In previous articles, we have discussed in detail the working of an assisted living referral service.  We have illustrated what goes into evaluating facilities, keeping a database, assessing needs and then matching seniors to facilities.  Soon we will talk about the dynamics of touring, negotiating, moving and follow up.  But the step between meeting the client family and touring the appropriate facilities is very interesting.  It is here, where the good referrals services are separated from everyone else.  As one would expect, the harder the referral agent works, the better the matches between the client and the facilities. 

Referral agents are paid by assisted living facilities when they refer a client, and that client moves in for care.  But with so many referral services competing and families contacting multiple agencies for help, what happens if a facility is contacted by multiple agents for the same client?  Certainly, the facility cannot pay both agents for the referral.  Well, as one would expect, the simplest policy is the one that is used; the first agency to inform the facility of the refer is considered to be the referring agency and any referral fee that comes due is issued to that party.

Therefore, it becomes a business necessity for the referral agency to inform potential facilities of their referral.  Usually, this is done on the phone, person to person, or by what is known as a “fax face sheet”.  Now, here is a question.  What is the best way to insure that your company will receive a referral fee when you are contacted by a new client?  Obviously, the most effective thing to do would be to inform every facility that you work with of the new client as soon as possible.  Of course, the facilities are going to became very impatient with your agency if they are receiving hundreds of notifications when very few of them are appropriate for their care.  Therefore, the facilities will request contact information on the clients to they can attempt to sell to them.

But imagine this, a client, in a time of desperation, contacts a referral service for help.  To help insure a referral fee, the agent gives this client’s contact information, personal information, to many facilities.  It will not be long before the client is inundated by calls from these hungry facilities.  Talk about giving assisted living referral companies a bad name!  Unfortunately, this is the norm rather than exception.  In fact, every company that I am aware of uses this nasty tactic.  In fact, some referral services do not even qualify their lists before they send out private information.  This means that families will be getting sales calls from facilities that cannot even meet their needs.  So you see, now the family is in worse shape than if they had never contacted a referral service at all.

Let me make perfectly clear that Assisted Living Placements does not participate in this malicious practice, nor condone it in anyway.  Companies that operate in this way have only one priority; money.  They have no interest in the well being of their clients.  Their only objective is to make money and that takes precedence over the well being of the senior citizen.  It is because of these unscrupulous companies, that some families are hesitant to reach out for help when they really need it.  These companies should be ashamed of themselves. 

Ironically, it is because of Assisted Living Placements commitment to the security and well being of our clients, we will not share personal contact information with any facilities, without the clients’ permission.  Even when we explain this to the facilities, they still hound us for the information and become irate and impatient.  In fact, the marketing director at one community, Westminster Terrace in Westminster California, insisted that we give out this private information and when we refused, became so outraged that she actually tried to cancel our contract.  Unfortunately for her, she did not have the authority to accomplish her goal.  I am happy to report that the rest of the staff at Westminster Terrace does not share this selfish and shortsighted mindset. 

Let’s reserve this topic for more study another day.  It really does cut to the heart of something I see as a great problem in this industry.  Until next time, Kindest Regards!

So, what we are seeing evolve is almost a “quasi-medical” type of facility, or perhaps more aptly, non medical facilities that are approved for medical procedures.  Indeed, this is more accurate because, at this point at least, the facilities themselves are still not providing the service.  What is happening is they are being allowed to admit residents that have had these previously forbidden conditions, or keep residents who, as time passes, develop these conditions.  In most cases, however, the condition is still being treated by a medical professional, brought in from an outside source by heath insurance.  But, I believe we are beginning to see the state of California vacillate on what the facility employees can do as well. 

Let’s look at an example.  The state of California has, historically, been adamantly opposed to assisted living facilities admitting or retaining a resident with a feeding tube.  Now certainly, this is a serious, invasive procedure, but there is no reason that, with training, the staff of a competent assisted living could not care for this resident.  Regardless, this is one of the conditions for which there were virtually no exceptions.  Recently, however, we are finding licensing representatives allowing existing residents to stay in assisted living, even after a feeding tube is inserted.  This is wonderful because in most cases this assisted living will have become “home” to the resident and forcing them to move during such a difficult time seems almost criminal. 

Another example also utilizes the feeding tube procedure.  We are now seeing some assisted living communities and homes being allowed to admit new residents with feeding tubes if there is a plan in place to wean the resident off the feeding tube.  Now, of course, it is always the hope that the feeding tube is temporary and that patient will resume oral nutrition, but sometimes that just doesn’t happen.  What we are seeing is that if that plan is in place, assisted livings can receive waivers to have the patient admitted immediately.  So I beg the question, what if that plan is never realized?  Say that the hope was to have the resident weaned in six months; at the end of that time will the state force the resident to leave?  I am betting that then we can extend that exception by claiming existing resident status.  This is good news for senior and family members of seniors who have difficulty eating.

Unfortunately, we are seeing a negative trend in the industry as well.  While the assisted living facilities themselves continue to provide excellent services and are even being allowed to take on more responsibly, the referral services that purport to help families locate these are becoming more and more numerous, greedy and underhanded.  Of course, as a referral service myself, I take great offense to this trend and will do my best to target these nefarious agencies.

Any internet search for assisted living will return endless results of companies that promise the sun and the moon in aiding in the search of assisted living.  Just plug in your info or give us some basic data over the phone and we will connect you with the best assisted living in your area, they say.  And yet, how many of them are actually doing a physical inspection of the property?  None, save Assisted Living Placements.  Do they advertise that they inspect; yes.  Do they; no.  These companies, many times made up of just one or two people, are playing a numbers game; providing lists of every facility in the area in hopes of getting a referral fee.  They are providing a disservice to the seniors.

Well, now I have gotten my blood up again, so I see that I will need to re-visit this topic in more detail.  I will go and cool off now, and soon be back with more info on this disturbing subject.  Until then, Kindest Regards

With that, I would like to take time to relay a situation I recently observed which really drives home the need for adult children to evaluate their motives when looking at assisted living.  We have discussed, previously, how adult children will often evaluate assisted living, not so much by how it will meet the parents needs, but rather by how they would like it.  This often happens unconsciously.  It happens often, and is usually a recipe for mistakes and hard feelings.  Just this week I have been dealing with such a family.

We received a call from a family that has to find a place for mom who is suffering from dementia.  The dementia is light to moderate but definitely dementia.  They quoted us a budget amount they were comfortable with and after discussing alternatives that met needs and budget constraints, we decided to look at Board & Care homes.  As we all remember, B&C homes are all licensed for dementia patients and are usually “one fee covers all”.   Our tour (Thanksgiving weekend – yes we are amazing) went very well and the family seemed very pleased.

Today we were contacted by the family and asked for a list of large apartment style assisted living communities.  Of course, this type of facility, the type the family is interested in, are prohibited by state law from accepting residents with a diagnosis of dementia.  This family was interested in pursuing the often used strategy of having a doctor change the diagnoses to ‘mild cognitive impairment’ so as to by-pass this law.  It seems that they had gone to one large community after our tour and felt that it was “head and shoulders” above the places they had just so recently told us were excellent.

Our problem here is three-fold.  First, if they do choose one of these assisted living communities they will be looking at another move, sooner rather than later, more than likely.  As soon as that dementia expresses itself in public, the assisted living community will begin to push to have her move.  They will not risk their license.  Second, the family, in looking at the large facilities increased the budget they were “comfortable” with by a full thousand dollars a month.  If we had been given this tolerance while looking at Board & Care homes we would have seen a different caliber of homes.  Finally, they are evaluating these assisted living choices for what they would like rather than mom.  It is a statistical fact that dementia patients do better in a small assisted living environment, rather than a large.

This is simply a classic case of good intentions leading a family down the wrong path.  Of course if they do choose a large community and then have to move, we will be their for them, but even one move is so hard on a senior.  I hope they will re-evaluate their motivation for a large assisted living community.  Board & Care assisted living is the proper choice in this case.

What motivates owners and operators of assisted living communities?  What is the bottom line?  Is the profit the bottom line, or is it the care and well being of the seniors, their residents?  Are they a business or a social service?  The answer is not as clear cut as it may appear at first.  In order to succeed, they must understand that they will have to satisfy a dual purpose.  They must learn to fuse together both motivating factors; by definition and by necessity. 

Assisted living communities are businesses.  In fact, 93% of licensed communities are for-profit entities and as such they must maintain profitability and a competitive edge in order to remain functional.  On the other hand, their customers are placing themselves in a vulnerable position which brings with it great responsibility.  One hand cannot be neglected at the expense other.   Assisted living communities must serve both their business interests and equally their social responsibilities.  This concept is all too often not understood.  The business aspects of assisted living do not have to suffer to offer outstanding service to residence and conversely, residents do not have to suffer for the business interests to best be served.  In fact, we will see that exactly the opposite is true.  Residents are best served by successful business practices and the business is best served by meticulous care of the residents. 

So why some do assisted living residences and communities survive, some thrive and others fail?  That is the topic we will be examining here in detail, in an attempt to identify and articulate the business model that experience shows to be the best recipe for success.  This is the first step to success.  Identify business models that work for similar entities and then reproduce that model.   Our goal is to create a blueprint for success that works in any market.

For thirteen years I have evaluated assisted living facilities.  As a third party, independent observer, I have had the unique opportunity to be invited into a significant majority of the licensed assisted living communities and homes in Orange County California.  I have truly seen the good, the bad and the ugly.  Being an independent observer is not the same as being an impartial observer.  There is nothing impartial about what I do.  Families trust me to find the best assisted living available for their loved one so I am bias by nature and when I visit communities and homes I do so with an agenda.  As an advocate for the seniors, I am looking for the very best assisted living options available.  But I am also an advocate for the assisted livings. 

When I visit an assisted living community or home, I evaluate the property from multiple points of view.  This provides me a valuable insight into the mechanics of what makes for the successful fusion of a business and a caring social service.  I am looking for the places that will best serve my clients.  Without exception, these are the communities best meet the needs of the residents while allowing the business entity to thrive.  They have to be attractive, they have to deliver on what they promise, they must be caring, they must be comfortable, they must be safe and they must be profitable enough to insure continued operation.  Remember, profit is not bad, unless it is taken at the expense of the residents.

As you will recall, we were attempting to describe a large assisted living community from the viewpoint of a resident.  In our last article we had travelled through our day to lunch time.  Now we pick up.  Remember, large assisted living communities are designed to promote independence and indeed seniors must maintain some independence for life to be viable.  So, we are done with lunch.  What now?  That is completely up to us.  We can go back to the apartment and take a nap or watch T.V.  If, however, we are interested in a little more activities, we can check with activity coordinator to see what is happening around the community.  If none of the scheduled activities interest us, we can utilize the community transportation to safely and conveniently go where we need to go; bank, doctor, mall etc. Again, the choice is ours. We are independent and do what we want.Now, during this time, just like all times, we can have access to care giving services, provided by the community. We setup these services with the staff in advance. we pay additional costs for these services, and they will be very regimented. For instance, we can have a caregiver come to our apartment at specific times to check onus; maybe we need help to the bathroom. Maybe we want them to check on us every two hours. What we cannot have is access to a caregiver at a moments notice. Even if we use our phone to call for assistance, response time is going to be poor. And we will run into issues is we call for unscheduled assistance very often.If we need assistance on a random schedule, we arc going to need to think about looking outside the community for help. some communities are fine with this and some communities do not allow outside services. Regardless, this kind of assistance is going to be very expensive. As we mentioned before, this type of assistance is best and most economically met at a board & care home.At dinnertime we head back down to the dining room, with or without scheduled escort service, as per our needs.  Wait staff will help us as needed. After dinner we are free to spend time in our apartments, doing as we desire, or we can join community activities. At bedtime we can have help as needed.During the night our limited safety net is in place. If we need help unexpectedly, staff is on duty, awake and ready to help. We do have to contact them, however, and this is why we say limited safety net. We can use the phone, or a pull cord, or maybe a pendent, but we do have to get their attention. If for some reason, we are incapacitated, and unable to signal for help, we will, in all likelihood, not be missed until we do not show up for breakfast. The only thing we can do to avoid this is to set up bi-hourly checks throughout the night.  Do not forget, this will cost extra. of course, we do relieve this kind of advanced care, and even more, automatically, at a board & care.And so ends the night. The next day, we get up and do it all again. And this is our very independent life in an assisted living community. It can be a wonderful, active environment, and it can provide us great support for peace of mind. But take time to understand the limits of the services and safety net, and make sure you understand the fee structure so you are not surprised.That is it for now. We hope you have found it informative and we thank you for reading.  Kindest Regards.

When a resident awakes to a new day in an assisted living community, they wake in their bed.  Remember, these are apartment communities and residents bring their own furniture.  Of course, the apartments are generally studio, one bedroom or two bedroom suites, so in most cases our new residents will have been downsized from a large home, but what they maintain is all their own.   In most communities our resident is responsible for making their own bed (if they want it made).  They may opt to have community staff make the bed for them but this usually entails an additional monthly charge.  Once a week, when the apartment is cleaned the sheets will be washed and laundered.  This service is included in the base fee.

Now for our residents morning.  Remember, a very rough statistic puts about 50% of residents at physically independent.  This means that, for these residents, they are free to spend their morning in any way they want.  They can get up, take a shower in their bathroom, maybe make a cup of coffee, get dressed, even make breakfast if that is their desire.  Of course the opposite side of this coin is the 50% of residents that do need assistance in the morning.  Care giving staff can provide little or much morning care.  Resident might need simple standby assistance while in the shower for safety or they might needs help getting out of bed, into the shower and getting dressed.  Our resident can choose how much care they need, but remember, the more one on one time with care staff, the more their monthly charges will be.

Breakfast.  As we mentioned, residents are more than welcome to make their own breakfast.  Almost all assisted living apartments come with a kitchenette, and many even have a full kitchen.  However, at all assisted living in California, three daily meals is part of the base fee.  So our resident can make their own meal, but they are still paying for the meals in the dining room that they do not eat.  If our resident does not feel well they can have “tray service” brought to their apartment.  Sometimes there is a charge for this service.  Today, our resident feels fine and is going to the dinning room for breakfast. 

One important thing to note and plan for is the trip to the dinning room.  In some cases the dinning room will be very far from the apartments.  If it is troublesome or dangerous to make this trip without help, escort service can be established, for an additional monthly fee.  As we have discussed previously, meals are served in the communal dinning room, which is usually run, restaurant style.  Services staff will take orders and deliver meals.  Some communities have assigned seating, at others you sit where you want.  Many dining rooms will have buffets and salad bars.  If it is difficult for the resident to utilize these amenities, the service staff can help. 

Breakfast is done.  No dishes for cleaning to do today.  Our resident is free to do what they will, and there are many choices.  They can join with any number of scheduled activities that are put on by the community.  These activities are part of the base fee.  There might be trips to casino or beaches (gambling money not provided!)  There will be arts and craft classes, card tournaments , walking clubs, any number of great activities.  Perhaps our resident has a doctor appointment.  They are welcome to take their car or the transportation provided by community.  In fact the community can even schedule doctor appointments and order and dispense medication, but of course, there is an additional monthly fee for this service.

More about transportation.  This service goes beyond trips to and from doctor appointments.  Transportation can also be established to malls, banks, stores and movies.  The transportation is usually very liberal.  Normally, it just needs to be scheduled in advance.

Half our day is down, and we will continue the day at another point.   This is enough to digest for this issue.  Our next episode will take up here.  Until then, Kindest Regards.

Assisted Living Communities are what most people envision when thinking of retirement communities.  These communities are for seniors that are still partially independent and although they can be licensed for any number the averages are between 50 and 300.  They are usually not licensed for people with diagnosis of Alzheimer’s or dementia as they simply do not have the supervisory structure necessary for these residents and equally important, they are not “secure facilities”.

The average age of seniors who move to these communities is 80 and just about 50% of them are still independent and could stay at home.  Their reasons for moving are usually because they are tired or cooking and cleaning and want a safety net of services available for when they may need it.  The resident generally chooses his or her medical doctor and dental services and can actually receive help making and maintaining doctor appointments.  Transportation to these appointments is also provided.  Mail is delivered to the community for each resident just like at an apartment.  Residents can even have computers with internet and many maintain a vehicle. 

Think of these facilities as apartment communities.  They are usually fairly large with multiple sizes of apartments.  More recently built facilities are designed with an emphasis on ease of use by disabled people. Bathrooms and kitchens are designed with wheelchairs and walkers in mind. Hallways and doors are extra-wide to accommodate wheelchairs. These facilities are by necessity fully compliant with the Americans with Disabilities Act of 1990 (ADA) or similar legislation elsewhere.  These are actual apartments and the residents get keys to their apartments.   They, in the vast majority of cases, bring their own furniture.  Most all of these facilities serve breakfast, lunch and dinner in a communal dining room. 

An easy way to understanding how these communities work is to understand how they charge residents.  The base fee is determined by the size and location of the apartment and the number of occupants.  That fee covers the rent of the apartment, all three meals per day for all occupants, housekeeping once per week, linen laundry (and sometimes personal), reasonable transportation, all utilities except for the phone and lots of scheduled group activities. 

So what does our base fee not include?  We spent so much time talking about the activities of daily living that I am sure you have spotted it.  It doesn’t include traditional care giving services!  This is why many of these types of assisted living communities advertise themselves as “independent and assisted living”.  If you go to one of these communities and just pay the base fee you are really must be independent because you are going to be alone, on your own, in a real apartment as long as you stay in there. 

Also included in the base fee is a safety monitoring system that is really wonderful.  24 hour dedicated and trained staff members are looking out for all residents’ best interests.  If, for example, a resident does not come down for a meal, the staff will realize this and call the apartment.  If no answer, staff will go to the apartment and inquire.  There is multiple staff on duty 24 hours per day.  If a resident needs assistance of any kind, they can call to the staff office and receive quick attention.  For some senior and families this will provide great comfort.  Unfortunately, it is the rare person that has not heard or known a senior who has fallen and was down for an extended period of time.  There is no way to ever completely remove the fall risk for seniors, but we can minimize it and assisted living can help with faster response time in case of emergency.

The socialization aspects of ALFs are very beneficial to the occupants. Normally the facility has many activities scheduled for the occupants, keeping in mind different disabilities and needs.  These activities are usually covered in the base fee and they can really offer an opportunity for fun, education and fellowship.  So many seniors slowly isolate themselves as they begin to face difficulty with ADLs.  These convenient enjoyable activities can really add to quality of life.  We have seen poker tournaments, trips to casinos, walking clubs, art classes, bowling leagues, computer classes etc.  Assisted living activities are one of the main benefits of community living.

When we think about the job of assisted living, we understand that they are designed to assisted in activities of daily living, or ADL’s.  As we grow older, very often it becomes more and more difficult to do the normal functions of living, such as dressing, bathing, etc, and we are called upon to make long term plans for this care.  Sometimes, when our needs are minimal, we can start by making due with help from spouses or family.  Sometimes some in-home care hours provided by a licensed company, or we might choose to move to a very active, assisted living community that promotes independence. 

But unfortunately, because we are living longer, we often completely lose the ability to preform some of these acts without help, or we become incapacitated to the point that we need help with all of the ADL’s throughout the day.  Here, our only choice becomes twenty-four hour care.  Whether we receive this in home (a very expensive proposition) or in a Board & Care type home, we need our caregiver to be available at a moments notice.

From our previous articles, we know that board & care home is the least expensive route to 24 hour care.  And this is not even including the cost of maintaining our existing house when we have care come to us.  So cost is a huge benefit, but it is certainly not the only one.  We are also moving into a very lively environment with caregivers and residents interacting as a family all day long.

We also benefit from the same caregivers every day, which ensures a loving and understanding relationship develop quickly.  We are insured nutritious food and proper medication management.  We also know that a trained staff is monitoring our physical and mental condition constantly.  Any change in our condition is going to be noticed quickly. 

Let’s talk more about the social aspect of Board & Care assisted living.  A senior citizen receiving 24 hour care in their own home are often actually prisoners in their own homes.  Often the only interaction they get is from the their caregiver, many times not even the same caregiver every day.  At the Board & Care assisted living, we have the lively interaction between care staff number 2 or 3 as well as senior citizen residents who call this home.  You will have conversations, games movies; activities designed just for this population.

The health benefits should be obvious.  Any dietary needs can best be met here.   Meals can be specifically targeted to each individual.  Believe it or not. every med that is taken by the senior is recorded in their file.  No chance of mis-medication.  Physical exercise to the extent that is healthy for the individual senior.  This environment is wonderful for stabilizing seniors who are recovering from any type of condition.

Cognitive impairments such as Alzheimer’s or dementia are excellently served in a Board & Care assisted living.  Again, here we have the highest level of supervision in a small stable environment.  Any “triggers” that might cause agitation can easily be identified and avoided.  An activity program specifically designed for this population can easily be designed.  And the small, intimate environment helps to keep residents comfortable.  Large, chaotic environments can cause agitation and aggression. 

But, of course, as with anything, there are drawbacks to Board & Care assisted living homes, and populations that are not well served.  This will be the topic of our next article.  It will, hopefully, be very illuminating.  Until then, Kindest Regards.

Government programs such as Medicare, Medicaid and the Veterans Administration will cover the cost of long-term care under certain conditions. Medicare will cover rehabilitation from a hospital stay or limited care at home if there is a skilled (medical) need. The Veterans Administration will cover the cost of nursing home care indefinitely if the veteran is at least 70% service-connected disabled. The VA will also cover other forms of home-based or community-based care if there is a medical need and the veteran served during a time of war.Medicaid will cover both medical and non-medical related long-term care but in order to qualify for Medicaid a person has to have less than $2,000 in assets and income that is insufficient to pay the cost of care. In other words a person must be impoverished. Otherwise Medicaid will not pay, and in some states, like California, this aid will only come in the form of custodial care at a skilled nursing facility and only if certain conditions are met.

It is my experience that average people are simply not very concerned about preparing for long-term care. Perhaps they have seen it in their family or among friends and seen the effect that it has. Because of the unsavory aspect of receiving long-term care, perhaps the people prefer to ignore it rather than embrace the need for it. Perhaps they mistakenly think the government will take care of them. Or they are assured that family and friends will provide the care when needed, but don’t know how difficult is for loved ones to provide that care when the time actually comes.

Whatever the case, without proper planning, the need for long-term care can result in the single greatest crisis in an elderly person’s life.The single most shocking statistic I have seen blatantly illustrated in my years in this industry is that 40% of adult children now end up paying for a portion of their parent’s assisted living care!  Unbelievably, a huge percentage of these people, people who should know better, people who are forced to help pay for their parents care, will not plan for their own possible need for assisted living and thereby consigning their own children to the same fate!  Remember, the very best case scenario right now is one out of every two people alive right now will need assisted living and that ratio is increasing.

This lack of planning will always have an adverse effect on all families.  It usually results in great sacrifice or financial cost on the part of the spouse or children.  I have seen hundreds of “well-spouses” providing in home care and stress often will disable or kill.  I have heard so often, “mom should care for dad at home.”  At the expense of her health or very life?  Care giving is hard.  It takes such a toll on seniors that years that would have been enjoyed are wasted or lost.  In other cases the well spouse realizes they are not physically capable so then are forced to live in poverty so their loved one can receive care. I encourage adult children who press well parents to care for ill parents to experience the roll of care-giver themselves for a month or so, before they pass judgment.  Care giving is a massive undertaking and should not be thrust upon someone lightly or without the proper resources.  Also, it is important to remember that every care giving plan must be re-evaluated periodically, to insure that all needs, caregiver and recipient, are being met.

Unfortunately, with the economy in dire straits, we can expect that when we need assisted living, there will be little or no government assistance.  We must assume personal responsibility, and that means, for most of us, some sort of long term care insurance.  We all pay for auto insurance, and yet only one in twelve drivers will ever file a claim.  As we know at least one out of two people alive today will require assisted living.  Those are disturbing odds. We will cover Long Term Care Insurance in much greater detail later.  Until that time, let’s start thinking about what we can do to protect ourselves.  As always, Kindest Regards.

Depending on who you talk to, there are six, seven or even eight basic ADLs.  The basic activities of daily living consist of self-care tasks:  Every one agrees on these six…

            Eating, bathing, dressing, toileting, transferring and continence 

A seven or eight activity matrix will also include walking, grooming or both.  I think the easiest way to identify and examine a basic ADL is to look at the day in a life of a human being. 

On awakening we sit up in bed.  The physical act of uncovering ourselves, swinging our legs out of bed and moving ourselves into a sitting position is, believe it or not, an activity of daily living.  We are in the process of transferring ourselves from one position of rest to another.  Whether we now move ourselves to a wheelchair or stand with or without a cane or walker, we are transferring.  Can this be done without assistance?  If not we definitely have a need.  How about in a year?  Will we still be able to? We must, as loving family members, be cognizant of the future needs as well.

Please note how easy it is to evaluate a person’s ADL needs by just imagining (or watching) them perform these activities that are common to us all.  Okay now we are up.  Heading to the bathroom; how are we getting there?  Can we do it on our own?  Do we need a walker?  Are we in danger of getting lost or falling down?  We are now looking into the ADL of walking or ambulating (ambulate – To walk; to relocate one’s self under the power of one’s own legs with or without aids, such as braces and crutches).  Maybe we cannot walk but we can move ourselves independently with a wheelchair.  Here we are still independent, even though we have lost walking ADL because we maintain the transferring ADL.

Just a little more on ambulation and seniors before we move on.  Impaired mobility is a major concern for older adults, affecting fifty percent of people over 85 and at least a quarter of those over 75. As adults lose the ability to walk, to climb stairs, and to rise from a chair, they can become completely disabled.  Trouble with ambulation is the number one reason people come to us for help.  Becoming non-ambulatory is an instant and automatic need that has to be addressed.

Once we are in the bathroom we are going to have an opportunity to evaluate a number of ADLs.   First let’s look at the possibility of accidents.  As uncomfortable as it can be to talk about the fact is that many seniors face loss of bladder and bowel control.  It is, unfortunately, common and just another of those things we have to deal with.  Continence is voluntary control over urinary or fecal discharge, and if I become incontinent then I have needs that have to be addressed. 

We are now in the bathroom and faced with toileting.  A little confusing maybe but here we are talking about the ability to groom ourselves; to care for our appearance and to make neat.  This ALD covers brushing teeth, shaving, hair and skin care, nails etc.  Can I do these by myself or do I need help.  Maybe I can do them but I need someone to remind me.  Maybe I just need some supervision occasionally. 

Okay, while I am in here, maybe now is a good time for bathing.  Am I in danger of falling; do I no longer bath because I am scared?  Do I just need someone to offer stand by assistance in case I loose my balance?  Do I need reminders?  This is a difficult ADL and in many cases this can be the first ADL which gives us difficulty.  It is important to note when doing a needs assessment that the bathroom and especially the tub or shower can be a place of great danger.  Be realistic when evaluating a loved ones safety in bathroom.

Now we are out of the bathroom, and we are ready to dress.  Do I remember to put on clean clothes?  Do I choose appropriate clothes?  Can I tie my own shoes?  Am I in danger of falling?  Am I capable of independent dressing or is this one of my needs.  This is a pretty strait forward need but do not forget to assess not only the physical ability but the mental capacity.  Note that we said “remember to put on clean clothes” and “appropriate clothes”.   The need to be supervised is just as much a need as a physical need.

Finally we have eating.  This ADL is not concerned with the preparation of food so much as the actual mechanics of getting the food to my mouth, chewing and swallowing.  Am I capable of moving food and consuming it without assistance?  Can I cut food?  Can I choose foods that are healthy for me and meet my personal dietary requirements? 

One thing that we hope has been impressed upon you is similarity between physical inability to perform ADLs versus mental incapacity to plan and execute ADLs.  Either shortfall establishes the same need.  Having the physical ability to perform an ADL is not enough.  We also must have the mental capacity to plan and navigate the ADL as well as the physical ability or we are incapable of performing without assistance.

I cannot stress enough the need for families to be honest and realistic when evaluating a loved ones needs.  It is natural for us, as family members, to wish that loved ones conditions were better than they are and sometimes we can even fool ourselves into believing this.  But an unrealistic needs assessment hurts everyone, especially the senior.