A third activity of daily living is toileting. A geriatric care management assesses a client by using a Katz ADL scale and speaking to the older person and their family or care provider. A client who needs assistance getting on and off the toilet because of physical problems may also need a referral for a home health aide. This also comes under the ADL of transfer. Installing a raised toilet seat or adding a grab bar next to the toilet may help to keep this person independent. If a person has difficulty getting to the toilet, for example, at night, having a commode next to the bed may allow him or her to toilet safely alone without waking a caregiver. In addition, if in a review of medications the care manager notes that the person is taking a diuretic in the afternoon and getting up frequently to toilet at night, a change to a morning dosage can be suggested to the person’s physician.
In my last blog we discussed dressing as an area to assess with ADL’s . Pain is an often-overlooked problem when assessing activities of daily living Frequently, pain can be great enough to inhibit a person from functioning independently. Pain can definitely be a problem that affects a person’s ability to dress him- or herself. The geriatric care manager needs to be aware of whether pain is decreasing a person’s function and recommend a pain evaluation by his or her physician . In addition, a referral for physical therapy for range-of-motion exercises or other therapeutic interventions may assist with improving function in dressing as well as accomplishing other ADL’s and IADLs.
The Katz Index of Independence in Activities of Daily Living (referred to as the Katz index or the Katz ADL) is a tool for assessing an older adult’s baseline ability to bathe, dress, use the toilet, transfer, and remain continent, and feed her- or himself. It’s also used for evaluating changes in response to illness.
A second part of ADL’s is dressing. This is assessed to understand if the older person gets clothes from closets and drawers and puts on clothes and outer garments complete with fasteners and can tie shoes.
Detailed questioning can assist the geriatric care manager in making the best recommendations. If the family reports that the client is wearing soiled clothes, it may be that the person has a visual impairment that is preventing him or her from seeing that the soiled clothes should be changed. However, it may also be that, if the person has dementia, he or she is forgetting to change clothes and might just need reminders or need to have a caregiver lay out the appropriate clothes to wear.
If a person can get dressed unassisted except for shoes and socks, recommending that the person use adaptive devices such as a long shoehorn will enable the person to continue to be independent. Older people who need hands-on assistance because they are unable to dress themselves because of physical problems, such as Parkinson’s disease or cognitive loss, will need a referral to a home health aide if family members are not available.
The Activities of Daily Living
Here is the first activity of daily living assessed by the geriatric care manager during an functional assessment as part of a geriatric assessment
Determining the exact amount of assistance that a person needs in each ADL is necessary to make the best recommendations for a care plan . For example, in bathing, if we find that the person needs only standby assistance in getting into and out of the tub or shower, the person might need the assistance of a companion (or family member) who can provide this service rather than assistance by a certified home health aide. Each state has its own laws regarding who can legally provide what service in a home care setting. If the person indicates that he or she isn’t showering because of a fear of falling, the person might only need to have the security of a shower chair and handheld shower spray. If the person has dementia and the family reports that he or she is not bathing, the person might only need reminders to bathe.
More specific knowledge of joint function is also helpful in determining the amount and type of assistance that a person might need. For example, if the person has limited range of motion in one or both shoulders, will that person be able to bathe him- or herself? Will physical therapy improve shoulder function?