Making a Decision for Type of Care:
There are many instances when home care is a perfectly appropriate care choice rather than nursing home placement or a permanent move to a retirement or assisted living facility.
How does one determine if home care is the appropriate care choice for a particular person? The information below can help in the decision-making process.
Look at Activities of Daily Living Needs when Referring for Care
- Activities of Daily Living are everyday personal care activities such as bathing, getting dressed, getting in or out of bed or a chair, using the toilet, eating and getting around or walking.
- Instrumental Activities of Daily Living are activities related to independent living and include preparing meals, managing money, shopping, performing housework, taking medications, using a telephone, handling mail, etc.
When making a referral for care following an illness or injury, one should assess the person’s physical or mental limitations, using the following three-part scale for each activity.
- Independent (performs tasks without assistance)
- Assistance Needed (performs tasks with assistance from human being or support device)
- Dependent (unable to perform)
When aspects of daily life become challenging, a natural reaction for many people is avoidance. Caregivers should develop a habilitative or rehabilitative care plan that meets the needs of the care recipient.
- Habilitative care is appropriate in situations where a person is expected to gradually lose the ability to provide self-care and live independently, to help the person function at his or her highest possible level in the least restrictive environment.
- Rehabilitative care is appropriate in situations where a person is expected to make a full or partial recovery, to assist and encourage the person to relearn or regain skills with the goal of restoring independence.
Decision Tree to Assist when Making a Choice for Care Needs
Follow the subject titles on the left column and circle appropriate responses for each. If more responses fall under either Home Care or Possibly Move to a Facility, strongly consider that category for the care choice.
| Home Care | Prossibly Move to a Facility | ||||
| Independent | Minor Care | More Care | Full-Time Care | Total Care | |
| Emergency Response | Independent. Able to negotiate stairs and call for assistance. | Able to respond appropriately. | Probably needs assistance. | Needs major assistance. | Needs total supervision and assistance. |
| Mobility | Walks and transfers independently. | Walks and transfers independently. If falls, infrequent. | Transfer: stand-by assist may be needed. Falls frequent. | Transfer: needs assistance, one-person transfer. | Transfer: mechanical lift/two-person transfer/bedfast. |
| Activities of Daily Living • Bathe and dress | Able to accomplish all without assistance. May need assistance in meals and/or housekeeping. | Needs some assistance and reminders. • Bathe and dress • Toilet use • Grooming • Take medications Independent to: | Needs reminders and assistance. | May need heavy assistance for all. | Total assistance in all areas. |
| Socialization and Recreational Activities | Completely able to socialize and enjoys recreation. | Would benefit from socialization and activities. May need minor encouragement. | Needs reminders/ encouragement to participate in activities. | Needs escort to participate in social activities, maintain self at home. | Encouragement/ escort to activities or one-on-one activities or visits. |
| Mental Status | Oriented to place, time and self. No memory impairment. | Oriented to place, time and self. Slight or no memory impairment. | Mild memory impairment. Sometimes disoriented. | Impaired memory. Poor orientation. Mild confusion. | Needs 24-hour supervision. |
Understand that making a decision to move into a facility and sell a home is an unalterable decision, once completed. Care should be taken to perform a complete assessment of medical conditions and prognosis, formal and informal support systems available for assistance, financial ability for care, mental status and family customs prior to making any formal recommendation for long term care that involves a move away from home.
San Diego Home Caregivers can provide a complete geriatric assessment with a suggestion for care needs. Call us today!
