From the Guidelines
To demonstrate independence and capacity when facing pressure to move into a nursing home, it is crucial to showcase your ability to make informed decisions about your care and living situation, as emphasized in the concept of shared decision making 1. When trying to stay independent and out of a nursing home, while family members are pushing for inability to be independent, several steps can be taken.
- Documenting daily activities and self-care abilities through a journal can provide tangible evidence of independence, highlighting management of medications, meal preparation, personal hygiene, and financial handling.
- Scheduling a comprehensive assessment with a primary care physician to evaluate functional status and cognitive abilities can offer objective evidence of capacity, as it aligns with the criteria for discharge from an inpatient setting which includes being functionally independent or able to be assisted by family or caregiver 1.
- Considering in-home support services as a compromise, such as meal delivery or a medical alert system, demonstrates a willingness to address safety concerns while maintaining autonomy.
- Improving home safety by installing grab bars, removing trip hazards, and ensuring adequate lighting can significantly reduce the risk of accidents and demonstrate a proactive approach to independent living.
- Developing and sharing a detailed plan for managing emergencies, including contact information and medication lists, shows responsibility and foresight in health management.
- Attending regular medical appointments and following treatment plans demonstrates responsibility for one's health and a commitment to maintaining independence.
- Involving a neutral third party, such as a geriatric care manager or elder law attorney, can provide advocacy and support in making informed decisions about care and living arrangements. Remember, demonstrating independence is not about doing everything alone but about showing good judgment in seeking appropriate assistance while maintaining control over major life decisions, which is in line with the principles of patient-centered care and shared decision making 1.
From the Research
Demonstrating Independence and Capacity
To demonstrate independence and capacity when trying to stay independent and out of a nursing home, and facing family pressure regarding inability to be independent, consider the following points:
- Autonomy is a complex concept that involves self-determination and the capacity to act independently 2
- Promoting autonomy and independence for older people can be achieved through comprehensive individualized assessment, multidisciplinary care planning, and encouraging patients to participate in decisions about their care 3
- The Mini-Mental State Examination (MMSE) is a widely used screening tool for cognitive impairment, but its accuracy in detecting dementia in people with mild cognitive impairment is limited 4, 5, 6
- The MMSE should not be used as a standalone diagnostic tool to identify dementia, but rather as part of a comprehensive assessment 6
Assessing Cognitive Impairment
When assessing cognitive impairment, consider the following:
- The MMSE is influenced by age and education, and normative data should be used to account for these variables 5
- The diagnostic acuity of the MMSE varies depending on the type of dementia, with excellent specificity for Alzheimer's disease but lower sensitivity for other types of dementia 5
- A comprehensive assessment should include multiple tests and evaluations to accurately diagnose cognitive impairment and dementia 4, 6
Promoting Independence
To promote independence, consider the following:
- Encourage patients to participate in decisions about their care and involve them in the care planning process 3
- Modify the environment to promote independence and minimize risk, such as installing handrails or removing tripping hazards 3
- Provide support and resources to help older people maintain their independence, such as home care services or adult day programs 3