Care Assessments
Understanding Care Assessments
The assessment process determines the right level of care, sets the cost, and shapes the daily experience of your loved one. Here is what it involves — and how to advocate effectively within it.
Why Assessments Matter to Your Family
The care assessment is not just a formality — it directly determines the monthly care fee, the type of community that can legally accept your loved one, and the specific support they receive each day. An accurate assessment protects your loved one and sets realistic expectations on both sides.
Many families are surprised to learn that care costs can vary by $1,500–$3,000 per month between different care levels at the same community. Understanding how assessments work helps you budget accurately and advocate effectively when a reassessment occurs.
The Three Core Assessments
ADL Assessment (Activities of Daily Living)
The most fundamental care assessment. A trained professional evaluates how much assistance a person needs with the six core self-care tasks. The number of ADLs requiring help directly determines the care level — and the monthly cost.
Bathing
Does the person bathe independently, need prompting, or require hands-on help?
Dressing
Can they select appropriate clothing and dress/undress without assistance?
Eating
Can they feed themselves, or do they need setup assistance or direct feeding?
Toileting
Can they get to/from the toilet and manage hygiene independently?
Transferring
Can they move from bed to chair, or stand from seated, without help?
Continence
Do they have control of bladder and/or bowel function?
Cognitive Assessment
Used to evaluate memory, orientation, judgment, and safety awareness. Results help determine whether Assisted Living or Memory Care is the appropriate level of care.
- Mini-Mental State Examination (MMSE) — a 30-point questionnaire
- Montreal Cognitive Assessment (MoCA) — sensitive to mild cognitive impairment
- Clock Drawing Test — a quick screen for executive function
- Wandering and elopement risk evaluation for memory care placement
- Ability to understand and respond to emergency instructions
Medical & Nursing Assessment
A comprehensive review of medical history, current diagnoses, medications, and physical health that informs whether a community can safely accommodate the resident.
- Current medication list and administration requirements
- Chronic condition management (diabetes, heart disease, COPD, etc.)
- Wound care or skilled nursing needs — may exceed AL licensure
- Fall history and mobility status
- Pain management and palliative care needs
- Nutrition and swallowing (dysphagia) evaluation
The Assessment Timeline
Pre-Admission Assessment
Before move-inA nurse or care coordinator from the community visits the current location (home, hospital, or skilled nursing facility) to conduct the full assessment. This determines whether the community can safely accept the new resident and at what care level.
State-Required Assessment
Within 14–30 days of move-inOregon, Arizona, and Nevada each require a formal state assessment within the first weeks of residency. This is conducted by a licensed professional and creates the official care plan that guides all care decisions.
Ongoing Care Plan Reviews
Every 60–180 days or after a health changeCare plans are living documents. Any significant health event (fall, hospitalization, functional decline) should trigger an immediate reassessment. Routine reviews happen every 2–6 months depending on care level.
Family Care Conference
At reassessment or by requestFamilies have the right to attend and participate in care conferences. This is your opportunity to ask questions, share observations, and ensure the care plan reflects your loved one's current needs and preferences.
How to Advocate at a Care Assessment
Be present at the assessment if at all possible — or send a written summary of your observations
Bring a written list of all current medications, diagnoses, and recent health events
Document specific incidents (falls, confusion episodes, missed medications) before the assessment
Don't let your loved one downplay their needs in front of the assessor — this is common
Ask specifically: "At what point would the care level change, and what would that cost?"
Request a copy of the completed assessment and care plan in writing
If you disagree with the assessment, you have the right to request a reassessment or second opinion
A Silver Linings advisor can attend or prepare you for the assessment at no cost
Questions About an Assessment?
Our advisors can help you understand what to expect, how to prepare, and how to advocate for the right care level for your loved one.