Before a potential resident moves into any type of senior living community, the staff should conduct a thorough, in-person assessment of the senior’s physical and cognitive health.

While doctor’s notes can be helpful in documenting a senior’s medical issues, long-term care facilities shouldn’t rely on this information for admission purposes. Instead, an evaluation, often conducted by a nurse or another admissions employee, should be performed to obtain current information about a senior’s care needs. This assessment determines the level of care a potential resident requires, the services that the facility can provide and the associated costs. The process is also instrumental in creating a senior’s care plan.

At HarborChase of Naples, FL, a senior living community that provides assisted living, memory care, and skilled nursing services, a nurse sits with every prospective resident (and often their families, too) and conducts a thorough evaluation of the elder’s ability to independently perform activities of daily living  (ADLs) throughout a typical day.

Using an eight-page evaluation packet, the elder is ranked on a “point system,” which determines the level of care they require. Levels at HarborChase range from Basic Care, Level 1, Level 2 and Level 3, with Level 3 being the highest, most intensive level of care. This process ensures the facility is able to provide the resident with the care they require, and it also determines the monthly fee they will pay.

Not all assisted living facilities and skilled nursing homes use a point system like HarborChase, but the key is that an assessment is conducted, that it is thorough and that there is a formal process for using the assessment to determine care and services for residents.

Typically an assessment for prospective residents will inventory and rank a person’s behaviors, chronic illnesses, communication abilities, dietary requirements, ability to perform activities of daily living (ADLs), ability to manage medications, need for assistive devices and much more. HarborChase has provided the following sample criteria that its staff members use during resident assessments.

Senior Housing Evaluation: Level of Care Assessment

Gauging Orientation

The senior:

  • Is oriented to and aware of people, places and time.
  • Has occasional confusion and some difficulty recalling details. Needs some prompting.
  • Requires regular prompting due to confusion and disorientation.
  • Has severe cognitive deficits and a history of poor judgment, creating potentially unsafe behaviors.

Level of Bathroom Assistance

The senior:

  • Is continent of bowel and bladder and manages toileting independently.
  • Is continent of bowel and bladder and manages protective and/or assistive devices independently.
  • Requires occasional reminders/prompting to go to the bathroom.
  • Has intermittent episodes of incontinence.
  • Requires reminders for protective garment use.
  • Requires assistance to manage bowel and/or bladder.
  • Requires a two-person lift/assist when toileting.

Fall History and Risk

The senior:

  • Has never fallen.
  • Has had one fall in the last three months.
  • Has had more than one fall in the last three months.

Level of Mobility

The senior:

  • Is independent in mobility.
  • Requires reminders to use assistive devices.
  • Requires the assistance of one person for transfers.
  • Requires assistance to push a wheelchair due to a physical limitation.
  • Requires a two-person assist/lift for transfers.

After touring and interviewing staff at prospective senior living communities and selecting a new home for your loved one, make sure that a new resident assessment is conducted. Ask your loved one if you can also attend the meeting to better understand the evaluation process and how these communities determine the level of care residents need. This will help you with future care decisions as your loved one’s abilities decline and needs increase.

Furthermore, your input is equally as important as resident feedback. Senior living communities typically like caregivers to attend whenever possible to help fill in gaps in information and provide objective insight on a senior’s level of functioning. In some cases, the staff may conduct separate assessments, one with the caregiver and one with the elder alone. This helps both parties feel comfortable about being completely honest during the evaluation and enables the staff to establish a realistic care plan.

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After a senior moves into long-term care, their needs and abilities should be periodically reassessed to ensure they continue getting the care they require. The frequency of these subsequent evaluations depends on whether a resident is declining and how often the state mandates care plan assessments for all residents. While state regulations vary, a reassessment should be conducted at least annually, even if a resident does not show any obvious signs of decline. Family caregivers usually request to be involved in these ongoing evaluations and attend care plan meetings with staff to receive updated information about services and costs.

In short, needs assessments are crucial for any senior, whether they are living at home or moving to senior housing. These evaluations help family caregivers and professional caregivers alike determine the services and supports that an elder needs and facilitate tracking fluctuations in their condition.

Print a sample ADL Assessment Checklist