Understanding the Pre-Assessment: What Nurses Ask and Need to Know

A nurse is coming to pre-screen Dad, checking to see if he can move into assisted living, and you’re on pins and needles.

What will the nurse be looking for? And why can’t assisted living facilities just take everyone?

Don’t worry, it’s not about creating some exclusive club. It’s about making sure that particular assisted living facility is a good fit for your dad.

By law in Wisconsin, each Assisted Living Facility has to be licensed, showing what client group they specialize in (e.g. mental health, dementia, frailty). And if they take care of more than one type of client group? They have to prove how those groups work together.

So all the nurse’s inquiries will boil down to three reasons for the evaluation:

• Can they handle Dad’s needs?
• How much will it cost to care for him?
• Will his situation fit in well with other residents’?

Some of the nurse’s questions might be for you, some for Dad himself if he’s able to answer.

But you know how it is when you get put on the spot.

Your mind goes blank.

Want a head start on collecting your thoughts? Here’s a list of information the assisted living nurse might be looking for.

The Basics

These are those same questions you get asked every time you go to the doctor:

• Insurance, Immunizations, Height, Weight…
• Did he get the flu vaccine? Pneumonia shot? Tetanus?
• How are you hoping to pay? (Private? County?)
• What hospital does he prefer?

The one question that might catch you off guard is his preferred funeral home. If you haven’t researched those yet, that’s okay. Just take it as a gentle suggestion of something to do soon.

Medications and Drugs

These questions will go beyond names and quantities. They’ll also want to know

• how he takes them (whole, crushed, hidden in peanut butter, intravenously)
• if he takes them by himself, if he needs reminders, or if he refuses them and needs persuading
• any allergic reactions to medicines
• if he’s ever struggled with substance abuse

Any history of smoking will probably also come up here.

Food and Diet

Hopefully you and Dad have had a chance to try several meals in the senior living facility, both for taste and climate, asking lots of questions.

Now, their questions for you:

How does Dad eat?

Can he feed himself? Need cueing (i.e. reminders on what to do)? Need spoon-feeding? Tube feeding?

How does he need his food prepared?

Cut up into pieces? Pureed? A Diabetic menu? Heart-healthy?

What will he eat?

Likes/Dislikes? Does he have a healthy appetite? Has that changed recently? Does he need supplements like Ensure?

What are his food hazards?

Allergies? Chokes on food? Struggles to chew or swallow?

Eating is a huge part of our daily life, both physically and socially, so these answers can help match him with a good-fit assisted living facility—one that can help him thrive regardless of his eating needs.

Physical Health

This category can cover him head to toe.

1. First, the basic 5 senses questions:

• His sight. Hearing. Does he have all his teeth?
• How’s his speech?
• Does his skin bruise easily, develop pressure sores? Does he have dry skin, environmental allergies? Does he need a lot of lotion?

2. Weight Issues, especially obesity:

While you’ve already given his weight, it might come up again. Why?

Obesity puts him at risk for more falls, skin issues, accidents, injuries, diabetes, heart concerns, and a need for more than one person to lift him if he needs support.

3. What nursing procedures would he need?

• Rehab?
• Wound care? Catheter or colostomy care?
• Is he in pain?
• Is he on Hospice? (which one?)

4. How’s his mobility?

• Does he need a cane, walker, wheelchair? Is that wheelchair motorized? Extra-wide? (Not every facility is wheelchair appropriate.)
• Has he fallen? How often? How badly? Does he struggle to walk around furniture or patterns on the floor?
• Has he taken off on his own, either wandering or eloping?

Obviously, the physical body has a lot of different parts. Just do your best to talk through Dad’s needs with the nurse, concentrating on recent changes that you’ve seen.

Activities of Daily Living (ADL)

• Can he take care of his own personal hygiene? (Bathing, dressing, grooming…)
• Is he continent? Does he have constipation? Loose stools? Does he wear incontinence pads?
• Can he take care of his personal space? (Make his bed, put away his clothes, keep his bathroom tidy)

Maybe he can do most of these, but he needs a little help? Lots of cueing and reminders? Partial assistance with a few? Full assistance?

Recent Hospitalizations

Go ahead and cover all the W’s: What, Where, When, Why and How long?

Mental and Emotional Health

For this category, the nurse may be able to pick up on Dad’s issues by talking with him, but chime in where you can.

• Does he suffer from depression? Confusion? Memory loss or dementia? Are these gradually getting worse? Or something that came on suddenly?
• Has he experienced negative mental/emotional side effects from prescription drugs or illnesses? (e.g. medications that increase confusion, bladder infections that heighten memory loss)

One overall question the nurse will want to know is, Can Dad make decisions and express what he wants or needs?

Behavior

• Is Dad an extravert, introvert? Loud or quiet? Brash or pleasant to be around?
• Has he ever become verbally or physically aggressive? Or is he more likely to withdrawal to a corner? How does he react when others are aggressive?
• Does he enjoy social interactions?

Depending on your dad’s mental and emotional state, he may not be able to control his behaviors. So rest in the fact that these questions should help him find the safest place for him.

Sleep

Is Dad up a lot at night or does he sleep straight through? If he’s up, is he just restless? Taking a trip to the bathroom? Does he take naps during the day?

Interests

• What jobs has he held?
• Hobbies, talents?

Be sure to include ideas from both before and now. (Just because he can’t ride a motorcycle now doesn’t mean he’s lost the desire. And knowing information like this could help recognize the background of repetitive motions if he has dementia.)

Transportation Needs

• Can he still drive?
• If not, where does he need to be chauffeured and how often? Doctor appointments, therapy, family events, religious services, other activities separate from regular assisted living events?

Of course, you won’t know every trip Dad needs to make from now till kingdom come, but there may be regularly scheduled events that you can share.

Family Connections

• Does family live close by? Who should be contacted and for what level of issue?
• Is Dad connected to groups in the community? Does he have religious and church preferences?

Give the nurse any phone numbers the assisted living facility might need.

Emergencies

If the fire alarm went off, would Dad be physically and emotionally capable of responding? How much support or assistance would he need to leave the building?

And in regard to his own health emergencies, has he stated in a living will what his preferences for care would be?

Putting It All Together

You’ve sat through the nurse’s eval on your father. Now what?

• Once the nurse sees Dad’s specific abilities and challenges, she’ll look at her assisted living facility to decide if it has the resources he needs.
• Then she’ll create an individual service plan for him, outlining care that the facility can provide and what it will cost.

Take a deep breath.

The assisted living nurse’s quote may be higher than the base price you heard originally. Why? Most likely because your father needs extra support with medical conditions like diabetes or cardiac issues, he needs help bathing, taking medicines, he has a special diet, allergies, or generally has a higher cost of interventions.

However, the facility should be able to explain the break-down of any and all charges. If it can’t, you might need to look elsewhere.

Take your time in understanding your dad’s care plan. It isn’t just about the money. It’s about the care. What are they providing?

Something isn’t clear? Ask.

Your Turn: Questions to Ask Them

This pre-admission screening should not be the last assessment the facility performs on Dad.

• Ask them how often they schedule future evaluations once he moves in, and how you’ll be notified of the results.
• Also, can a care plan change in between scheduled assessments if Dad’s needs suddenly change?

Your goal? To partner with this assisted living facility to make sure Dad gets the care he needs in his new home. It’s going to mean a lot of asking questions and sharing concerns openly.

And it all starts with that Pre-Assessment.

Don’t worry. You’ve got this! And if you need more help navigating the senior living world, reach out to Frontida Assisted Living today!

Need to talk with family about senior living options? Check out these other helpful posts on choosing an assisted living facility.

Elizabeth Daghfal is a writer, teacher, speaker, and community volunteer. When she isn't teaching or writing-- Who are we kidding? Her husband and five kids say she's ALWAYS teaching and writing. She has a passion to help people who are struggling and is happy to say her shoulders are drip-dry. Born and raised in the South, she now lives in Wisconsin and loves it--except for the fifteen months of winter. Read more about her at elizabethdaghfal.com.