The COVID-19 pandemic swept the nation, killing more than 184,000 residents and staff of nursing homes and other long-term care facilities. The post pandemic response to this massacre has been confusion, doubt, and indecision on the part of the elderly and their caregivers about the use of long-term care facilities.

• Should I even consider putting my grandmother in a nursing home as she becomes frailer and more dependent?
• Would it be better for me to find someone to care for me here in my home? Can I afford it? Can I find someone both compatible and competent? Do I need round the clock nursing care?

These considerations, and many more, occupied the minds of the elderly and their caregivers before the pandemic struck, but now they have reached a boiling point. No one knows exactly what to do. What would be best?

Adult Services Specialists

For many years, social workers have served as adult services specialists, providing an array of services to assist eligible elderly and adults with disabilities in preventing or delaying premature or inappropriate institutionalization. This practice specialty evolved protocols and procedures used by social workers around the world to help the elderly and their caregivers make sound decisions. Before the pandemic the emphasis was on making sure that institutionalization was not premature as the elderly patient might fare better outside a nursing home. Now the decision to either enter a nursing home or opt for home care is weighted on the opposite fulcrum because the elderly are afraid of nursing homes and trying to avoid them at all costs. Social workers serving as adult services specialists are continuing to apply the tried-and-true protocols that they have developed over the years to evaluate premature institutionalization. Now, however, they are experiencing inappropriate reluctance rather than a too eager audience.

The Evaluation Tools Used by Adult Services Specialists

1. The inter RAI HC instrument is an internationally validated instrument consisting of several domains such as cognitive functioning, ADL, social and psychological wellbeing, health status, environmental characteristics, etc. The use of a comprehensive geriatric assessment such as the interRAI HC is essential in adult services social work in order to have an in-depth view of the client’s health and functional status.

Quality of Life

2. The WHO defines Quality of Life as "individuals’ perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns”. The WHO-QOL-8 scale measures the perceived overall quality of life of the clients. It encompasses physical and psychological health, social relations, and environment.

Caregiver Burden

3. In the international literature caregiver burden is perceived as a multidimensional response to stressors associated with care giving. These stressors may be physical, psychological, emotional, social, and financial. This scale contains 12 items with a score from 0 to 4. The total score can vary from 0 to 48 and the higher the total score, the higher the caregiver burden. 

Functional Performance

4. The ADL hierarchy scale is a measure of a person’s functional performance. It is based on the concept of early, middle, and late loss of ADLs and consists of 4 items from the inter RAI instruments: personal hygiene, toilet use, locomotion and eating. The scores vary from 0 to 6 and the higher the score, the greater the dependency.

Cognitive Performance

5. The cognitive performance scale (CPS2) is an internationally validated scale that describes a person’s cognitive status. The scores vary from 0 to 6 and the scale consists of 5 items from the interRAI HC instrument: skills for daily decision-making, making oneself understood, short-term memory recall, procedural memory and eating impairment. Higher scores indicate a greater degree of cognitive impairment. 

These five evaluation tools are used by adult services specialists to create an accurate profile and needs assessment of every elderly client being considered for institutional care. During this post-pandemic time of fear and confusion, they have never been more essential.

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