The Six ADLs: What They Are
Activities of Daily Living (ADLs) are bathing, dressing, toileting, transferring, continence, and eating. List each one and note whether your parent is independent, needs reminders, needs one-person assist, or needs full hands-on help. The more hands-on assistance required, the more support you'll need from a care setting.
Add Instrumental ADLs (medications, cooking, finances, transportation) for a full picture.
Cognitive vs Physical Care Needs
Physical needs are obvious — mobility issues, weakness, incontinence. Cognitive needs are trickier. Memory loss, poor judgment, wandering, or paranoia can make an otherwise mobile person unsafe to live alone. Note behavioral concerns like sundowning or exit-seeking; they directly affect the type of home you should tour.
The Care Level Spectrum
Level 1: Independent with reminders. Level 2: Needs cueing plus occasional hands-on help. Level 3: Requires daily physical assistance for multiple ADLs. Level 4: Requires two-person transfers or specialized equipment. Level 5: Complex medical care (feeding tubes, ventilators) — usually skilled nursing territory.
Most AFHs handle levels 2–4 comfortably; level 5 typically goes to skilled nursing.
Signs Your Parent Needs More Than Home Care
Watch for falls, medication errors, wandering, weight loss, unpaid bills, caregiver burnout, and unsafe nighttime behavior. If two or more of these are happening despite in-home help, it's time to explore residential care.
How Washington DSHS Assesses Care Levels
DSHS case managers use the CARE assessment to assign a numerical score that translates into a payment tier for Medicaid services. Even if you're private pay, reviewing the assessment worksheet helps you quantify need. Ask your parent's doctor or social worker for a functional assessment letter if you plan to share the data with homes.
Matching Care Level to the Right Setting
Level 1–2: independent living or assisted living. Level 3–4: adult family home or memory care unit. Level 5: skilled nursing facility. Consider future trajectory — if Parkinson's or dementia is progressive, choose a setting that can handle the next stage so you avoid another move in six months.
When in doubt, schedule a free assessment with a placement specialist or geriatric care manager.
Frequently Asked Questions
Q: Who can perform an assessment? A: Physicians, physical/occupational therapists, geriatric care managers, or DSHS case managers.
Q: Should my parent attend the assessment? A: Yes, if possible. Their voice matters, and assessors need to observe abilities directly.
Q: Do homes charge for assessments? A: Most AFHs offer complimentary in-home or hospital assessments before admission.
Q: What if siblings disagree? A: Use objective data — ADL checklists, physician letters — to anchor the conversation.