What loved one can, can't do should determine what you do

(Fifth of a series)

Like buying a car, the first step in choosing quality eldercare is understanding your universe of choices — what kind of care (or car) is available in your area? The second: Know the costs involved and how you'll pay, a major factor in determining your choices.

Step 3 in today and next Monday's columns: Evaluate a loved one's care needs.

An accurate evaluation is important for three reasons. First, it helps families organize around real problems, not the unknown. Second, it allows them to zero in on the kind of care that's appropriate, not waste time with services that won't work.

Third, unlike choosing a car (which is mainly driven by what you can afford), the cost of eldercare is determined by need. There's a big price difference, say, between getting a little help with groceries and moving to an assisted-living facility. So an accurate assessment guides you to choose the care that's needed at the least cost.

I'm always amused when I see quizzes on Internet eldercare sites asking what the family "can afford," as though its ability to pay determines which services are appropriate.

When you evaluate a person's needs, focus on his/her functional gaps — the tasks he/she can no longer do day-to-day. What someone can't do tells you the assistance he/she needs that will allow him/her to live as comfortably and independently as possible. And, whether a functional gap results from a cause that's physical, cognitive or just personality, if the task doesn't get done, it's a gap.

To help with this important process, I've created a two-page "Basic Older Adult Needs Assessment" that steers you to ask the right questions. You can download it at www.seattletimes.com/living. Professionals in the aging field use longer, more complex tools. However, if you can answer the basic, common-sense questions I recommend, you'll be on the road to figuring out what to do next.

Two preliminary comments:

• Just because someone has trouble with a task doesn't mean he/she needs help. The key is: Can he/she self-manage? If your dad can take his medicine without human assistance (by using a medi-set or other reminder system), for example, then he doesn't have a functional gap. Long-term care services are expensive. You'll make your dollars go farther and help your dad stay independent longer if you focus on the incapacities that require a family member, home-care aide or facility to fulfill.

• If someone lives alone, it's difficult to evaluate his/her capabilities, especially if memory loss is involved. So make some educated guesses. Observe: Are your mom's clothes clean? Is your dad getting threatening letters from the utilities? Does the fridge have rotting food? Is there a smell of urine in the bedroom?

Now to the assessment list: Here are three of seven key factors to consider. I'll talk about the remaining four next week.

1. Diagnosis It's important to know what's causing a person to fail, so don't guess — find out. If a doctor says, "It's just old age," find a new doctor. "Old age" is not a diagnosis! The reason you want a correct diagnosis is that it gives you a prognosis — a ballpark idea of what the future is likely to hold and how much care will be needed, and a roughly approximate time frame. Even if the diagnosis is hard to take, it helps you plan.

2. Cognitive Impairment Memory loss is the most common reason older people need care. There are numerous causes (including some that are temporary, which means with treatment it can improve). So knowing what causes a person's memory loss is essential to understanding what care is needed and for how long. In this space, spell out the symptoms and the reason.

3. Personality The personality of an older person is often overlooked in choosing his/her care, but it's vital to that person's quality of life. Because there are so many eldercare choices today, it's important to try to match the services/workers you hire and the care environment you choose with the impaired person's life, values and attitudes.

Liz Taylor's column runs Mondays in the Northwest Life section. A specialist in aging and long-term care for 30 years, she consults with families and their elders. E-mail her at growingolder@seattletimes.com or write to P.O. Box 11601, Bainbridge Island, WA 98110. You can see all of her columns at www.seattletimes.com/growingolder/.