Levels of Care

Clients receive an evaluation to determine their
personalized individual level of care plan.

Level One:

Independent in transfers with or without device. Independent with ADL’s with minimal standby assist. Oriented to Time, Person and Place. Functions independently. Manages medications with little or no supervision or may need medication reminders.

* Alzheimers/Dementia Stage 1, 2 & 3

Level Two:

Decreased Independence in transferring, with or without assistive device, needs minimal assist x1 to stand but uses assistive device to walk on own with standby assist one or more times daily. Cannot manage medications. Oriented x3 at times, needs re-orientation daily. Memory Deficit. Needs assist to toilet in Bathroom, unsteady gait. Incontinent of Bowel and/or Bladder 3 times or more weekly.

* Alzheimers/Dementia Stage 4 & 5

Level Three:

Dependent in all transfers. Wheelchair bound. Total dependence with all ADL’S, Meds must be managed. Incontinent of Bowels and/ or Urine, needs diapers. Needs assistance with setting up meals, but can feed self. Confused at times. Needs re-orientation throughout each day. May need 2 person transfers.

*Alzheimers/Dementia Stage 6

Level Four:

BedBound, Needs turning every 2 hours. Incontinent of Bowels & Bladder all the time. Needs to be fed, Meds must be given or crushed and put in food, Confused, potential for Elopement, up during nighttime hours.

*Alzheimers/Dementia Stage 7

The following could constitute a Follow up Assessment which would assist in determination of change in Level of Care:

Cognitive Changes
Increased Memory impairment
High Risk for Elopement/Unauthorized absence from building
Inappropriate dress for weather
Behavior changes (disruptive to self/others, increased vocalizations, combative),
Increased weakness,
Increased Incontinence
Decreased Appetite
Increased pain

Alzheimer/Dementia Assessment

Your doctor may also use a diagnostic framework with three, five, six, or seven levels. Progression through these stages may last from 8 to 10 years.

The seven stage framework includes the following dimensions:

Stage 1 – No impairment. Memory and cognitive abilities appear normal.

Stage 2 – Minimal Impairment/Normal Forgetfulness. Memory lapses and changes in thinking are rarely detected by friends, family, or medical personnel. Half of those over 65 begin noticing problems in concentration and word recall.

Stage 3 – Early Confusional/Mild Cognitive Impairment. Subtle difficulties impact functions. Try to hide problems. Problems with word retrieval, planning, organization, misplacing objects, and forgetting recent learning affect home and work environments. New learning, complex planning and organization may be impacted. Depression and other mood disturbances can occur. Duration: 2-7 years.

Stage 4 – Late Confusional/Mild Alzheimer’s. Problems handling finances result from mathematical challenges. Recent events and conversations are increasingly forgotten. Still know selves and family, but have problems carrying out sequential tasks, including cooking, driving, and home management tasks. Ordering food at restaurants, independent shopping, and other sequential tasks are affected. Often withdraw from social situations, become defensive, and deny problems. Need increasing assistance with the “business” of independent living. Accurate diagnosis of Alzheimer’s disease possible. Lasts roughly 2 years.

Stage 5 – Early Dementia/Moderate Alzheimer’s disease- Decline is more severe, and requires assistance. No longer able to manage independently in community. Unable to recall personal history details and contact information. Frequently disoriented to place and or time. A severe decline in numerical abilities and judgment skills leaves patients vulnerable to scams and at risk from safety issues. Even if able to dress, feed, and perform other basic daily living tasks, require supervision. Loss of current information is inconsistent and personal history is no longer reliably recalled. Duration: average of 1.5 years.

Stage 6 – Middle Dementia/Moderately Severe Alzheimer’s disease- Total lack of awareness of present events and can’t accurately remember the past. Progressively lose ability to dress and bathe independently. Bowel and bladder incontinence often occur, repetitive verbal or nonverbal behaviors are present, wandering, suspicion, and other dramatic personality changes are common. Can’t remember close family members but know they are familiar. Agitation and hallucinations are particularly present in the late afternoon or evening. Late in this stage, need care and supervision but can respond to nonverbal stimuli, and communicate pleasure and pain behaviorally. Lasts approximately 2.5 years.

Stage 7 – Late or Severe Dementia and Failure to Thrive. Severely limited intellectual ability. Communicate through short words, cries, mumbles or moans. When speech is lost, also lose ability to ambulate without help. Health declines considerably as body systems begin to shut down, swallowing is impaired, and the brain is no longer able to interpret sensory input. Generally bedridden, increased sleeping, seizures possible. No longer responds to environmental cues and requires total support around the clock for all functions of daily living and care. Duration is impacted by quality of care and average length is 1-2.5 years.