When is Long-Term Care Needed?

Whether a person needs long-term care and what care she needs are determined by a healthcare professional, such as a physician, nurse, or medical social worker experienced in long-term care. An important part of the process is an assessment of the person's ability to perform activities of daily living (ADLs), basic functions required for a person to take care of herself. The inability to perform ADLs is the most reliable and objective indicator of the need for long-term care services.  The following six ADLs are commonly used to assess this need:

bathing -- washing oneself by sponge bath or in a tub or shower (including getting into and our of the rub or shower);
dressing -- putting on and taking off all clothing and any necessary braces, fasteners, or artificial limbs;
toileting -- getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene;
transferring -- moving into or our of a bed, chair, or wheelchair;
continence -- being able to maintain control of bowel and bladder function or, when unable to maintain control, being able to perform associated personal hygiene (including caring for catheter or colostomy bag); and
eating -- feeding oneself by getting food into the body from a receptacle such as a plate, cup, or table, or by a feeding rube or intravenously.

 These ADLs are listed in the order in which people normally lose the ability to perform them. This order is quite predictable, and, interestingly, it is exactly the reverse of the order in which children acquire the ADLs. For example, eating (picking up food and putting it in the mouth) requires only gross motor skills and a limited range of motion. It is the first ADL children acquire and the last one that an impaired or aging adult generally loses. In contrast, bathing and dressing are highly complex tasks that require fine motor skills (managing buttons and zippers), balance (standing on one leg while putting on pants), and an extended range of motion (reaching back to pull on a sleeve). These are the last ADLs children attain and the first ones an adult usually loses.
The inability to perform ADLs constitutes functional (or physical) impairment. However, some people can perform all ADLs but still need long-term care because of a cognitive impairment, a condition (such as Alzheimer's disease) that causes a significant diminishment of reasoning, intellectual capacity, or memory and results in confusion, disorientation, impaired judgment, or memory loss.