Don't Let a Level 4 Fool You!!

I can't tell you how many therapists have told me that an Allen Level 4 patient was safe to go home by his/herself because the patient has answered every question correctly. As a therapist in a sub-acute rehab facility or as a caregiver/family member assisting someone with early dementia; it is vital that you understand the difference between cognition and executive functions. WATCH what the patient does; don't test by asking questions. They will pass the Mini-Mental and every other test you throw at them. Neurologists and physicians will say that these patients are fine because they test using questions. Watch for impulsiveness, hallucinations, excessive blaming, paranoia, unusual anxiety, persistent loss of items, getting lost when driving in familiar areas, asking "What do I do now?" after every step of a task, visual changes coupled with body awareness decrease which results in him/her bumping into doorways/edges of furniture/people frequently, personality changes, unusual actions to fix problems (not something they would normally do to correct a problem - very unusual fixes that don't make sense), have difficulty talking and working on a task at the same time, dangerous reaching and bending without regard for safety, look at family members to answer questions requiring complex memory, and unable to solve complex problems. Although this level of mental ability appears normal when answering your test questions; this is the same person that will go home and burn to death in his/her kitchen because they can't react fast enough to an emergency situation.... this is the same person who will bleed to death in their home because they don't recognize an emergency.... and the same person that although he/she will tell you how they should take their medicine - frequently this level takes their medications wrong even when they are set up for them in advance... it is this level more than any other that falls due to poor safety judgements/impulsive movements.