In-Home Aging in Place Assessment
An in-home assessment isn’t a one-time task. Getting a clear picture of your loved one’s functioning and safety is challenging, and self-reporting isn’t always reliable. Establishing a baseline can give you much-needed perspective on changes as time goes on. Here are the steps to take.
- Schedule a Time to do Your Assessment
If you can’t conduct the assessment yourself due to time or proximity, hire a local geriatric care manager, occupational therapist, or CAPS (Certified aging-in-place specialists). Be transparent about your reasons for doing the assessment- that you want to ensure your loved one can remain in their home for as long as possible.
- Home Safety
Home safety examines the home environment- inside and out. You may choose to hire a home inspector to do a detailed review of systems and maintenance issues. An occupational therapist can make home accessibility recommendations. Other areas to evaluate:
- Falls are the leading cause of death and disability for older Americans. Although falls can’t be prevented, they can be minimized. Is the home cluttered with throw rugs and poor lighting? Check every room in the house. Are there too many stairs? Do you need to install grab bars or a toilet riser with handles in the bathroom?
- Consider the outside environment and the ability of your loved one to manage landscaping or shovel snow. You can easily hire these tasks out.
- Are there railings inside and outside the home for better stability? If not, have those installed.
- Functional Review
A functional review can be challenging since you may see your loved one infrequently. However, there are some ways you can assess your loved one’s ability to dress, bathe, cook, eat, and manage hygiene. And don’t take their word for it!
- The first step to understanding how your loved one is functioning is to pay attention. Notice hygiene and whether clothes are clean and changed frequently. Is the house clean and the dishes done? Look in the fridge to see if there is adequate food and notice if there is spoiling food.
- Assess mobility by noticing if there has been a decline in balance or endurance.
- A functional review needs to include the ability to manage finances. Discussing finances can be delicate. However, if you have noticed that bills aren’t paid, or there is confusion over finances, it is time to discuss these issues. Be on the alert for unusual financial activity that could indicate criminal activity. Remember, you won’t be able to access financial accounts without financial power of attorney.
- Health Review
Over time, it is easy to assume that your loved one manages their healthcare without your involvement. However, a decline in health indicates that you may need to arrange for in-home help. Remember that you will need a release of information to access health care providers or records. Assess the following:
- Medications. Medication misuse is a significant problem for older adults and can have serious consequences. Make a list of all medications, what they are treating, and evaluate the current medication system- is it working? Identify any expired medications and dispose of them appropriately. Consider a medication dispensing system.
- Medical conditions. Review your loved one’s medical conditions- what they are and prognosis.
- Cognition. Do you notice memory problems, getting lost, or difficulty performing normal tasks? If so, suggest an appointment with a physician to rule out dementia or Alzheimer’s.
- Appointment compliance. Is your family member able to get to medical appointments independently and consistently?
- Nutrition and hydration. Nutrition and hydration can slip through the cracks; monitoring those is challenging without someone in the home daily. Look for weight loss, dizziness, or confusion as possible signs of dehydration.
- Social and Emotional Well-being
Loneliness is a serious health risk for older adults, contributing to depression, anxiety, and other health problems. Loneliness often arises when someone stops driving and can’t access activities or friends. Consider some transportation options through family or home caregivers to transport your loved one to preferred activities. Keeping connected through social media requires a computer but is well worth the time, training, and investment.
How to Identify Triggers for a Higher Level of Care
The value of having a baseline of functioning from your assessment is to identify triggers that indicate a need for increased care. Here are some things to look for
- Declining health. Worsening health could indicate poor management or simply a consequence of a chronic medical condition. Examples include heart problems, diabetes, respiratory conditions, neurological disorders like Parkinson’s and Multiple Sclerosis, cancer, arthritis, and dementia.
- Behavior changes. Behavior problems could be depressed or anxious mood, agitation, memory problems, and confusion.
- Decline in activities of daily living (ADLs). Trouble managing ADLs is often a red flag that something is wrong. Examples are falls in the bathroom, not taking a shower, unclean clothes, and poor hygiene.
- Poor management of the household. Suddenly, you notice your loved one isn’t cleaning or shopping or can’t keep up with maintenance tasks.
- Financial mismanagement. Unfortunately, in many cases, financial mismanagement is often only noticed once some damage is done. Cognitive impairment is the main reason most people can’t manage their finances.
- Multiple emergency calls. Frequent emergency calls or visits to healthcare providers may suggest unmet medical needs or increased health concerns.
- Multiple hospital admissions. Multiple hospital readmissions may indicate inadequate post-hospitalization care or difficulty managing health conditions at home.
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