her thinking appears to be clear, if she can safely get around she would probably be OK at her daughter's home during the day until her medical condition worsens. However, because of her present weakness the odds are that she will not be able to be alone and without help when she leaves the hospital. This means that it will be too risky for her to be alone at her daughter's home while everyone's at work.

So I recommended that her daughter and her doctor do their best to get her to agree to spend some time in a rehabilitation facility. If and when she can get around on her own, then she will be able to safely live with her daughter.

"So what are the other signs that we can't leave her alone during the day?" her daughter wanted to know. "I know she can't live alone, but when do we know she can't be left alone at all?"

The answer to that question depends a lot on the cognitive abilities of your senior. If he or she has good judgment, then the option of being alone during the day will last longer than if judgment and/or memory are poor.

These are the typical things that move a senior from "can't live alone" to "can't be alone."

Wanders

A senior who is at risk of wandering out the door and getting lost can't be left without supervision. Even running to the store for an hour can be risky when you are responsible for a wanderer.

Can't Get Out of Bed or Chair Without Assistance

A full day is too long for anyone to be alone and fully chair-bound or bedbound. A senior with full mental capacity can usually be left alone for an hour or two as long as there is no other physical risk and there is easy access to a telephone or emergency alert system.

Moderate to Severe Dementia

People with moderate to severe dementia are too unpredictable to be left alone. They are unable to make good decisions in an emergency, and they are too likely to find some sort of trouble to get into.

Difficulty Swallowing

Anyone who has difficulty swallowing without choking should never be left alone. Even without food or drink, it is possible to choke on one's own saliva. Should a choking incident occur, it will take too long for emergency help to arrive, even if the person is able to signal the need for help.

Indulges in Dangerous Behavior the Minute Your Back is Turned

The person who will do anything to get his hands on alcohol the moment you aren't looking is not safe alone in the house during the day. Ditto for the diabetic who will eat anything and everything the moment you aren't watching, and for the smoker who burns carpet and clothing when not closely supervised. You won't want to leave someone alone for any length of time who might do something to injure either themselves or the house.

As long as she is independently mobile and her heart failure doesn't get significantly worse, because Ellen is alert and aware she will probably be safe at home during the day. From this point forward she will probably need some help with things like transportation, bathing, preparing meals, housekeeping and laundry, and perhaps keeping up with her medication. These are things that her daughter and son-in-law will be available to help with after work and on weekends.

As her congestive heart failure progresses or if she loses mental capacity she may eventually have to move to a care facility where professionals can watch over her all day and all night.