Assessing Whether a Dementia Patient Can Safely Live Alone

/Home/Living Alone with Alzheimer's

This is the live alone assessment developed at the University of Iowa. It was developed because the average social worker has no uniform guidelines to make such a determination. One of the big problems is there is no way to know how a person will react in an emergency situation.


Signs to Watch For in People who Live Alone or Who are at High Risk

The following factors may indicate when a person with dementia is no longer appropriate to live alone or at
minimum requires greater services are needed.

Classification:

A = Emergent – Immediate help/placement required. Only one factor needs to be present

B = Semi-Emergent - Not an immediate threat to safety or well-being. May wait a few weeks, but there is a clear
need for inhome services or support or work towards placement. Increasing safety risk when two or more are
present

C = Non-Emergent – Consider additional help, especially when three or more are present. Re-evaluate monthly

Combined letters indicate the ranking depends on reviewers perception of severity


Reported or observed conditions

Grade A:
__Weight loss of > 6 lbs or 10% body weight in 6 months; loose clothing, evidence of wasting (protruding bones)
__Florid (agitated) paranoia, hallucinations, delusions, suicidal thoughts, aggression
__Weapons present, especially loaded
__Evidence of misuse or appliances or equipment, evidence of fire
__No food in house or rancid food
__Falls (especially with long lie >2 hrs), evidence of injuries, unexplained bruises, evidence of substance use
__Medication mistakes or poor care for potentially life-threatening/unstable conditions
__Reports of self-neglect or dependent adult abuse, founded or unfounded
__Repeated ER visits, hospitalizations, physical complaints
__Evidence of caregiver injury, domestic violence
__Calls police or emergency services frequently
__Wandering outside the home
__ Eviction notice served

Grade A/B:
__Malfunctioning plumbing, especially no water or toilet stoppage
__Thermostat set inappropriately for weather conditions
__Chronic anxiety, panic attacks, chronic worry, depression
__Unsafe driving, refuses to stop
__ Law Enforcement referred

Grade B:
__Poorly managed incontinence
__Repeated calls to family or others asking what to do next or expressing concern about planned activities
__Dirty or infested household that poses risk to health
__Garbage accumulation
__Food stored inappropriately (Ice cream in closet)
__Exploitation by neighbors, friends, relatives, others
__Resists personal care for prolonged periods of time

Grade B/C:
__Client states “I need to move,” “I can’t take this much more,” or otherwise indicates he/she feels a move is imminent
__Neighbors and others complain of unwanted or unrealistic dependence on them
__Phone calls from community members advising help is needed


Grade C:
__Vegetative or socially isolated behavior (sitting all day with TV on or off)
__Missing belongings, hiding things
__Poor grooming and wearing sam__Post-it notes throughout house


Observation Cues

1. Outside the home
• Condition of the yard
• Are the windows open or shut consistent with safety and the season?
• Condition of the home
• Is the door locked or unlocked appropriately?
• How does the client answer the door?

2. Just inside
• Temperature of the home
• General condition of interior
• Client appearance- does the client have body odor, grooming- or absence of, stains on clothing, hair/ shaving, absence of mouth care, appropriateness of clothing (shoes)
• Any odors
• Clutter or looking “unlived in”
• Evidence of infestation
• Pets and their condition

3. Further inside
• Stacks of papers, mail, evidence of overuse of scams
• Dust and dirt
• Interactions with others
• Where the client sleeps
• Soiled furniture
• TV on?
• Condition of the bathroom
- Plumbing clean/work?
- Medications present?
• Condition of the bedroom
- Clean linens?
- Clothing?

4. Kitchen
• Clean? Infested?
• Evidence of cooking or eating?
• Stocked with food?
• Fridge? Food? Mold?

5. Listening
• Does what the client says fit with what you see?
• Social skills?
• Telephone use during the day- amount, repetitions