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Determining the Appropriate Level of Care

Nearly all clients want to remain in their home for as long as possible. Determining when additional levels of care are necessary and when it is not safe for an individual to remain at home often requires the intervention of a team of persons dedicated to ensuring the client receives appropriate care and oversight.

Rather than bore you with technical requirements when assessing whether your loved one needs care, you should consider whether the individual has a diagnosis or receives medical treatment that limits the individual’s ability to manage his/her own care or maintain himself or herself in their home independently. If he/she is unable to manage care independently, your loved one may need additional services – whether provided in home, or in a facility.

To meet the nursing home level of care requirement, the individual who needs assistance must be unable to manage three Activities of Daily Living (ADL). ADLs include: feeding, bathing, dressing, walking, transferring, and continence.  Many of our clients may have sufficient needs, but are still able to manage their ADLs. As a result, a nursing home is not a suitable placement.

When individuals are able to manage the majority of their ADLs, but are unable to perform Instrumental Activities of Daily Living (IADL), such as cooking, driving, shopping, managing finances, managing medication, cleaning, etc., we recommend less restrictive care options. Many clients who have some impairment can sufficiently live independently, or remain in their home with minimal assistance. Other clients may need to be placed into a more structured environment for more intensive oversight.

Whether your loved one needs immediate care, is in a financial crisis, or whether your loved one should start planning in light of possible long-term care needs down the road, we can help assess care options and financing.

Kit KatAsk Kit Kat – The Lowly Vole

Hook Law Center:  Kit Kat, what can you tell us about voles?

Kit Kat:  Well, it turns out a lot. I’ve written previously on moles and mice, but the prairie vole it turns out has a lot to offer, too, in the way of contributing to scientific research and its applicability to humans. Researchers at the University of Virginia have chosen them as research subjects, because they are a lot like humans with regard to mating and parenting. The prairie vole breeds year round and can have as many as 4 pups per litter. They are found in the central part of the United States from New Mexico to Ohio and West Virginia. They are small and never weigh more than 3 ounces!

Anyway, there is a relatively new field in science call behavioral epigenetics in which cell changes from environmental factors are examined. The cell itself does not really change, but how it reacts can change depending on things that happen to it. Additionally, some scientists believe that these cell reactions can be passed down to future generations. ‘Offspring of low-care parents (voles) become low-care parents themselves, and this alters the epigenome of the next generation of offspring,’ says Kelly Wroblewski (UVA Grad ’20). It happens through a process called methylation, in which the effectiveness of the gene is reduced. In the case of prairie voles, they found that voles with parents who spent little time with them had more trouble bonding with potential mates and their own offspring. The implication for humans is that offspring of parents with mental health weaknesses such as depression or victims of trauma could be pass their impaired coping mechanisms down through the generations.

More research needs to be done, but it is intriguing that this humble creature is very useful to humans in their quest to understand how emotions and their resulting behaviors can be passed down to offspring, just as much as a predisposition to acquire certain physical ailments.

(“What can voles tell us about ourselves,” UVA Magazine, Fall 2016, p. 45)

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