By Bryan Wogen, PA-C
The world of geriatric medicine can be filled with nuances and tricks from years of experience working in the field. One such nuance is knowing when a patient is appropriate for assisted living.
To give some background on the services that we are talking about, lets look at the various stages of care that a patient can be placed into. The following is a brief list of levels of care with applicable services you can expect your geriatric patient to receive.
Independent Living: A senior community with a common community of residents. Some have consolidated resources such as dining services, cleaning, etc. There is very minimal oversight by staff and residents are generally self reliant.
Assisted Living: many consolidated resources available including help with most ADL’s, meal services, medication management. Most work closely with various Home Health agencies to bring services into the facility.
Nursing Home/ Long Term Care: all of the above services plus additional 24/7 nursing staff. This is also more appropriate for patients with severe mobility issues and require 2+ assistance for transfers, hoyer lifts, etc. Patient's here often are afflicted with end stage medical conditions that requiring a great amount of attention/ resources.
Skilled Nursing Facility: this is where there are a great number or resources consolidated into one location where a patient can go when they still need an extraordinary level of care/rehabilitation but are not appropriate to stay in a hospital. They will usually spend 6-8 weeks here before going back to any of the above locations or their home.
Our focus here is on Assisted Living and when it is appropriate to consider advocating that your patient find placement in one of these homes. Many families will do their best to keep their loved one at home, and usually at great cost (either financial cost or personal efforts). Here is a list of clues that can better help you advocate for your patient.
Patient has issues with transportation: Patients will often complain that they have difficulty getting family to take them to appointments. Are there vision or physical limitations? These limitations are likely impacting them at home more than they are acknowledging.
Patient has limited mobility: consider their ability to self transfer at home unless they have help 24/7. Often times, patients will not want to ask for help from family and are at high risk of injuring themselves.
Patient has bruising: patient’s will often try to minimize their injuries as “silly mistakes” but this is a major indicator that they are at high risk of a significant injury at home and likely do not have the assistance they need.
Patient is losing weight: This may be a sign that ADL’s are becoming too difficult. This is also a subtle warning sign of the onset of dementia and you may be behind the power curve already. See our dementia rating scale for a quick, yet comprehensive analysis that you can do with your patient.
Poor personal hygiene: this again is a warning sign of physical and mental challenges. This is also a powerful indicator of depression in geriatric patients.
Forgetfulness: Strong indicator of mental health challenges/ dementia.
Depression: is common in patients who are isolated and alone. Assisted living is often wonderful for these patients as it gives them a community of other people who are experiencing similar circumstances.
Strange or inappropriate behavior: often a sign of early dementia. This is also a strong indicator that they are suffering from an organic abnormality (I.E. UTI, depression, undisclosed pain, etc.). Assisted living staff can help warn family and clinicians that the patient is experiencing a change in their baseline and help you better serve your patients.
Any one of the above concerns warrants consideration for assisted living placement. Knowing your patients history along with a focus on patient advocacy can help prevent many unnecessary injuries and disease exacerbations. Assisted living can be a wonderful addition to a patient's treatment plan. The consistent care, regimented medication management, and enriched social engagement often results in improved patient outcomes and simplified work load for a primary care provider.