I am a Service Coordinator at an INDEPENDENT senior living community - we offer NO assistance whatsoever. Out of 130 residents, most are sincerely independent and get along quite well. It always makes me sad when I see people's quality of life decline due to the natural aging process. There have been SO MANY instances here where the person is declining but they are in denial! When something is quite obvious to me, I'll have discussions with family members but, they are in denial as well! A resident falls, they go to the hospital, then rehab, and they come back to the same environment and change nothing. Or a resident "suddenly" gets confused and forgetful and the family says it's just typical "old age". I discuss getting the resident checked for a UTI, but that goes unheeded. So many of these situations end up with me calling DHS and filing a report. This happens so often that they know me by name at the DHS office! The thing is, 95% of these reports are "denied" because the resident somehow has a "lucid" moment while they are speaking with the caseworker or a family member. If they can tell you what day it is, what year it is, where they live, etc., they are deemed still "independent"...while it's SO CLEAR to me they are NOT, and SHOULD BE in an ALF - or at least get proper home care to enable them to stay where they are. Family members think I'm interfering or exaggerating certain things. I would say 9 times out of 10 it takes a tragedy to get these people and their family members to wake up.

Is there a more in-depth list of criteria I can use to try to determine dependency? As we all know, seniors have a remarkable ability to be on their "best behavior" when it's a crucial moment, then, when they "know" the perceived "danger" is over, they relax and continue on in their confused and questionable way. I see it ALL THE TIME and it's VERY frustrating!

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I have the same issue in assisted living when an elder requires long term care but continues to stay in the 'gray area' and do not qualify. And it is true, when the assessment is done and the family is around they are quite lucid and then we have issues going forward when they leave.
I sometimes get a few volunteers who are willing to 'watch over' the elder and monitor their behaviours and abilities over a 24 hour period as a baseline and continue to monitor during the week and find the pattern of when they are lucid and when they are not. When this extra information can be presented with the assessor it generally helps. It is difficult when you have someone who requires more care and you don't have the resources to be able to help.
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Do you have a "Needs Assessment" form that you can fill out to show the decline on a person's ability to perform ADLS or decreased cognition and decision making?  Here are some information about "Needs Assessments" that you might want to look at and maybe use at your Independent Facility.
Assessment of Need for Community Services & Out-of-Home Placement
This Assessment Tool will give you a general idea about which type of housing or care may be most appropriate for you or your loved one. For each category below, please select the description that may be most appropriate.
The Needs Assessment - What it is And Why it is So Important to Assisted Living Residents
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Unfortunately in private homes it also takes a tragedy to be able to implement any kind of change when the elderly person refuses all manners of assistance. Families wait for a fall because they know there's going to be one. Or they wait for an illness because they know there's going to be one.

I'm not aware of any specific list of what determines an elderly person who goes from independent to dependent. I would imagine that DHS might have such a list. If there even is a formal list.

And yes, we all know that seniors demonstrate show timing, when they put their best face forward. I would imagine that would be on such a list. But how can one measure that particular behavior? The DHS have to go by what they see, what they can measure. Anecdotal reporting is fine but DHS has to be able to witness the behavior themselves. Which puts you in the position of having to wait until the elderly person has deteriorated to such a point that DHS will be able to witness it. So you're back to waiting for a tragedy to happen before action is taken.

If there is such a list somewhere hopefully someone here will know where to find it but I would think you in your capacity as a service coordinator would have better luck finding such a list than we would.
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