When a parent is not eating much
Loose clothes and a full refrigerator are usually what a family notices first, and the question of why belongs to a doctor.
Why this comes up
Say you opened your father's refrigerator on Sunday and the groceries you bought the week before were still in the bag. He says he eats. His belt is on a different hole than it was in the spring.
Almost every family misses this at first. Weight comes off an older adult slowly, winter clothes hide it, and a parent who eats one real meal a day will tell you honestly that he ate today. Nobody hands families a number and says this is the point where you step in. So families notice late, and then feel guilty about it for a week.
Getting a weight and making an appointment is enough for today.
How much weight loss is worth acting on
There is a published threshold, and it is lower than most families guess. In its review of unintentional weight loss in older adults, the journal American Family Physician defines it in adults older than 65 as a loss of 5 percent or more of body weight over a six to twelve month period. For a man who weighed 180 pounds last winter, that is nine pounds.
If nobody has a baseline weight written down anywhere, that same review says a change in clothing size or an estimate from a relative can stand in. Your sense that his shirts have gotten big on him counts.
That review also reports how often a workup comes up empty. After an initial evaluation, somewhere between 6 percent and 28 percent of cases still have no identified cause. A thorough appointment can end without a clear answer. That is deflating after a week of working up to it, and the visit is still worth making: the clinic treats what it can see, and a weight on file now gives the next visit something to compare against.
What the clinic is looking for
Families want to know what is wrong with him, which is what the appointment is for. The American Family Physician review sorts the causes it studied into broad groups: nonmalignant gastrointestinal disease accounted for 9 to 45 percent of cases, and malignancy for 19 to 36 percent. It also points at medications, since drug side effects and the sheer number of prescriptions a person takes can alter the sense of taste or suppress appetite, and its tables list drug classes tied to dry mouth, trouble swallowing, and nausea.
Those ranges are wide because the underlying studies disagree, and none of them can tell you which group your father falls into. A physician with his chart, his medication list, and his labs can start narrowing it down. That is the clinic's job, and it takes a visit.
A second set of reasons comes out of how his days go at home. We see this part in houses, and families rarely bring it up at the clinic. A parent who cannot stand at the counter for twenty minutes stops cooking. A parent who used to eat across the table from somebody eats standing at the sink now, and eats less while he is at it. Teeth hurt. A pork chop needs cutting and there is nobody there to cut it. A chart rarely records any of it, and weight comes off all the same.
What to bring to the appointment
A few specific things will make the visit more useful.
- A weight. Same scale, same time of day, shoes off, written down. Two weights a week apart beat one.
- Everything he takes, including the things he does not count as medicine: over-the-counter sleep aids, antacids, supplements, eye drops.
- Three days of what he actually ate. "Toast, coffee, half a sandwich around four, nothing after" tells a doctor more than a tidy food diary.
- Anything you have noticed about his mouth or his swallowing: coughing during meals, a wet-sounding voice afterward, food parked in one cheek, bread he pushes away.
- Whether anything changed around the time the eating did: a move, a death in the family, a new prescription, a hospital stay.
If you only manage two of these, bring the weight and the medication list. Nobody will send you home for showing up with a partial picture.
Swallowing and nutrition can both be worked on at his house if it comes to that. Minnesota's home care statute counts dietitians, nutritionists, and speech-language pathologists among home care services, so that work can happen at his house.
What help with meals at home actually looks like
Families expect a caregiver to cook, and cooking is some of it. Minnesota's licensing statute splits the mealtime tasks into two groups. A basic home care license covers "assisting with dressing, self-feeding, oral hygiene, hair care, grooming, toileting, and bathing," and separately covers "assisting with laundry, housekeeping, meal preparation, shopping, or other household chores." That second group is allowed only alongside at least one of the hands-on tasks in the first. Cooking by itself is not a licensed home care service in this state.
In practice that rule rarely blocks what a family wants. A visit gets built around the hands-on help as well as the cooking: personal care at the table, plus companionship and household support for the shopping and the meals. Ask an agency how it would structure a visit where the meals are the real problem.
In most houses, company and timing matter more than the cooking. The help that matters is somebody who shops for the four things he will eat, who is in the house at five thirty when he gives up on dinner and has cereal, and who sits down with a cup of coffee while he eats. If you want to see how an hour gets spent, what a visit looks like walks through one.
If breakfast is fine and dinner disappears, put the hours in the late afternoon.
When it becomes a nursing question
Some eating problems move past what an aide is allowed to handle. Minnesota's statute treats them as their own category: a comprehensive home care license covers "assisting clients with eating when the clients have complicating eating problems," which is the state's language for swallowing difficulty, aspiration risk, and feeding that takes a nurse's judgment.
If your father is at that point, an agency holding a comprehensive license has to get a nurse into the house quickly. Under Minn. Stat. 144A.4791, subdivision 8, a registered nurse must complete an individualized initial assessment in person within five days after services are first provided. Subdivision 9 requires a written service plan finalized within fourteen days. In practice a nurse comes to the house during the first week.
If your father is in that second category, ask any agency whether it holds a comprehensive license, because a basic one cannot staff it. Abloom Senior Living holds one, and supports G, J, and GJ tube feeding in clients' own homes along with nursing visits and dementia care at home. If you do not know which of the two he needs, the nurse settles that at the assessment. Personal care or nursing lays out the difference.
Meal programs in the East Metro
Paid hours are one route. Minnesota also runs a meal program for older adults. The Minnesota Board on Aging's Senior Nutrition Program is made up of dining sites and home-delivered meals. Its page on food for older adults says anyone 60 or older can take part, and a spouse can come along even if under 60. Participants contribute toward the cost as they are able, and the state sets no price.
To find the dining site or the home-delivered meal provider for his city, call Minnesota Aging Pathways at 800-333-2433. The counseling is free and the counselors are not selling anything.
Medicare does not cover meals at home. Medicare's own page on home health services lists "Home meal delivery" among the things the benefit leaves out, along with "Homemaker services (like shopping and cleaning) unrelated to your care plan." What that leaves is the meal program above, private hours, or a long-term care policy if he has one. The meal program takes one phone call, so check it before you price paid hours.
When dementia is part of it
Dementia changes eating in its own ways. A plate holding four separate things can be too much to sort out. A parent may lose track mid-meal that she was eating, or hold food in her mouth without swallowing, or announce at six that she already had dinner.
Arguing about whether she ate does not get food into her. Food she can pick up and carry with her helps, as do fewer things on the plate at once and the same seat at the same hour every day. Dementia care goes into how caregivers build a routine around the parts of the day that are hardest.
If home stops being enough
Sometimes weight keeps coming off even with help in the house, and the care a parent needs stops fitting inside visits. What comes next depends on what has changed: assisted living, a small residential home, or a nursing facility. Abloom Senior Living runs a five-resident home in Woodbury, and you are welcome to walk through it long before anybody needs it. You do not have to decide any of this now.
Where to start
If the weight is the thing keeping you up at night, start with his clinic. If what you need is somebody in the house at the hours the meals go wrong, you can request in-home care and describe it in your own words. Someone will come out and look at his kitchen with you, or you are welcome to come and see the Woodbury home first. Abloom Senior Living may not be the right fit for your family. If that is how it turns out, we will say so and point you toward someone who is a better match.
This article is general information from a care provider in Woodbury, Minnesota. It is not legal, financial, or medical advice. Program rules, coverage, and your parent's clinical situation all turn on specifics, so check anything here against his own clinic, his plan, and the agency you are considering.
Frequently asked questions
How much weight loss in an older adult is a problem?
American Family Physician's review of unintentional weight loss defines it in adults older than 65 as a loss of 5 percent or more of body weight over six to twelve months. On a 180 pound frame that is about nine pounds. If no baseline weight exists, the review says a change in clothing size or a relative's estimate can substitute. Bring whatever you have to his clinic.
Can a home care aide feed my mother?
Help with self-feeding sits inside a basic home care license in Minnesota, and so does meal preparation when the provider is also doing at least one hands-on task. Eating problems that carry a swallowing or aspiration risk fall under a comprehensive license, in the statute's words "assisting clients with eating when the clients have complicating eating problems." An agency should tell you plainly which license it holds and which of those two situations it is staffing for.
Will Medicare pay for someone to cook for my father?
No. Medicare's home health page lists "Home meal delivery" and "Homemaker services (like shopping and cleaning) unrelated to your care plan" among what the benefit does not cover. Medicare pays for part-time skilled visits when a provider has certified the need. Ongoing hours for cooking, shopping, and company are generally private pay or long-term care insurance.
How do we get home-delivered meals in Woodbury?
Call Minnesota Aging Pathways at 800-333-2433 and ask for the home-delivered meal provider serving his address. The Minnesota Board on Aging's Senior Nutrition Program is open to people 60 and older, with spouses welcome even under 60, and participants contribute what they are able toward the cost.
What if she insists she already ate?
Take her at her word and move on. Pressing the point usually turns a meal into an argument and does not get more food into her. Families get further by leaving something she can pick up where she sits, keeping a meal at the same hour each day, and tracking her weight weekly so the clinic has numbers to work from.
Related reading
- When a parent stops bathing
- Who can give your parent their medications at home
- Free help for East Metro families arranging care
Sources
- American Family Physician, Unintentional Weight Loss in Older Adults, 2021
- Minnesota Office of the Revisor of Statutes, Minn. Stat. 144A.471
- Minnesota Office of the Revisor of Statutes, Minn. Stat. 144A.4791
- Minnesota Office of the Revisor of Statutes, Minn. Stat. 144A.43
- Minnesota Board on Aging, Food for older adults
- Medicare.gov, Home health services coverage