Answer: The best way to tell if one is ready for in-home care is to have developed a “baseline” of abilities to perform the normal Activities of Daily Living (ADLs) that we must perform in order to live well and safely at home.
These activities are actually broken down into two groups. Activities of Daily Living which include personal hygiene and grooming; dressing and undressing; feeding oneself; functional transfers such as moving from bed to a chair; control of urinary and fecal discharge; toileting; and walking or other forms of ambulation. These basic ADLs are complemented by a set of “Instrumental” ADLs, including ability to do housework; prepare meals; take medications; manage finances; shop for necessities; communicate on the telephone; use technology.
Ideally, we should assess our ability to perform these activities early in our adult lives, when we are well able to perform them. This removes emotion from the exercise and allows us to do a more objective job of planning for the future. Or, I may have no problem with mobility at this time but determine that having to depend on others to safely move from bed to a chair means I will need home care
The Advance Living Directive’s focus on our ability to perform normal activities helps us create an objective base for making future – or current – decisions about home care. If I do not plan ahead, I am likely to be more emotional and much more stressed when the time actually comes. Working through that planning process with my spouse and children will also get all of us on the same page, before there is any opportunity for distress or discord.
We all understand the need to develop Advance Health Care Directives, Trusts, Wills and the like. This is simply another instance of planning for the future. The good thing is that the focus on ADLs and IADLs is not tied to chronic medical conditions, requiring health care. I may have Diabetes or COPD, for example, and still be perfectly capable of performing the normal activities of living at home. There is obviously a correlation, but the need for home care (non-medical) needs to be assessed separately.
Bert Cave, President
Support For Home
Sacramento, California 95825
Member of the national ElderCare Matters Alliance, California chapter
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