The challenge of describing difficulty

One of the most common problems in CLSC assessments is understatement. Families — out of pride, embarrassment, or a desire not to seem demanding — describe the best version of the situation rather than the real one.

The result is a care plan that doesn't reflect actual needs.

The goal is not to exaggerate. It is to describe what is happening accurately, which is harder than it sounds when the natural instinct is to say "we're managing."

Use specific, observable language

Less useful: "She has trouble bathing."
More useful: "She cannot step over the edge of the bathtub without holding onto two people. We've had three near-falls in the last two months."

Less useful: "He forgets things sometimes."
More useful: "He forgot to take his insulin three times last week. He didn't remember he'd had lunch and tried to cook again two hours later."

Less useful: "Getting dressed takes longer now."
More useful: "She can put on her shirt but cannot do the buttons, zip a zipper, or put on socks and shoes. It takes about 40 minutes with my help, and about 90 minutes if she tries alone."

Specific, observable descriptions help the assessor understand the actual level of functional impairment.

Describe worst days, not best days

A person's condition is often not constant. There are good days and bad days. During an assessment, describe the bad days — these represent the level of risk and care need more accurately than peak performance.

If the person is having a good day during the assessment itself, say so: "Today is actually a relatively good day. There are days when [describe the worse version]."

Use the word "safely"

Assessors are trained to pay attention to safety. The phrase "can do it, but not safely" carries weight.

• "He can walk to the bathroom, but not safely without someone nearby."
• "She manages her medications, but not safely — she sometimes takes double doses."
• "He can cook basic meals, but not safely — he's left the stove on twice."

Talk about time

Time is a meaningful indicator of functional difficulty.

• "What used to take 15 minutes now takes over an hour."
• "She needs me to be present the entire time — I can't leave the room."
• "The morning routine takes three hours and I have to help at every step."

Talk about what you have to stop doing

Caregiver sacrifice is a meaningful factor. Describe what you've had to give up or arrange differently because of caregiving demands.

• "I've had to reduce my work hours to four days a week."
• "I'm driving over every morning before work."
• "I haven't had a weekend off in eight months."

Write it down

You are not expected to remember all of this under the stress of a home visit. Write down specific examples — three or four concrete situations — before the visit and refer to your notes during the conversation. This is entirely appropriate.

The Caregiver Journal article offers guidance on building this habit over time.