Friday, October 12, 2012

Determing the Level of Care Needed

What are ADLs?
One of the most important ways of determining the Level of Care you need for a loved one is the number of ADLs they need assistance with along with the amount of assistance needed.

ADLs are Activities of Daily Living
They include the basic levels of self care; ambulation, feeding, dressing, bowel and bladder management (toileting), transfers (bed, toilet, wheelchair) and hygiene/grooming.

How Much Assistance is Needed?
Your loved one may be able to walk, but needs to use a walker, and must have help going up or down stairs. He can feed himself, but needs help preparing meals and cleaning up. He can dress himself if someone helps select his clothing and assists him with his socks and shoes. He can get undressed by himself. He needs help with bathing as he can't get in and out of the tub alone. He is able to use the toilet, but occasionally has accidents if he waits too long to go. Reminders would help.

Many private care, non-medical service agencies offer a wake-up and /or good-night care from a CNA (certified nursing assistant) or HHA(home health aide). wake-up careis comprised of a visit in the morning to help clients get ready for the day including grooming and hygiene which could include bathing if desired and dressing. The aide can prepare and serve a morning meal, and perhaps make a sandwich to be eaten at lunch.

The good-night care would be for bathing or bedtime care. Perhaps it could be scheduled to include meal prep for dinner or an evening snack. Or it can be schedule later in the  evening  and the aide can then tuck the patient in bed and make sure lights are out and the house is closed up and locked for the night.

Medication reminders can be given, but the medications have to be prepared in a med box, or the client able to dispense on his own from the prescription bottles. Only licensed nurses (RNs or LPNs)  can dispense medications. Medications can be set up in a med box and labeled by family members. Med boxes are available for once a day dispensing or with multiple sections for several doses a day.

If your loved one needs assistance with IADLs (Instrumental ADLs) such as housework, meal preparation, shopping, managing money, using the telephone, or using transportation you may need to hire care for more hours/day or days/week. Other IADLs can include safety and caring for pets or others such as a spouse. These issues can require even more care.

Make a list of tasks that are essential for someone else to help your loved one with, and those which you can assist with, and discuss with the caregiving agency.

Tips for Hiring
My best advise is to make sure you're hiring from a licensed and bonded agency. Not all agencies are created equal and not all are required to be licensed by your state. Licensed agencies are overseen and required to adhere to state requirements and standards of care for hiring and supervision to ensure safe, quality caregiving. Unlicensed agencies are not overseen to ensure that they adhere to standards of care. Some may provide excellent care, but if they don't there's no one to answer to. A licensed agency will have experienced nurses and personnel to assist you with selecting the type of care needed; where as the unlicensed agency may be run by a lay person with no caregiving experience.

If you hire privately, be sure to check references and have them demonstrate how they will assist your loved one with ADLs before hiring. You should observe any caregiver in the care they provide to ensure they meet your expectations.

Additional reading...
You Won't Know What You Don't Know
Aids to Help Keep Aging Family Safe