Pain Management in Senior Care

At Support For Home, we provide non-medical in-home care.  That does not mean, however, that our clients are not receiving medical treatment for a variety of chronic conditions.  One of the more frequent issues is arthritis and other causes of on-going and intense pain.

Where the client's doctor has stipulated a clear and specific course of treatment and medication, caregivers, family members and the client have an easier time with managing that pain.  All too often, however, the doctor has prescribed pain medication to be taken PRN (pro re nata), meaning as needed by the client.

As long as the client does not suffer from dementia, that is still manageable for caregivers, family and the client her- or himself.  But what happens if the client does have dementia.  The doctor often recommends that the pain medication be given when the pain level is above X (provided the maximum dosage has not been reached). 

The other day, however, our Director of Client Services was meeting with a client and asked her what pain level she was at, on a scale of 1-10.  The client, however, was unable to grasp that scale.  She could not really manage to put a number on her pain.

Knowing where the client is, in terms of pain level, is critical to complying with doctor's orders.  In these situations, a tool our Director of Client Services often uses is the Wong-Baker Pain Rating Scale(c).  That scale goes from a big smile on the left to tears on the right, in a total of six faces.  This tool was developed for use in pediatrics, but works well with some seniors with dementia.

Check it out.  It might help someone you care for and love.


Best wishes, Bert

Federal Study on Aging Good, But ...

There are some very interesting data points in the recently published study, "Older Americans 2010: Key Indicators of Well-Being."  The study was put out by
The Federal Interagency Forum on Aging-Related Statistics.

As most of us are aware,

Americans are living longer than ever before. Life expectancies at both age 65 and age 85 have increased. Under current mortality conditions, people who survive to age 65 can expect to live an average of 18.5 more years, about 4 years longer than people age 65 in 1960. The life expectancy of people who survive to age 85 today is 6.8 years for women and 5.7 years for men.

That is, on its face, a wonderful thing.  However, there are many implications that are a bit more complicated.  When one begins to look at the size of the senior population (including me), one's eyebrows begin to rise:

In 2008, 39 million people age 65 and over lived in the United States, accounting for 13 percent of the total population. The older population grew from 3 million in 1900 to 39 million in 2008. The oldest-old population (those age 85 and over) grew from just over 100,000 in 1900 to 5.7 million in 2008.

The implication for Social Security is old news, but still a valid concern.  Less intuitively obvious, however, are some of the other issues.  For example, 42% of women 65 years of age or older are widowed (much smaller number for men).  76% of women over the age of 85 are widowed and 38% of men that age are widowers.  This has very significant meaning, socially.

Another set of issues involves the chronic medical conditions which face us as we age.  The chart below, from the study, has a great deal to say about that:

The number of seniors with multiple chronic conditions is clearly evident when one looks at the percentages for each.

One of the areas that the study clearly fails in, at least in my judgment, is dementia, including Alzheimer's.  Statistics are really not reported and analysis is missing.  As the study itself says,

While there are several studies which report estimates of the prevalence of Alzheimer’s, one of the major barriers to reliable national estimates of prevalence is the lack of uniform diagnostic criteria among the national surveys that attempt to measure dementia or Alzheimer’s. A meeting convened by the NIA in 2009 to describe the prevalence of Alzheimer’s concluded that most of the variation in prevalence estimates is not driven primarily by the reliability of the measures or instruments per se but by systematic differences in the definition of dementia.

This is very, very disappointing to all of us involved in senior care.  Until we really gain an understanding of what it means and what the impact is, we will not do the best job of addressing the problems of dementia and Alzheimer's.

An area that the study better addresses is the need for assistance with Activities of Daily Living (ADLs).  That need is the real basis for non-medical home care existing in the first place:

It is interesting that the largest growth in meeting ADL needs is in the area of equipment.  That is one reason we work so closely with mobility and durable medical equipment suppliers for our own home care clients.  We have to understand and be able to address the total universe of need.

All in all, it is a very good and interesting study.  Check it out.

Best wishes, Bert

Could We Get a Little Attention!?

So, this is a fairly minor irritation, but it is a real one.  I do not intend to hire a lawyer or start a petition, but I am complaining, publicly (since it is in this blog) about MSNBC's categories for the Health section of their Internet site.
Actually, it is not just MSNBC, but that is a site I go to frequently, so I feel the proprietary right to criticize!

Our company, Support For Home, is dedicated to providing high quality in-home care to seniors who need help with Activities of Daily Living.  That is our passion.  The challenges of aging are many.  The focus on those challenges is inadequate, in terms of "news" coverage, beyond an occasionally "sexy" story about Alzheimer's and dementia.

So, what are those categories?

• Health Care
• Diet and Nutrition
• Women's Health
• Kids and Parenting
• Men's Health
• Sexual Health
• Mental Health
• Pet Health
• Fitness
• Cancer
• Skin and Beauty

So, pet health and skin and beauty are more important, according to MSNBC, than Geriatrics and Gerontology.

If I turn to The New York Times, on the other hand, right smack in the middle of the Health page I find "The New Old Age: Caring and Coping," a great, virtually daily series of articles on the issues we face as we get older. 

In the interest of full disclosure, I do not own any stock in The NY Times, nor am I selling MSNBC stock short.  ;-)  I just want to see more focus in the mainstream, general news outlets, on the issues of aging.

Best wishes, Bert

Dementia and Alzheimer's Series #6: Sleep

As often observed by the Home Care Aides of Support For Home, sleep disturbance is a major issue for many individuals with dementia, as well as their families.

Families of patients with dementia can often tolerate agitation, delusions, and wandering as long as nighttime sleep remains uninterrupted.  However, when behavioral disturbances occur day and night, families often feel compelled to resort to institutionalization.  Educating families about strategies for preventing or correcting sleep problems may help delay assisted living or skilled nursing facility placement.  Helping with such placements is what Senior Care Solutions does, but if we can help folks stay at home, that is great.

Many factors can contribute to poor sleep habits in persons with dementia, including disrupted sleep patterns, alterations in circadian rhythm, concurrent medical problems that cause frequent urination, daytime use of sedating medication, and frequent napping. In our experience, the chief causes of sleep disruption are frequent napping and excessive expectation of sleep needs.

Families often report that the patient wakes and dresses for morning activities at 3 AM. On further questioning, they may reveal that the patient naps while watching television during the day and goes to bed at 8 PM. In this common scenario, the patient's early morning awakening is not abnormal. Daily sleep requirements do not increase as a person ages, and the patient is often sleeping more than the 7 to 8 hours required for most persons to feel rested. In addition, caregivers often see the patient's nap time as an opportunity to accomplish tasks around the house. This is a shortsighted view that many come to regret.

The first step in reestablishing a normal sleep pattern is to limit daytime napping. Leaving a patient with dementia in front of a television set almost always leads to napping.  As an aside, the content of TV watched by a person with dementia must be monitored carefully, as violence or other content may be very disturbing to the patient, making sleep issues even worse.

To prevent the problem of napping in front of the TV, caregivers should engage patients in activities that are tailored to the degree of dementia, such as simple handicrafts, household tasks and, most important, regular physical exercise. Such activities can be carried out at home, but many patients and families benefit from the added structure of adult day care.

Once poor sleep hygiene has become established, it is much more difficult to eradicate. The first steps in correcting sleep problems are to set a more reasonable bedtime and prevent napping. The patient's activity level should be increased, and fluid intake should be decreased in the hours before bedtime. After a few difficult nights, the patient will begin to sleep for longer periods.

For families who cannot accept the possibility that the problem will worsen before improving, talk to the patient's doctor about the possibility of limited use of a hypnotic or sedating drug (e.g., trazodone, zolpidem tartrate, a short-acting benzodiazepine).  However, long-term reliance on sleeping medication, especially benzodiazepines, is rarely successful.  Again, a medical professional should be the decision maker concerning these approaches.

Environmental lighting may also have a role in sleep disturbance.  Light is an important modulator of circadian rhythms, which may be disrupted in dementia.  Increased lighting during afternoon and early evening hours may improve sleeping patterns.  In one sleep study on the effect of increased daytime illumination in 22 patients with dementia, improvement in the rest-activity rhythm occurred in patients with intact vision but not in visually impaired patients. A clinical trial assessing the efficacy of melatonin in the treatment of sleep disturbance in Alzheimer's disease is under way, but results are not yet available.

The most difficult part of managing sleep problems is the need for continued adherence to a rigid schedule.  Families should be taught that periodic disruption of the schedule will likely result in a return to irregular sleep patterns.  A doctor's prescription for use of a hypnotic agent for periodic administration is helpful and provides families with a sense of control.

Best wishes,

Carol Kinsel, Senior Care Solutions

 
 
 
 
 
Bert Cave, Support For Home

Dementia and Alzheimer's Series #5: Driving

There is an excellent, on-going  series of in The New York Times, called The New Old Age.  Written by Paula Span and Jane Gross, the blog series covers a wide variety of topics involved in aging and senior care.  All of the topics are important, but one that concerns us very much, at Support For Home and Senior Care Solutions, is driving.

In an April 2010 article, titled "Driving While Demented," Paula Span points out that "several studies had shown that a considerable number of those with mild dementia — 41 percent to 76 percent, depending on the study — could pass an on-road driving test."  We absolutely believe that.  It does not, however, mean that folks with dementia should be driving.  Rather, it means that we do not have good driving tests!

Every one of us who drives has "gotten away" with periods of inattention or bad judgment.  Some one else avoided the accident we might have caused or there was no one else around.  The point is, even without dementia, driving is extremely dangerous.  When families look at Dad or Mom and consider whether they should be driving, they either forget that or do not want to face it.

One reason they do not want to face it is they might then have to be the "bad guys" and take the keys away from someone who has been an authority in their lives forever.  They do not want to hurt their parent(s).  In our view, this is simply making the wrong choice.

Paula Span includes two very important points in her article, including the standard used by the American Association for Geriatric Psychiatry, as stated by their past President, Dr. Gary Kennedy:

“Our recommendation is that you stop driving once you have a dementia diagnosis.”

Less formally, he relies on “the grandchild rule”: If a patient’s children don’t want the grandchildren in the car when the patient is driving, he or she needs to relinquish the keys before hurting someone else’s grandchildren.

We think that is a good approach.  Assume that there are children who are at risk -- because they always are when we drive -- and let that guide you.

Too often, we talk to seniors with dementia and family members who think that driving is OK, as long as it is just in the local area.  Our response to that is to ask where most non-driving accidents happen: answer, at home, with the bathroom the most dangerous location.  So, being close to home does not improve our safety.  Why would it do so while we are driving?

Another reason that some families want Dad or Mom to keep driving is that they see it as therapy.  "It keeps him stimulated and sharper," we actually heard from one daughter.  With all due respect, NO!  This is part of a larger problem we will talk about in another article, which is that some families are unable to absorb that dementia is truly a disease; that their parent(s) cannot help their behavior; and that it is not going to get better simply by expecting the parent(s) to work at it.
 
Best wishes,
 
Carol Kinsel, Senior Care Solutions

 
 
 
 
 
 
 
Bert Cave, Support For Home

 
 
 

Dementia and Alzheimer's Series #4: Hospital Stays

The following great set of guidelines comes from the Alzheimer's Aid Society of Northern California.  We thank them sincerely for all of the support they provide to Alzheimer's patients and their families and friends.

Almost everyone who has ever had the experience of being a patient in a hospital knows that it can be frightening. It is even scarier for persons with dementia.  Unfamiliar surroundings, food, and caretakers can be devastating
when one is confused and disoriented. Confusion and disorientation affect how quickly and how well a patient recovers.  Providing useful techniques for staff and family visitors can mitigate resulting problems such as anxiety and wandering.  Some suggestions include: 

• Have a caregiver advocate on behalf of the patient. If possible, a family member should remain with the patient at all times. This person can help distract and soothe the patient during medical procedures.

• Use non-verbal techniques and simple language to communicate. Gestures, facial expressions, pictures, and signs are all examples of non-verbal communication. These can be used when cuing the patient to eat or bathe.

• Have a list of patient’s likes and dislikes. Favorite items can provide comfort and distraction. Knowledge of dislikes can help the staff avoid negative reactions and minimize anxiety.

• Studies have shown that the use of restraints tends to increase injuries and causes distress for the patient.  Other methods that can keep the patient safe are distraction, soothing touch, music, or prayer.

• Be sure the patient is not over or under-stimulated.  Patients with dementia have more difficulty communicating when over-stimulated by television or multiple conversations. Conversely, insufficient stimulation may increase anxiety. 

• Be aware of changes that may be occurring in the patient. Some patients won’t express pain or other feelings. Note any physical or mood changes which may indicate a complication or new illness.

• Allow the patient to make as many decisions as he or she can. Guided choices providing some control can limit distress.

Best wishes,

Carol Kinsel, Senior Care Solutions

Bert Cave, Support For Home

Dementia & Alzheimer's Series: #3

Perhaps the most meaningful and moving resources for individuals with dementia or Alzheimer's and for the families that love them are from people who are already suffering.  Their blogs, articles, books and interviews provide insights that we really need to continue to drive us to a cure.  They also are excellent reminders of the dignity of the individual and the respect they deserve. 

One such resource is Mike Donohue's blog, plus his book, From AA to AD, a Wistful Travelogue.  Started in 2007, his blog began after he was diagnosed with Alzheimer's.  One of the critical points he makes -- there are a great many, in a blog with over 250 articles -- is that we tend to focus so much on the cure (the future) that we forgot the needs of now:

AD needs more attention, in so many different ways, than it is getting. There is so much concentration on raising money to find a cure, little more than lip service to the universe of needs of those suffering the disease.

Take a long look at what Mr. Donohue has done for us.  It is worth it.

Just one other suggestion for today, which is actually a novel named STiLL ALiCE, by Lisa Genova.  Dr. Genova is a Neuroscientist who has written about a professor who develops early onset Alzheimer's.  It is a story we should all know and feel.

Best wishes, Bert

Dementia & Alzheimer's Series: #2

One of the on-going goals of this blog is to point to other sites and resources that we at Support For Home believe are useful for both professional and family caregivers.  One of those sites is SeniorsList. 

Not every article they publish is great, but a number of them are.  while you will find our business listed on the site, we do not necessarily think Internet sites are the best way to find home care agencies.  A local human whose business is to know the agencies in an area is a much better approach.

However, as I say, some of the articles are very good.  One that has just been published is "Caring for Someone with Alzheimer's," by Murphy Ortiz.  The author begins by saying something that, from our experience, we all need to let "sink in," and that is -

It's very easy to say "I'll never put Mom in a nursing home" when she's healthy. But if you're one of the many family caregivers of someone with Alzheimer's, that promise may not be easy to keep.

There are still many folks who hold to that promise, but it can be very tough, and there are some critical points we believe family caregivers need to remember.  One of the most important principles, in our experience, is that the family caregiver must be able to be selfish.

Sounds strange, right?  What we mean by that is that we see too many families where the primary caregiver (and secondary ones, too, sometimes) is absolutely physically, emotionally and psychologically exhausted, because she or he is not getting the respite that is vital to being able to go on.

When that respite is missing, provided either by other family or professional home care agencies, the chances of being able to keep that promise are significantly diminished.  It will be more expensive to bring in a home care agency to help than going it alone, but the chances of success, in keeping that promise, are tremendously higher.

As Murphy Ortiz writes,

Learn how to ask for help. You might be trying to do too much yourself. Caring for a loved one with Alzheimer's requires a great deal of patience and sacrifice, and one person can't do it alone. Don't feel guilty asking for help. You'll be doing your Mom more good having help on your side...  Maybe you can ask a friend or family member to sit with your Mom to give you a much needed break. You can also contact a home care agency that can provide someone to assist your Mom with her care. These caregivers can also engage your Mom and participate in enjoyable activities with her.

It is a noble promise, and it is possible to keep it, but it means being willing to ask for help.

Best wishes, Bert

Dementia and Alzheimer's: A Series

In senior care, one of the most frequent conditions we encounter is dementia, in one of its 1000+ forms.  The most "famous" is Alzheimer's, but in any form it is very serious, for the individual and his or her family.

Over the next few weeks, we will be talking about this issue from a number of perspectives: the client / patient, family members, including family caregivers, professional caregivers at home and the facilities who serve people with dementia, including those that provide memory care.  We will talk about the dignity of those suffering and the immense respect we have for them, as well as for those helping.

One of the topics we will be spending time on is the many resources that are available to us on the topic of dementia.  Thankfully, this is a condition that we take very seriously as a society, and there is a great deal of study going on and helpful material that has been published.  We will just mention a few of the "biggest" in this first article:

1. One of the most significant sources is the National Institutes of Health's  National Institute on Aging.  This site has many helpful sections.  One of the most important is their Alzheimer's Disease Education and Referral (ADEAR) Center.  The Center has many publications and links to tools and services that can be very helpful to everyone affected by or supporting someone with Alzheimer's.  The site is updated frequently and well maintained.
2. Also part of the National Institutes of Health is the National Institute of Neurological Disorders and Stroke.  They have an excellent section called Dementia: Hope Through Research.  That Institute has a separate "page" called Dementia Information that is also very useful.
3. The third resource we will mention today, as we get started, is one all of us concerned about this topic should be aware of and with which we should be involved.  That is the Alzheimer's Association.  They have great information, but, even more than that, they are at the heart of the fight.

In future articles, we will include other resources, including some you might tell us about.  We will also have some stories from our own collective experience.  If you have a story to share, let us know.  Thank you.

Carol Kinsel, Senior Care Solutions

Bert Cave, Support For Home

It’s Senior Care – Do The Right Thing

Some folks in the industry feel that there is a fight for customers between Assisted Living (with a variety of levels of support) and Home Care. Some of know that is not what it is about at all. For those of us with a passion for senior care, it is about the living solution that is the best fit for the elder client and her or his family.

That is the situation for Support For Home In-Home Care and Senior Care Solutions, for example, in the Sacramento region. We and others who are committed to our clients’ well-being work together to look for what is best for them. As Carol Kinsel, owner of Senior Care Solutions puts it, “if you always do what’s right, good things will follow.” Our individual businesses will continue to grow and prosper, because we focus on what is right for the client and the family.

Over time, that best living situation may well change. For some seniors, the best option is to live at home until they pass. For others, a time is reached when, economically or medically or for other reasons, an alternative is needed. It may be that a memory care unit is appropriate, for example.

At Support For Home, we have had clients who needed to move from their home of 30 years to assisted living. We look to Senior Care Solutions to help them, and we do so with confidence. If the family calls Senior Care Solutions, but the “right” situation is staying at home, with excellent home care, Carol and her team turn to Support For Home or one or two other top quality home care agencies.

We will be continuing the dialogue about “doing what’s right” in these pages, covering a variety of elder care topics. We would love to see your comments and suggestions.

Best wishes,

Carol Kinsel

Bert Cave

"Convergence Between Healthcare IT and Life Sciences Informatics"

The reason for the quotes around the title is that there is a conference coming up on the subject, and below are some comments I added to the discussion thread in preparation for the conference.

As an old IT geek, myself -- my wife and business partner is an IT pro, as well, but I'd get hit if I called her an old IT geek :-) -- now managing a non-medical in-home care agency, we are always thinking about ways that information technology can help our clients.

This is obviously an incredibly important topic, one which we feel is still not fully appreciated by the Healthcare IT, vendor or medical provider communities.

As a former IT Director at Intel, supporting Digital Health and other business groups, the importance of IT for healthcare was easily seen, if more difficult to implement. What was not included in most of the usage models at Intel's Digital Health and other suppliers in the field, however, was the non-medical home care needs of seniors, folks recovering at home from hospitalization or skilled nursing facilities. These usage models became very clear to us as we founded Support For Home, which provides non-medical in-home care.

For our clients, many of whom have either family caregivers or professional Home Care Aides, the issues are Activities of Daily Living (ADLs) and Instrumental ADLs, in addition to the interface between the caregiver / Home Care Aide and a Home Health agency (e.g., skilled nursing, PT, OT, ST) and/or other healthcare providers.

Given that few Home Health agencies do shift nursing -- and few clients can afford it -- having the Healthcare IT products that a non-medical caregiver can assist a client / patient to use is very important. From medication reminders and automated dispensers to cognitive testing, remotely, for dementia, the opportunities for non-medical -- but critical to health and healthcare -- IT products and services are enormous.

Bonding with Your Caregiver is a Good Thing, But ...

This is something that every really good home care agency experiences -- the client falls in love with the caregiver.  In some ways, that's great, but it is a double edged sword. 

First, we stress to our Home Care Aides -- and to our clients -- that the relationship between the two of them is and must remain a professional one.  That does not mean that they should not care personally, but, for the Home Care Aide, there is a job to be done, every shift.  They are not family members or guests in their clients home.  The are providing critical support for Activities of Daily Living (ADLs) and Instrumental ADLs, such as cleaning, cooking, bathing, dressing and so forth.  That service role is primary.

At Support For Home, we even make employees sign waivers forfeiting any chance of inheritance, and gifts are very closely monitored.  We do not want our clients or their families negatively impacted in any way.  That is the case regardless of whether the client has any level of dementia.

The second concern about emotional bonding with the Home Care Aide is what sometimes happens when the caregiver is ill or needs time off from an assignment.  Ideally, the client will remember that we, the agency, are the ones who assigned the wonderful Home Care Aide, in the first place.  They will say, yes, I still need the services, and I have confidence that you will give me someone equally good as a backup.  Thankfully, that is the norm.

Unfortunately, some clients sacrifice the care they actually need, feeling that no one else could possibly provide that care.  "If Mary is not available, then I don't want anyone."  That puts the client in jeopardy, since, if they did not need the care, the shift would not have been scheduled in the first place.

We actually had one extreme case of this recently.  When an employee did not show up for an assignment until an hour after they were supposed to and gave no indication of recognizing this as a problem, we terminated the employee.  When a different client was told that the Home Care Aide was being replaced, because that person no longer worked for us, the client's response was not, "Thank you for watching out for the best interests of Support For Home clients."  Instead, the client felt that we were making life "miserable."  Even though after two days with the new caregiver the client said the new person was "great," the bond with the prior Home Care Aide simply could not be overcome.

We want to make it very clear that this is not a complaint.  As mentioned earlier, a bond is a very good thing in some ways.  Our clients need to trust our employees.  Rather, it is a recognition of the importance of emotion in senior homecare.  It is not just about services X, Y and Z.  The really good homecare agencies keep that in mind, all the time.

Caring for Spouses with Dementia

There is a very serious article on MSNBC (http://www.msnbc.msn.com/id/36975938/ns/health-aging/) concerning a strong correlation between caring for a spouse with dementia and developing dementia oneself.  The first paragraph raises grave concerns:

"Being married to someone with dementia may sharply increase your own risk of developing the condition, a new study shows."

There is no causal link established yet, but one very significant point is made by Dr. Gary Small of UCLA:

"'Caregiving is very stressful,' said Dr. Gary W. Small, director of the University of California-Los Angeles, Center on Aging and director of the Geriatric Psychiatry Division at the Semel Institute for Neuroscience and Human Behavior at the David Geffen School of Medicine at UCLA. 'Studies have shown that caregivers for dementia patients have a high risk for major clinical depression. And there has been a study that showed that people who are prone to stress are at higher risk for Alzheimer’s.'"


To those of us in the home care industry -- or family caregivers -- the stress level is not news.  However, the issue of stress related to Alzheimer's risks is something on which we all really need to focus.  It reinforces how important it is for the family caregiver -- whom we already know has the hardest job in the world -- to receive adequate respite and support.

If you or a family member face this situation, talk to a social worker with knowledge of gerontology about options, or give a solid, certified home care agency a call, just to talk about your situation.  There is help!

Best wishes, Bert

Great Expectations

If you are serious about being in the homecare industry, rather than simply doing it instead of selling insurance, you learn a lot about the issues facing your clients and their families.  There is a wide range of such issues, from falls that lead to hip replacements to heart conditions to Parkinsons and many others. 

Two major conditions facing too many of our clients are dementia (including Alzheimer's) and MS.  We were delighted to have the opportunity to sponsor and participate in major events this year with the National Multiple Sclerosis Society (the Home Smart Home Expo) and the Alzheimer's Association Memory Walk.  Both events were huge successes in terms of raising the awareness of the community and even serviced providers.  These associations and others focused on different issues face huge challenges, but also raise great expectations.

With every client that we support, we are always looking at the total plan of care, the "pie" of needs, of which our homecare is one slice.  Without the proper plan of care partners, whether that's the Alzheimer's Association or emergency alert systems or fiduciaries or living space designers, our homecare will not succeed. 

We salute the more than 70 members of our Bright Lights team for the Memory Walk, and every other volunteer and association helping to create great expectations for the future.

A Focus on IADLs

For most of us, if there is an issue with Activities of Daily Living (ADLs), such as bathing or dressing or eating, the need for support is very obvious.  We will return to this topic (ADLs) in a future blog, but today we want to talk about Instrumental ADLs (IADLs) as a basis for determining need for homecare support.  We have adapted an IADL discussion from an early gerontology article, because we think it is still one of the most useful.  We have provided just three examples, below, of the seven IADLs included in an Excel spreadsheet we have created that is posted on our Web site.

IADL Status

Ability to Use Telephone (4 points - highest - to 1 point)
Operates telephone on own initiative; looks up and dials numbers, etc.
Dials a few well-known numbers
Answers telephone but does not dial
Does not use telephone at all.


Shopping (4 points to 1 point)
Takes care of all shopping needs independently
Shops independently for small purchases
Needs to be accompanied on any shopping trip
Completely unable to shop.


Food Preparation (4 points to 1 point)
Plans, prepares and serves adequate meals independently
Prepares adequate meals if supplied with ingredients
Heats, serves and prepares meals or prepares meals but does not maintain adequate diet
Needs to have meals prepared and served

The idea, for each IADL, is that the more functionality I have, the higher my score will be.  In this particular scale, as we have implemented it, there is a maximum of 31 points, total, for all seven IADLs.  However, each IADL needs to be looked at by itself, as well as being part of an overall pattern.

In my current baseline (as discussed in a prior blog), I'm doing okay and do not need home care.  However, for each IADL, I have set a lowest acceptable status before taking a very serious look at getting home care for myself.

We would be delighted to have your feedback and suggestions.  Thanks for listening.