NEW YORK ( MainStreet) — With all the buzz over the rocky rollout of the Affordable Care Act , some nitty-gritty household health care decisions may have slid to the back burner.

But that doesn't mean those problems are going away.

Consider the Genworth Cost of Care Survey , which reports that 70% of American over the age of 65 will need private care services "at some point in their lives" and that families dealing with private, in-house health care are in for some serious sticker shock: an average daily rate of $65 in 2013 , up 6.56% from 2012.

The monthly cost for an assisted living facility rose 4.55%, to $3,450 — for one-bedroom, single-occupancy residence.

Those are frightening numbers, no doubt, to middle-class, Main Street Americans. The first step is to know whether it's yet time to deal with those numbers.

Aging Outreach Services , a Southern Pines, N.C., elderly care services provider, wants to help, with a list of "warning signs" that let household decision makers know its time to start thinking about in-house, elderly care help.

"We all want to feel like the time we spend with our elderly loved ones is of value and not a burden, but the truth is they tend to have set routines that help keep them stable day to day, and it's natural for our presence over the holidays to cause some different behavior from them when we disrupt those routines," says Amy Natt, a certified geriatric care manager at the company. "However, if we observe a number of these behaviors over the holidays and their personal safety in the home becomes a concern, we may need to explore options for how we can obtain in-home assistance for them."

Natt offers a "red flags" list of behaviors that may signal the need for in-home care planning:

  • A change in memory
  • Bills not being paid on time or mail piling up
  • Missed doctor appointments
  • Personal hygiene (such as clothing or hair) becoming difficult to maintain
  • Kitchen problems, such as scorch marks on pots or other signs of fires from cooking
  • Grocery supply (such as limited food or lots of expired food)
  • Weight loss or gain
  • Home repairs and yardwork not being maintained
  • Isolation or skipping activities formerly of interest
  • Driving issues, such as accidents, tickets or car repairs not being addressed

If you notice some of those signs in a senior family member, don't panic and start calling in-home care providers — at least, not yet.

The next step, she advises, is to start a conversation — and listen. After that, if you feel additional steps are warranted, start vetting local private home care service providers (the Private Care Association has a thorough list of member registries that conduct background checks and check the references of professional in-home care groups near you.)