Elder Care Assessment Checklist for Louisiana Families

Before you call a facility, hire a caregiver, or apply for Medicaid, you need to know exactly what your parent can and cannot do on their own. A structured assessment prevents two common mistakes: overreacting to a bad week and assuming a serious decline is just normal aging.

In Louisiana, this assessment also has regulatory implications. The state uses ADL (Activities of Daily Living) and IADL (Instrumental Activities of Daily Living) deficits to determine eligibility for Medicaid home care programs, waiver enrollment, and nursing facility placement. The more precisely you document your parent's needs now, the smoother those applications go later.

Activities of Daily Living (ADLs)

ADLs are the basic physical tasks of self-care. For each one, assess whether your parent can perform it independently, needs some assistance, or requires full assistance.

Bathing. Can they get in and out of the shower or tub safely? Do they wash all body parts? Do they remember to bathe regularly without prompting?

Dressing. Can they select appropriate clothing, manage buttons, zippers, and shoelaces? Do they dress for the weather? Do they change clothes regularly?

Toileting. Can they get to the bathroom in time? Do they manage clothing and hygiene independently? Is incontinence an issue, and if so, how frequently?

Transferring. Can they move from bed to chair, chair to standing, in and out of a car? Do they use grab bars, a walker, or a wheelchair? Have they had falls during transfers?

Eating. Can they use utensils, cut food, and bring food to their mouth? Do they remember to eat? Do they choke or cough during meals (a sign of swallowing difficulty)?

Continence. Do they have bladder or bowel control? If not, can they manage incontinence products independently?

Louisiana's clinical screening tools — the LOCET (Level of Care Eligibility Tool) and the interRAI Home Care Assessment — weight ADL deficits heavily. A parent who needs full assistance with three or more ADLs will generally meet the Nursing Facility Level of Care (NFLOC) threshold, which opens the door to both institutional Medicaid and waiver program eligibility.

Instrumental Activities of Daily Living (IADLs)

IADLs are the more complex tasks that support independent living. Decline here is often the first visible sign that something has changed.

Medication management. Do they take the right pills at the right times? Are they refilling prescriptions on schedule? Check the medicine cabinet for expired medications, duplicates, or bottles that should be empty but are not.

Financial management. Are bills being paid on time? Are there unusual charges or withdrawals? Is mail being opened and handled?

Meal preparation. Can they plan, shop for, and cook simple meals? Is the refrigerator stocked with edible food? Check for spoiled items, empty shelves, or evidence of relying entirely on snack food.

Housekeeping. Is the home reasonably clean and safe? Look for tripping hazards — stacked newspapers, loose rugs, clutter in walkways. Check the bathroom for mold, the kitchen for grease buildup, and the general living areas for pest evidence.

Transportation. Can they drive safely? Have there been any fender benders, near-misses, or traffic violations? If they do not drive, can they arrange and use alternative transportation?

Phone and communication. Can they use the phone to call for help? Do they remember how to operate their devices? Can they communicate their needs clearly?

Shopping. Can they make a list, get to the store, select appropriate items, and handle payment? Or are they relying on others to bring everything they need?

Home Safety Assessment

Walk through your parent's home with fresh eyes, looking for hazards that someone living there every day has stopped noticing:

• Lighting: Are hallways, stairs, and bathrooms well-lit? Night lights in the path from bedroom to bathroom?
• Grab bars: Installed in the shower/tub and next to the toilet? Properly anchored into studs, not just drywall?
• Stairways: Handrails on both sides? Steps in good repair? Can your parent navigate them safely with their current mobility level?
• Floor surfaces: Loose rugs removed or secured with non-slip backing? No electrical cords across walkways?
• Kitchen safety: Stove being used safely? Auto-shutoff features? Expired or recalled items cleared out?
• Emergency access: Can they reach a phone from any room? Do they have an emergency response pendant or system?
• Smoke and CO detectors: Working and tested? Battery current?

What to Do With the Results

Once you have documented your parent's ADL, IADL, and home safety status, you have the baseline needed to:

1. Determine care level. IADL-only deficits usually mean home care is sufficient. ADL deficits push toward assisted living or nursing home depending on severity. ADL deficits plus medical complexity (wound care, IV therapy, ventilator) require skilled nursing.

2. Support Medicaid applications. The financial side of Medicaid gets all the attention, but the clinical side — documented through the LOCET screening and the physician's Form 90-L — is equally critical. Your assessment provides the raw material for these clinical evaluations.

3. Communicate with siblings and other family members. Written documentation turns "I think Mom is getting worse" into "Mom needs full assistance with bathing, toileting, and transferring, and she has fallen three times in the past month." That specificity reduces family conflict and focuses the conversation on facts.

The Louisiana care decision toolkit includes a printable care needs assessment worksheet that mirrors the ADL/IADL framework used by Louisiana's clinical screeners — so what you document at home translates directly into the language the state uses to evaluate your parent's eligibility.

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