What Does it Mean when the Doctor
says Mom can't live alone?

by
Jean Daily, Marketing Director at Westminster Village
and
Carolyn Durbin, Westminster Village Staff

  Sally had just gone to the doctor with her mother, because she had noticed some changes in her abilities and behaviors.  The doctor said that her mother should no longer stay in her home alone.  This news came as a huge shock, and Sally’s mother became very upset.  Sally didn’t ask for details from the doctor, so she and her mother had little guidance in how to make a good decision on the next step they should take.  Both Sally and her mother were very frustrated as they left the doctor’s office.

   Not eating well was one of the changes that Sally had noticed in her mother.  It did not seem to be a significant change, but she wasn’t with her mother every day and didn’t really know what she was eating.  Her mother’s house had stairs, and though her mother climbed the stairs much slower, she was still managing them.  What had worried Sally the most was the fact that her mother lived in a very rural area.  Her mother had mentioned that she was getting very lonely and that she wasn’t inclined to drive her car as often as she used to.  However, her mother was up and dressed each time Sally stopped by to visit her, and her mother was taking her blood pressure medicine as far as Sally could tell.

   Without asking the doctor about alternatives to Sally’s mother living alone, Sally had no idea where to start looking for a place that would best meet her mother’s new needs.  It seemed imperative suddenly that her mother make a move.  But to where?  An apartment?  A nursing home?  Assisted living?  Sally had recently heard about some assisted living places, so that was probably what the doctor had meant.  However, without having a more thorough conversation with the doctor and without discussing some suggestions from the doctor, assisted living was not necessarily the placement that would be in her mother’s best interest.  The types of services her mother might need with activities of daily living, such as assistance with dressing, feeding, incontinence care, etc., determines mother’s best care options.

   In retirement living there are many options and levels of care.  One option is called “free standing” with one level, like a nursing home.  Other options might include apartments, assisted living facilities, or what is known as continuing care retirement communities (CCRCs).  A continuing care retirement community offers more than one level of care.  The staff at a CCRC can help with relocating mother to the right environment based on the specific services she needs.

   Based on mother’s history, she could move to a retirement community and start with an independent living apartment, since she is still able to perform many of the activities of daily living on her own.  In an independent living situation, mother could count on a good healthy meal each day.  She would no longer have to negotiate stairs.  She could easily find companionship, and most CCRCs offer transportation to the doctor and other places their residents might like to go. 

   In a similar situation, Fred is another person who took his elderly parent to the doctor, and the doctor told Fred that his father could no longer live at home alone.  Fred’s father really needed help with bathing, dressing, and cueing for meals and medications.  With these kinds of specific needs, Fred’s father might qualify for an assisted living program or nursing home care.

   Below is information that includes an assessment tool to help you with the placement that best serves your parent or any elderly person. This tool, if answered honestly, will help you choose the best possible placement for the ones you care for.

   It’s important to ask a doctor to discuss in detail the reasons why a change in living circumstances is necessary and to ask for suggestions or referrals.  No two retirement living options are alike, so homework is necessary and worthwhile.  With this assessment tool and a list of services in hand, choosing a new placement for your loved one will be much easier. 

Questions and Answers to help determine the level services needed and to help determine the type of community that would best serve the needs of the potential resident.

 1.  Where is potential resident currently living?

1.  Alone at home independently
2.  In another type of living arrangement like a Retirement Community, Assisted Living or Nursing Home
3.  In their home with home health care for a certain number of hours

 2.  Is potential resident able to understand and follow instructions?     Yes - No

1.  With some cueing    Yes - No

 3.  Is potential resident able to remember instructions for emergency procedures?  Yes - No

1.  With some cueing    Yes - No

 4.  Is potential resident still driving safely?    Yes - No

 5.  Does potential resident require assistance from a caregiver with any of the following Activities of Daily Living?

1.  Preparing Meals
2.  Feeding Self
3.  Bathing
4.  Dressing
5.  Toileting
6.  Transferring from chair or bed

 6.  Does potential resident take care of their own medications safely?  
      Yes – No

 7.   Does potential resident know and understand usage of all medications? 
       Yes – No

 8.  Does potential resident have assistance with medications?  Yes - No

 9.  Does potential resident have mental illness or is potential resident being treated for substance abuse?   Yes - No

 10. Has potential resident been diagnosed with Alzheimer’s or dementia? 
Yes - No

 11.   Is potential resident able to walk with out assistance?  Yes - No

1.    with cane   Yes - No
2.    with walker  Yes - No
3.    uses wheelchair or electric chair   Yes - No

 12. Is potential resident able to communicate?   Yes – No

1.  speech   Yes – No
2.  hear    Yes – No

 13. Does potential resident have vision limitations? Yes - No

1. has some vision limitations
2. sever (near blindness)

 14.  Does potential resident have many social activities?   Yes - No

1.  Pay own bills?   Yes - No
2.  Make own appointments?   Yes - No

       Here is a guide to understanding the answers.  If you are working with a potential resident this tool could help determine the needs of the potential resident.   It could be printed out with answers and taken when you go to a community to determine the needs of the potential resident.  

 ANSWERS:

 1.  a:  Very independent
b or c:  Could mean a higher level of care such as a nursing home or Assisted Living might be the best solution.

2 and 3.    If yes –Independent Living would be an option.  If 2a or 3a is yes, there is a need for a more structured environment.

 4.  Consider the potential resident needs placement that provides transportation if unable to drive.

 5.  If yes to any of these, there may be the need for Assisted Living or Skilled Nursing. If it is yes to several, it probably means Skilled Nursing would be the best option.

 6, 7 and 8.  If the answer is no on question 6 and 7 and yes on question 8, the potential resident probably needs Assisted Living or Skilled Nursing or if assistance with medications is the only thing they need help with an outside caregiver could be used in an Independent Living setting.

 9 and 10.  If the answer is yes to either or both, there are limits to the types of communities that can meet the needs of these potential residents.  However, residents with mild dementia may be able to manage in an Assisted Living facility.

 11.  None of these would keep a resident from Independent Living, Assisted Living or Skilled Nursing unless the resident was unable to transfer from the wheelchair without assistance. Then the options would be to use a caregiver in an independent living situation or consider a higher level of care such as Skilled Nursing care.

 12 and 13. If yes to either or both this may limit the potential resident from interaction with other residents but would not disqualify them from Assisted Living or Skilled Nursing.

 14. If a potential resident is doing all of these activities well, they are very able to live in an independent environment.

 If you answer all the questions honestly this should help determine the type of community that would best serve the needs of the potential resident, setting them up to succeed instead of fail in an environment that does not provide enough of the services they need.