How Do I Know It's Time for In-Home Healthcare? (Part 3) - Elder Care Channel

How Do I Know It’s Time for In-Home Healthcare? (Part 3)

Preceded by Part 2

Mobility Test

One easy way to assess mobility is to have your parents try to do this simple test:

  • Mobility Deficiency
  • Get up from a chair without using hands
  • Stand still momentarily
  • Walk to a wall 10 feet away
  • Turn around without touching the wall
  • Walk back to the chair
  • Turn around again
  • Finally, sit down without using hands

Individuals with difficulty or demonstrate unsteadiness performing this test require further assessment.

Putting the above two scorecards together gives an overall score of 7. Again, there is no science to this, but the overall sense this gives you is that your elder parent is most probably in need either of your assistance as a caregiver, or through a home health service, or at an assisted living facility.

Perhaps much lower scores, depending, could place your parent or loved one in the category of “moderate need”, which could translate to requiring part-time assistance. However, again, this is a decision for the whole family. A geriatric planner or care manager also can assist in the “scoring” and understanding the needs of your parents to a fuller extent.

But for a very quick assessment, you could start with a quicker evaluation:

For example, you could list several of the important activities of daily living and assign a score of importance to each one. Depending on how high the score is, they could require different levels of in-home health care.

Example of a quick scorecard for ADLs and IADLs.

Points Need
2 Do they need hands-on help or standby assistance with bathing
1 Is cueing with toileting, such as changing protective garments, cleansing, and washing hands needed?
1 Are reminders necessary to maintain adequate food intake or assistance cutting up food?
2 Do they require verbal or physical assistance to complete dressing or undressing within a reasonable amount of time?
2 Are they unable to keep self or their environment clean?

Add the points. The level of assistance they may require is as follows:

Total Points Level of Care
2 Supervision (such as remote cameras, frequent check-in calls for medications)
3 Limited help (such as home visits)
4 Total help (8 hours or more of home health care)

Keep in mind this is only a general way to assess your parents’ situation, and you must also take into account the frequency with which a parent would require adequate assistance in their ADLs (e.g. rarely (1), sometimes (2), never (3).

Another quick assessment approach to see if your parents or loved ones have health needs that generally can be self-managed is to score their ADLs, add them up, and see if they have deficits in two of the six ADLs with at least a score of 2. In addition to this, you would see if your parents also have a:

  • minimum score of 2 in the need for supervision (above) OR a
  • minimum score of 2 in memory/cognition deficits (above).

Any score of 2 or more may mean they require at least some level of home care.

Finally, I did not include the obvious need for skilled nursing including end-stage cancer or other diseases, advanced stage skin ulcers, ventilator care, etc. These are obviously issues that must be addressed together with you, your parents’ physician and/or nurse.

Again, the scorecards we provide are examples only, and your final decision will naturally be more subjective. Each family should consider their own needs and necessities on an individual basis. In addition, keep in mind that home health care involves a spectrum of levels. Your elder parent might need just a visit or two a week to get help with cleaning because she can’t move her vacuum cleaner anymore. Someone with poor vision might need a ride or two a month.   Also be aware of the fact that these needs are dynamic, and can change constantly. My father has had several small strokes that gradually has led him and my mother to require higher and higher levels of care. This meant we had to re-assess each time the level of care he requires.

We invite you to share your comments to help us shed more light on this important topic.