Activities of daily living (ADLs) evaluations divide assistance into mimimal, moderate, and maximal. The Functional Independence Measure defines these levels by the percentage of a task a client can do independently like 25 - 49%. OTs can guesstimate these percentages because they see hundreds of clients which helps them judge a client's performance. Caregivers need a more practical way to know how much to help.
Minimal assistance = you can multitask because your loved one can do a lot, but stay near by. Moderate assistance = sit or stand in front of loved one because they will need repeated help. Maximum assistance = look for ways for your loved one to help you ( e.g. have them put their arm around you to help you scoot them to the front edge of the wheelchair before you stand them up).
OTs have an incentive to keep their hands in their lap - every time they help it lowers a client's ADL score. Caregivers have different incentives for waiting to see how much their loved one can do. Caregivers need energy to do chores their loved one usually does, like cleaning toilets and mowing the lawn. Caregivers also need energy to make doctor and therapy appointments, arrange transportation, deal with health insurance bills, pick up medications, set up home exercises, and deal with a loved one's difficult emotions.
When therapists say a client needs assistance, caregivers need to think about asking for help before they get into trouble. Nurses gave caregivers a preparedness questionnaire before discharge from rehab and asked them what they were thinking as they answered each question (1). A dialogue is much better than a handout. homeafterstroke.blogspot.com
1. Carmicia M, Lutz B, Harvath T, Joseph J. Using the Preparedness Assessment for the Transition Home After Stroke Instrument to identify stroke caregiver concerns predischarge: Uncertainty, anticipation, and cues to action. Rehabilil Nurs. 2021;Jan-Feb 46(1);33-42.
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