Article: Advance Living Directive™ Part IV

Bert Cave
President of Support For Home
Sacramento, California  95825
916-482-8484

Member of the national ElderCare Matters Alliance, California chapter

In the third article in this series, we discussed the first four Instrumental Activities of Daily Living (IADLs):

• Ability to use a telephone
• Shopping for food and other necessities
• Food preparation
• Housekeeping and organization

Today we will cover the last four:

• Doing laundry
• Meeting needs for transportation
• Managing medication
• Handling finances

As with other Instrumental Activities of Daily Living, each has a set of levels of ability to perform that help us gauge our ability to live independently at home.  Our goal with the Advance Living Directive™ is to provide a planning tool for seniors and families to use well before any question exists.  That eliminates emotional issues and lets individuals and families do what we really want them to do – plan for the future.

For the laundry IADL, there are three levels of ability:

• Does personal laundry completely (3 Points)
• Launders small items; rinses stockings, etc. (2 Points)
• All laundry must be done by others (1 Point)

Obviously, there are businesses which can perform laundry services, even picking up and delivering.  This makes laundry ability something that should be looked at in conjunction with other IADLs, rather than in isolation.  For example, my wife does not do laundry at all, but that’s another story.   

IADL number five is transportation.  It is a critical activity, with five levels of ability:

• Travels independently on public transportation or drives own car (5 Points)
• Arranges own travel via taxi, but does not otherwise use public transportation (4 Points)
• Travels on public transportation when accompanied by another (3 Points)
• Travel limited to taxi or automobile with assistance of another (2 Points)
• Does not travel at all (1 Point)

For transportation, the 2 point and 3 point levels should be looked at carefully, to determine the underlying issue.  For example, if I am at the 3 point level, is it because I am exhibiting symptoms of dementia?  If so, home care is definitely indicated.

Still within the realm of transportation, this is one of the most critical areas to focus on early in the creation of the Advance Living Directive.  It is important to set objective criteria for seniors to stop driving – and put it in writing.  Once I have dementia, it is too late to argue with me about whether I can drive “just around here.”  If I have agreed, in advance, to criteria such as my doctor says I should not (in writing) or DMV has pulled my license or I have gotten lost (documented), I am more likely to accept the situation.

The next IADL is responsibility for one’s own medications, with the following three point levels:

• Is responsible for taking medication in correct dosages at correct time (3 Points)
• Takes responsibility if medication is prepared in advance in separate dosage (2 Points)
• Is not capable of dispensing own medication (1 Point)

While the 2 point level raises questions about the need for care, there are actually pharmacies that will prepare “bubble” or “blister” packs of prescriptions, eliminating the need for someone to organize medications into pill boxes.  Thus, medication needs to be looked at in combination with other IADLs.

 The last IADL is the ability to handle finances, also with three levels of ability:

• Manages financial matters independently (budgets, writes checks, pays bills, banking) (3 Points)
• Manages day-to-day purchases; needs help with banking, major purchases, budgets (2 Points)
• Incapable of handling money (1 Point)

If I am at the 2 point level, there is reason to explore the need for care, but it is not automatic.  Often a family member or trustee can perform that function perfectly well, remotely.

Again, the key is to look at all the ADLs and IADLs individually and in combinations.  In order to avoid being overwhelmed, a free spreadsheet tool is available on the Internet.  It will walk you through each item.  And, most importantly, use the tool as a planning device for your family, your loved ones, yourself.  The Advance Living Directive can help take a lot of fear and emotion out of the discussion.