There are many instances when living at home is the best choice rather than a placement to an assisted living or retirement facility. Home care and supplemental community services set up appropriately, can avoid crisis, improve safety, enhance independence and enable one to live and recuperate in the comfort of their home.
In some instances, making the decision to move to a facility and sell a home can be the best choice, however, it can’t be reversed, once completed.
To decide the right level of care at home or the right time or place to move you need to look at options available, social support systems, ability to manage self care, mental status, medical prognosis, personal preferences and financial status. Eldercare Specialists can provide a complete geriatric assessment and plan to help you make the right choice that will provide independence, happiness, health and safety.
First Step: Determine the Level of Assistance Needed with Activities of Daily Living
Activities of Daily Living (ADL’s) are the simple daily activities are fundamental for caring for one self. They include bathing, dressing, getting out of a bed or chair (also known as transferring), using the toilet, eating and walking.
Instrumental Activities of Daily Living (IADL’s) are the activities related to independent living. They include managing finances, preparing meals, maintaining the house (shopping, cleaning, laundry), taking medications, using the telephone, handling mail, driving or using other transportation.
Determining the type of ADL and IADL assistance required will help you determine how much care is needed in the home or the appropriate level of care at a facility.
Admission policies to facilities and community programs are based on ADL assistance.
Second Step: Determine the Level of Memory Loss or Other Cognitive Issues
Dementia impacts a person’s memory, judgment, insight, behaviors, appropriateness and psychiatric status. Understanding the cause of the dementia and how it might progress is critical to planning for the level of care needed at home, community services and the appropriateness and timing of a move. The level of impairment and types of behaviors exhibited can limit placement options and impact an individual’s ability to remain at a facility long-term. This is important to consider because you only want to move somebody one time.
Third Step: Determine if Current Status can Be Rehabilitated or is Progressive
Health changes can be related to the progression of a chronic illness, psychiatric illness, an acute illness or the combination of the above. The goal is to develop a plan that meets the physical, social and psychological needs of the person receiving care and to determine if the care needed is rehabilitative or habilitiative.
Habilitative planning is used when someone has a progressive prognosis and will gradually lose the ability for self care. The goal is to keep the individual at their highest level of independence and function. The long-term care plan determines the level of care needed over time and if or when a move might be appropriate.
Rehabilitative planning is used when a person is expected to make a partial or full recovery. The focus is to encourage the person to regain skills with the goal of reducing assistance and restoring independence. In these cases, staying at home with assistance and rehabilitation services is usually the best choice.
Fourth Step: Determine the Individual’s Personal Preferences
If the individual wants to stay home, can afford the care and a safe environment can be created, this choice should be respected. The laws in California require that a person’s wishes be respected and state that everyone has the right to live in the least restricted and safe environment.
Fifth Step: Determine Current Finances Available and Long Term Costs of Care
Assessing finances includes looking at assets, income; long-term care insurance and entitled benefits (VA, Medicare and Medi-Cal). Financial planning is critical to the care plan because it is critical that the finances and benefits cover the cost of care for the individual’s lifetime.
Your team of geriatric care managers and healthcare advocates helped me respect my mother in law’s wishes to stay home. I don’t know how we would have done it without you. You were consistently there with helpful suggestions, for doctor visits, and, yes, even for emergencies. You were caring and gentle yet forceful when things needed to be done. We are all grateful for how you worked with her and for your wonderful, and much needed, family support.