What Determines the Patient’s Level of Care?

A key element of providing appropriate patient treatment in a medical setting is ascertaining what level of patient care actually is required. The process of ascertaining patient (or resident, depending on the terminology used) level of care also extends into the long-term care setting. The American Council on Aging has established some useful criteria that provides helpful guidance in determining a patient’s or resident’s level of care.

There are four primary elements utilized in determining the level of care of an individual who may be in need of some type of long-term care assistance:

  • Physical function ability
  • Health issues and medical needs
  • Cognitive impairment
  • Behavioral problems

The analysis and application of these elements is utilized to determine what type of patient or resident placement is advisable at this time. The long-term care placement options are:

  • Home care
  • Adult day care
  • Senior housing
  • Assisted living community
  • Skilled nursing facility
  • Continuing care retirement community

Physical Function Ability

At the heart of the physical functional ability determination component of a patient assessment is a determination of an individual’s ability to successfully undertake tasks of day to day living. These are activities that a person must be able to complete on a daily basis to completely take care of his or her self. Examples of tasks of daily living are:

  • Getting out of bed
  • Walking from room to room
  • Bathing
  • Dressing
  • Basic meal preparation

The physical function ability element of a patient or resident assessment might also include instrumental activities of daily living. These are tasks that do not necessarily need to be done on a daily basis. Nonetheless, these are tasks that are necessary for daily living. Examples of these tasks are:

  • Grocery shopping
  • Housecleaning
  • Laundry
  • Medication management
  • Bill paying
  • Attending appointments

Health Issues and Medical Needs

The second element of a patient assessment involves an examination of health issues and medical needs. The need for ongoing medical care and assistance is the line between a living environment that provides some assistance with tasks of daily living versus the need for professional help with matters associated to a health or medical matter. Examples of when health issues and medical needs cross the line necessitating medical assistance like that provided at a nursing home include such matters as:

  • Intravenous medications
  • Other types of injections
  • Catheter care
  • Significant lack of mobility
  • Substantial chronic or debilitating illness

Cognitive Impairment

Yet another element of a long-term care patient or resident assessment involves an evaluation of cognitive functioning and the presence and extent of cognitive impairment. If an older individual does have some type of cognitive impairment, living independently presents an actual danger to that person. Examples of cognitive impairment that impacts a patient’s level of care include:

  • Alzheimer’s
  • Parkinson’s related dementia
  • Lewy body dementia

Behavioral Problems

Finally, when it comes to the process of determining a patient’s level of care, a consideration is made in regard to any behavioral problems that have been exhibited. In most instances, behavioral issues or problems stem from dementia. This particularly is the case with mid to late stage dementia. Examples of behavioral problems that impact a determination regarding a person’s level of care include, but are not limited to:

  • Frequent wandering from residence
  • Becoming lost
  • Impulsiveness
  • Verbal aggressiveness 
  • Physical aggressiveness
  • Sexual aggressiveness 

Long-Term Care Options and a Patient’s Level of Care Assessment

Home care: Home care takes a couple of different forms. First, home care represents the most commonplace way in which an older person is cared for at this juncture in time. This is care provided by a family member, usually an adult child, for no compensation. While this is the most commonplace form of home care, it oftentimes is not the best course of action. It is utilized because it theoretically lessens the financial burden on an older person and his or her family.

Second, home care can involve the assistance of home care aides, professionals that provide assistance to an older person in tasks associated with day to day living. Home care can also involve the assistance of healthcare aides of different types to do help an older person with matters pertaining to that individual’s medical status.

Adult day care: This type of program provides an older person out of residence assistance from one to five days a week at a specialized facility or center. Services provided include such things as meals, activities, transportation, and so forth.

Senior housing: Senior housing is an apartment or similar type of residential setting that has been specially adapted for use by an older person. Some senior housing communities do offer meals, transportation, and some other basic services of this nature.

Assisted living community: Assisted living offers an older person room and board together with other forms of assistance. These include assistance with elements of day to day living as needed. These communities also offer a variety of activities, including enrichment programs, fitness classes, and so forth. 

Skilled nursing facility: This type of facility offers around the clock nursing and related care for residents. In addition, a skilled nursing facility provides a resident assistance with a full spectrum of activities associated with daily living. A skilled nursing center is designed to provide medical care as needed as well. 

Continuing care retirement community: This type of community offers several levels of care in one setting. A continuing care retirement community is likely to have:

  • Senior housing apartments
  • Assisted living units
  • Skilled nursing facilities
  • Specialized memory care centers

Once an individual’s level of care is determined, an appropriate placement can be made in a suitable senior or long-term care facility. Ongoing monitoring and evaluation of a patient or resident occurs to ascertain whether a current placement remains appropriate or a move elsewhere is recommended.