This article is for informational purposes only and does not constitute medical, legal, or financial advice. Always consult with qualified professionals regarding your specific situation.

Care Level Assessment — Figuring Out What Kind of Help They Actually Need

When you first realize your parent or older relative needs help, the question isn't always obvious. Do they need someone stopping by twice a week? Do they need 24-hour care? Should they move to an assisted living facility or can they stay home with some support? The answer depends on understanding exactly what they can still do independently and where they need assistance.

A care level assessment is simply a structured way of looking at your loved one's actual capabilities. It's not a medical diagnosis. It's not about what they used to do or what you wish they could still do. It's about what they can do right now, today, and what specific tasks they need help with. This clarity becomes the foundation for every decision that follows—where they live, what services they need, how much help to arrange, and what this will cost.

The good news is that you don't need a fancy form or a professional to get started. You need to think through two main categories of daily activities, check in on cognitive status, and understand their medical situation. Let's walk through each one.

Activities of Daily Living (ADLs)

ADLs are the basic self-care tasks that everyone needs to do every single day. These are the activities that determine how much physical help someone needs. The six core ADLs are bathing, dressing, toileting, eating, continence, and transferring (moving from bed to chair and back).

Start with bathing. Can your parent step into a tub or shower safely? Can they wash their entire body? Can they manage the temperature without burning themselves? If they can do all of this independently, they're managing this task. If they need grab bars but can still bathe themselves, they need environmental help. If someone needs to help them wash their back or hair, or they need to use a shower chair, they're getting assistance. If they need someone there the entire time, that's significant help needed.

Dressing works the same way. Can they select appropriate clothing for the weather? Can they button buttons, fasten zippers, and tie shoes? Can they get everything on the right way? Some people can do this fine but need help reaching things in a high closet. Others get confused about what matches or what's weather-appropriate. That matters.

Toileting includes both the physical act and the management of incontinence. Can they get to the bathroom, use the toilet, and manage personal hygiene afterwards? Do they need a raised toilet seat or grab bars but can do the rest? Do they have accidents? Do they forget to use the bathroom and need reminding?

Eating goes beyond just chewing and swallowing. Can they feed themselves with utensils? Can they cut their food? Can they remember to eat three meals a day, or do they forget lunch if you're not there? Can they get food from the refrigerator and prepare something simple? Can they manage their diet if they're supposed to avoid certain foods?

Continence is straightforward but important. Can they control their bladder and bowels? Do they have accidents? Do they need incontinence products? This isn't shameful—it's simply information you need to arrange appropriate care.

Transferring means moving from one place to another. Can they get out of bed independently? Can they stand from a chair? Can they walk across the room? Do they use a cane, walker, or wheelchair? Do they need someone to help them stand or do they need mechanical help like a lift? This affects safety and who can help them.

Instrumental Activities of Daily Living (IADLs)

IADLs are slightly more complex,they're the tasks that let someone live independently in their community. Someone might be able to bathe and dress themselves but still need significant help to stay at home.

Can they manage medications? This is important. If they take multiple medications with different schedules, can they remember which one to take when? Can they open the bottles? Can they recognize if they've already taken today's dose? Many people who are otherwise fine need help with medications just because the complexity gets overwhelming.

What about cooking? Can they plan a meal, shop for ingredients, and prepare food safely? Can they use the stove and oven without forgetting about them? Can they remember to eat if they're not reminded? Even someone who can bathe independently might not be able to manage cooking.

Finances matter a lot. Can they pay bills on time? Can they recognize a scam or financial abuse? Can they manage their checkbook? Can they handle a credit card responsibly? Do they forget to pay things? Do they start giving away large amounts of money to causes or charities without thinking it through?

Shopping includes getting to the store, remembering what to buy, and managing money at checkout. But it also includes the planning,knowing what they need, making lists, remembering dietary restrictions. Some people can get to the store with someone but can't manage the planning part. Others have forgotten what they came to buy before they get there.

Housekeeping and laundry come into play for independence. Can they do laundry? Can they keep their living space clean enough to be safe and healthy? Do dishes pile up? Is the kitchen or bathroom unsanitary?

Keeping up with appointments is another IADL. Can they remember they have a doctor's appointment? Can they get themselves there? Can they remember what to tell the doctor?

Cognitive Status

Beyond what someone can physically do, you need to understand their thinking and judgment. Someone might be able to bathe and dress themselves but have poor judgment about medications or money.

Memory is the first piece. Do they forget things they learned recently? Do they ask the same question repeatedly? Do they forget appointments, meals, or that someone visited yesterday? There's a difference between normal forgetfulness and memory that's affecting their function.

Orientation means knowing who they are, where they are, and what day it is. Do they recognize family members? Do they know where they live? Do they get confused about time,thinking a recent event happened years ago or that someone who died is still alive?

Judgment is about decision-making. Can they recognize danger? If there's a fire, would they know to leave the house? If someone calls offering them a prize, do they know it's likely a scam? Can they understand their medical condition and follow medical advice? Can they make safe decisions about medications, money, and personal safety?

Communication matters too. Can they express their needs? Can they understand what you're saying? Do they use the right words for things, or do they get words confused?

Medical Complexity

Finally, you need to understand their medical situation. Not because you need to diagnose anything, but because it affects what level of care they need.

How many diagnosed conditions do they have? One condition is different from managing five conditions. The more conditions, the more medications. The more medications, the greater the risk of interactions and side effects.

What about specialists? If they see a cardiologist, an endocrinologist, and a urologist, coordinating care becomes complex. Someone needs to keep track of all those appointments and make sure all the providers know what the others are doing.

What medications do they take? How many? Are there complex interactions or side effects? Do they have allergies to medications? This is information you need for any care arrangement.

What's their hospital and surgery history? Have they had serious health events? Do they recover well from illness? Are there ongoing complications?

Putting It Together

Once you've thought through ADLs, IADLs, cognitive status, and medical complexity, you have a clearer picture. Maybe they're independent with ADLs but need help with IADLs,they can bathe and dress themselves but can't manage medications or cooking. Maybe they're mostly fine but showing some memory loss. Maybe they can do everything but have complex medical needs that require professional monitoring.

This understanding is what determines whether someone can live at home with a few visits from helpers, needs assisted living, or needs more substantial support. It's the foundation for conversations with doctors, social workers, and family members. And it helps you plan what services to arrange, whether you're looking at home health aides, adult day programs, or facility-based care.

This assessment isn't something you do once and forget about. People's abilities change. What they could do last year might be different this year. Revisit this assessment every six months or whenever you notice a change. That way you're always working with current information, not assumptions.

How To Help Your Elders is an informational resource for families working through aging and elder care. We are not medical professionals, attorneys, or financial advisors. The information provided here is for educational purposes and should not replace professional consultation. Every family's situation is unique, and rules, costs, and availability vary by location and circumstance.