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How to Identify When Your Parent Needs Assisted Living

As your parents age and begin needing more help in their daily lives, you might find yourself wondering when it’s time for them to move into assisted living. The decision to move parents into a supportive living environment can be difficult and full of uncertainty, but it doesn’t have to be. This article focuses on what signs to consider when deciding whether or not your parents need to move out of their home and receive more care.

Determining Independence Using Activities of Daily Living (ADLs)

There are tools available to help you determine your parents’ levels of independence. The Katz Index of Independence in Activities of Daily Living (ADLs) is the most common tool used to assess how independent a person is, and it can help you decide what level of care they might need. The Katz Index was first developed in the 1960s and is still widely used to determine how well a person can physically care for themselves.

To use the Katz Index, assess your parent on each of the following six criteria. Give them one point if they can independently do everything named, and zero points if they need assistance to do the things named. Here are the ADLs:

  1. Bathing. A person can bathe or shower by themselves, or they can mostly bathe or shower by themselves but need help with cleaning only one body part.
  2. Dressing. A person can pick out their own clothes and get them from the closet or dresser. They can put the clothes on themselves, including fastening them. They don’t need help with anything except maybe their shoes.
  3. Toileting. A person can go to the bathroom themselves, removing clothes if necessary, and get on and off the toilet. They can also clean themselves without assistance.
  4. Transferring. A person can get in and out of bed or chairs without assistance from others. They may use devices to assist them.
  5. Continence. A person has control over their urination and defecation and does not wet or defecate themselves.
  6. Feeding. A person can feed themselves, moving food from a plate or bowl to their mouth. They do not need to be able to prepare food.

A person who receives a six on the Katz Index is considered completely independent on this scale, while a person who receives a zero is considered completely dependent. If you’re considering supportive living for your parent, they likely will not score a zero or six, but instead fall somewhere in-between the two extremes.

There is no hard ADLs cutoff score to determine if someone needs full-time care or not. A person who has scored a five can probably continue to live alone, although they will need someone to come in and help them with whatever task they can’t handle independently. A person who scores a two likely needs consistent assisted living support.

The type of care a person needs also depends on the type of tasks they have trouble with. A person who needs help feeding and bathing, for example, could do well with daily in-home care that helps feed and bathe them. A person who needs help toileting and transferring, on the other hand, likely needs full-time care to prevent an unsafe situation.

Determining Independence Using Instrumental Activities of Daily Living (IADLs)

Sometimes people who score a five or six in terms of ADLs still need more assistance because of their inability to handle other daily living activities that are less physical, but still extremely important. The Lawton Instrumental Activities of Daily Living (IADLs) Scale is available to measure independence in the following areas:

  1. Ability to Use Telephone
  2. Shopping
  3. Food Preparation
  4. Housekeeping
  5. Laundry
  6. Mode of Transportation
  7. Responsibility for Own Medications
  8. Ability to Handle Finances

The Alzheimer’s Association makes the full Lawton Instrumental Activities of Daily Living Scale available, which is too long to share here. For each of the eight categories, you read through multiple options and assign a person either a zero or one, so their final score will range from zero to eight, with eight being the most independent and zero being the least independent.

Like with ADLs, there is no hard number for independence in IADLs that determines whether or not a person needs to move to a supportive living environment. The inventory can help assess independence and identify areas of needed help, however. This inventory is a good one to do over time to see, in a more objective way, if your parent is declining in terms of independence.

If your parent lacks independence in IADLs, they may still be able to live alone if the tasks are outsourced, whereas if your parent is lacking independence in ADLs, they are more likely to need full-time help. For example, if your parent is lacking in IADLs they could have food delivered, which eliminates the need to shop or prepare food. They could have a housekeeper come and both clean house and do laundry. They can rely on you or other friends, family or a transportation service to drive them places, and a family member or financial advisor to handle money-related issues. If your parent is unable to use a phone or manage their medications, however, they might be unsafe and need the care of a trained assisted living team.

Reasons to Pursue Supportive Living

Although requiring help with ADLs and IADLs are common reasons people move into a supportive living environment, they aren’t the only reasons. Here are other factors that often come into play when families are trying to decide if parents should move out of their homes into a place that provides support:

  • Wandering. If someone has developed dementia and tends to leave their home and wander, it might be time for them to move somewhere with additional support. You don’t want your parent going for a walk and becoming lost and unable to remember where they live.
  • Safety. Wandering isn’t the only safety issue that comes along with memory loss. If a parent begins doing things like turning on a burner to boil water then forgetting to turn it off, they might be better off living somewhere with memory care available to help 24-7.
  • Illness. Physical illnesses can also become safety issues depending on the symptoms. For example, illness might put a person at risk for falling when they stand, or at risk for choking when they eat. In these instances, they would be safer living with professional staff nearby to assist with tasks and help in case of emergency.
  • Aggression. Sometimes people with dementia develop aggression. If it is mild, their family and friends might be able to handle it, but a stranger such as a mail carrier or neighbor might not understand the situation and call police when faced with aggression. Moving someone with dementia-caused mild aggression into a supportive living facility could keep them from entering a situation that escalates and causes further damage.
  • Caregiver stress. Sometimes family members, friends or in-home caregivers reach a point where they become overwhelmed, stressed and anxious about their caregiving, making it difficult for them to continue without compromising their own physical and mental health. This is usually a sign that the person being cared for needs outside assistance.

Choosing the Type of Care

If your parent is dealing with physical limitations, they will benefit from in-home care or a supportive living environment depending on the extent of their limitations, while a parent dealing with cognitive impairment is generally well-suited to memory care. If your parent can no longer stay in their home safely, even with part-time in-home care, the next step is to decide whether a supportive living community or a memory care community is the best option for them.

The Landings at Norcross in Georgia provides both supportive living and memory care. Memory care allows residents at any stages of dementia to thrive and maintain as much independence as possible while providing them the safety and support they need. The supportive living options allow residents to live independently in their own apartments, but still have experienced support available in case of emergency, along with food and laundry services. Supportive living also has attentive team members available to help with getting dressed and taking medications, if needed.

Both options are customized to each individual’s unique needs, with a focus on improving their physical, social, intellectual and spiritual wellness. Learn more about our wellness philosophy here, then contact us to schedule a tour of our Georgia community today!



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