(Revised 10/01/2024 ML #3871)
Case managers require specific information regarding the activities an individual can perform in order to arrange for services which enable the client to remain at home.
This section allows the case manager to determine the level of impairment an individual’s is experiencing, based on specific medical, emotional and cognitive status. It is based on standard scale which have been tested and validated in programs serving the individuals with physical disabilities.
The questions measure the degree to which an individual can perform various tasks that are essential to independent living. These tasks, called Activities of Daily Living (ADLs), include: bathing, dressing/undressing, eating, toileting, continence, transfer in/out of bed or chair, and indoor mobility.
The scale used to measure independence in ADLs uses ratings from 0 to 3. A score of zero represents complete independence (no impairment), while 3 represents complete dependence (impairment). Each item measures the level of impairment of the individual, regardless of how much help they might be receiving at present. In completing the section, the case manager should check the number which best corresponds to the individual’s impairment level. The following general definitions must determine the ratings.
Information on each of the ADLs can be collected by observation, from the individual, a significant other, or collateral contact.
Information will need to be provided on how the individual usually performs a task, i.e., most of the time. An individual who has occasional difficulty should be coded based on their usual performance. However, occasional difficulties should be noted in the corresponding narrative/note.
Barthel Scale Scoring (as defined by C.V. Granger, July, 1974) Mahoney FI, Barthel D. “Functional evaluation: the Barthel Index.” Maryland State Med Journal 1965;14:56-61. Used with permission. Permission is required to modify the Barthel Index or to use it for commercial purposes.
|
0: |
Completely Able - Activity completed under ordinary circumstances without modification, and within reasonable time. (A "reasonable time" involves an amount of time the client feels is acceptable to complete the task and an amount which does not interfere with completing other tasks, as well as the professional judgment of the Case Manager based on the client's age, health condition, (e.g. arthritis) and situation. |
|
1: |
Able with Aids/Difficulty - Activity completed with prior preparation or under special circumstances, or with assistive devices or aids, or beyond a reasonable time. |
|
2: |
Able with Helper - Activity completed only with help or assistance of another person, or under another person's supervision for safety, or by cuing. ANOTHER HUMAN IS INVOLVED IN ACTIVITY; but client performs at least half the effort him/herself. |
|
3: |
Unable - Client assists minimally (less than half of effort), or is totally dependent. |
Some general concepts govern the manner in which an individual is compared with the assessment criteria: The individual is considered as a "whole entity." The case manager does not measure physical capacity, cognitive ability, or affective state separately, but rather one's functioning as a whole. For example, if one has ample physical strength and skill to complete a task, but also has cognitive limitations which prevent the individual from doing so, that person cannot complete it. The case manager also measures the individual’s level of functioning in the present. What the individual could or could not do in the past is not an issue nor is what the individual, under hypothetical conditions, might be able to do in the future. Each task must be looked at as the sum of its parts. One must be able to complete all parts of a task in order to complete the task.
Further information to assist with evaluating the functional impairment includes the following: the case manager indicates the level of impairment in the Functional Assessment by choosing one of the four (4) selections (the number behind the description of the impairment indicates the points associated with the level of impairment). The total impairments and associated points are automatically added on the final screen of the functional assessment in the assessment tool. A Rating 2 OR 3 ON THE ASSESSMENT OF AN ADL INDICATES AN IMPAIRMENT.
The four (4) options for level of impairment under each ADL task is as follows:
Completely able: Able to complete the task independently and without difficulty.
Able with aids/difficulty: Able to complete the task without the assistance of another person, but does so with difficulty, use of equipment, or takes an inordinate amount of time to complete.
Able with helper: Needs another person to assist with the activity, but the individual is able to perform at least half the effort of completing the task.
Unable: Unable to complete or assists minimally (less than half the effort), or is totally dependent on another person to complete the activity.
For each ADL the case manager must note the reason individual is not able to independently complete the ADL task as follows:
If an ADL is scored a 0 or 1, skip to next ADL.
If scored a 2 or 3 and informal supports assists, complete a and b, and c just stating who assists.
If formal HCBS supports are authorized to assist, complete a,b, c, d and outcomes fully
I need support with this activity because [justify impairment score]
In the narrative box provided, indicate the justification for the impairment in sentence form.
Example: I need support with bathing due to overall weakness and unsteadiness getting in and out of the shower.
The note may include:
The reasons why this is or is not appropriate for the individual’s circumstances. Indicate if individual has been offered the service but refuses assistance.
Type of equipment used, if any. Any problems with equipment?
b. I like to [task] [frequency] times a week/day in the [morning/night/afternoon/no preference].
In the box provided describe the individuals request for when they would like the task completed and the frequency.
Example: I want assistance with bathing three times a week before bedtime.
The note may include:
Is individual able to complete the task as frequently as needed or wanted?
(Helpful hint: this is where the case manager starts to calculate how many units are needed for the overall service that the task fits under. Which will be noted under (c.) of the ADL. Such as bathing, dressing and nail care are all personal care tasks and would be authorized under the overall service of personal care.
For example: The frequency of the task for bathing would be as follows: The individual needs assistance with bathing for 30 minutes three times a week, and there are 5 weeks in a month. The individual would need 30 units of personal care services (PCS) for bathing.
Additionally, the individual needs one unit three times a week for dressing (frequency of bathing indicates 15 units a month) and 1 unit a week for nail care (5 units a month). This would add up to 50 overall units of PCS for the individual would need to be authorized. In letter (c.) the overall units for the authorized service (ie. PCS) will be noted.
[Provider/Natural support] will support me with this task as part of the overall service of [example: personal care, respite care, community supports, etc]. Total units authorized for this overall service are not to exceed [total monthly units you are authorizing for the overall service such as personal care, respite care, community supports, etc.].
In the box provided describe how this need is met.
Who assists with the task?
What service does this task fall under.
Indicate the overall number of units authorized for this service type.
Example: QSP will support me with this task as part of the overall service of personal care. Total units authorized for personal care services are not to exceed 50 units a month.
Indicate the appropriate outcome of the service authorized, if other indicate in the text box the appropriate outcome.
Outcomes
To maintain hygiene and prevent injury/burning.
To prevent skin breakdown and keep odor free.
Other (3)
[if Other] Describe.
Other information you should know about my [ADL]:
In this box indicate any other information that the individual may want the provider to know about how or why they prefer cares a certain way.
Example: I get anxious and panicky when water runs over my face in the shower. It makes me feel like I am going to suffocate.
A full description of the specific ADL and required documentation in the assessment is as follows:
Bathing
This item measures the individual’s applicant's/client's ability to bathe or shower or take sponge baths independently for the purpose of maintaining adequate hygiene as needed for the client's individual’s circumstances. Consider minimum hygiene standards, medical prescription, or health related considerations such as incontinence, skin ulcer, lesions, cognitive ability, and balance problems. Consider ability to turn faucets, regulate water temperature, wash and dry completely.
Completely able: Able to complete the task independently and without difficulty.
Able with aids/difficulty: Able to complete the task without the assistance of another person, but does so with difficulty, use of equipment, or takes an inordinate amount of time to complete.
Able with helper: Needs another person to assist with the activity, but the individual is able to perform at least half the effort of completing the task.
Unable: Unable to complete or assists minimally (less than half the effort) or is totally dependent on another person to complete the activity.
For each ADL the case manager must note the reason individual is not able to independently complete the task in section a. of the ADL as follows:
I need support with this activity because [justify impairment score]
In the narrative box provided, indicate the justification for the impairment in sentence form.
Example: I need support with bathing due to overall weakness and unsteadiness getting in and out of the shower.
The note may include:
The reasons why this is or is not appropriate for the individual’s circumstances. Indicate if individual has been offered the service but refuses assistance.
Type of equipment used, if any. Any problems with equipment?
b. I like to [task] [frequency] times a week/day in the [morning/night/afternoon/no preference].
In the box provided describe the individuals request for when they would like the task completed and the frequency.
Example: I want assistance with bathing three times a week before bedtime.
The note may include:
Is individual able to complete the task as frequently as needed or wanted?
c. [Provider/Natural support] will support me with this task as part of the overall service of [example: personal care, respite care, community supports, etc]. Total units authorized for this overall service are not to exceed [total monthly units you are authorizing for the overall service such as personal care, respite care, community supports, etc.].
In the box provided describe how this need is med.
Who assists with the task?
What service does this task fall under?
Indicate the overall number of units authorized for this service type.
Example: QSP will support me with this task as part of the overall service of personal care. Total units authorized for personal care services are not to exceed 70 units a month.
Indicate the appropriate outcome of the service authorized, if other indicate in the text box the appropriate outcome.
Outcomes
To maintain hygiene and prevent injury/burning.
To prevent skin breakdown and keep odor free
Other (3)
[if Other] Describe
Other information you should know about my [ADL]:
In this box indicate any other information that the individual may want the provider to know about how or why they prefer cares a certain way.
Example: I get anxious and panicky when water runs over my face in the shower. It makes me feel like I am going to suffocate.
Eating
This item refers to the individual’s ability to feed themselves, including cutting meat and buttering bread. Consider individual’s ability to chew, swallow, cut food into manageable size pieces, and to chew and swallow hot and cold foods/beverages. It does NOT refer to meal preparation. (This is covered in Meal Preparation).
Completely able: Able to complete the task independently and without difficulty.
Able with aids/difficulty: Able to complete the task without the assistance of another person, but does so with difficulty, use of equipment, or takes an inordinate amount of time to complete.
Able with helper: Needs another person to assist with the activity, but the individual is able to perform at least half the effort of completing the task.
Unable: Unable to complete or assists minimally (less than half the effort) or is totally dependent on another person to complete the activity.
I need support with this activity because [justify impairment score]
In the narrative box provided, indicate the justification for the impairment in sentence form.
Example: I need support with eating due to overall weakness and limited dexerity.
The note may include:
The reasons why this is or is not appropriate for the individual’s circumstances. Indicate if individual has been offered the service but refuses assistance.
Type of equipment used, if any. Any problems with equipment?
b. I like to [task] [frequency] times a week/day in the [morning/night/afternoon/no preference].
In the box provided describe the individuals request for when they would like the task completed and the frequency.
Example: I need assistance with eating three times a day for breakfast, lunch and dinner.
The note may include:
Is individual able to complete the task as frequently as needed or wanted?
c. [Provider/Natural support] will support me with this task as part of the overall service of [example: personal care, respite care, community supports, etc]. Total units authorized for this overall service are not to exceed [total monthly units you are authorizing for the overall service such as personal care, respite care, community supports, etc.].
In the box provided describe how this need is met.
Who assists with the task?
What service does this task fall under.
Indicate the overall number of units authorized for this service type.
Example: QSP will support me with this task as part of the overall service of personal care. Total units authorized for personal care services are not to exceed 70 units a month.
Indicate the appropriate outcome of the service authorized, if other indicate in the text box the appropriate outcome.
Outcomes
To ensure adequate nutrition
To prevent choking or other safety concerns
Other
[if Other] Describe
d. Other information you should know about my [ADL]:
In this box indicate any other information that the individual may want the provider to know about how or why they prefer cares a certain way.
Example: I prefer to eat soft foods due to mouth soreness.
3. Mobility Inside
This item measures an individual’s indoor mobility. The HCBS case manager may ask an applicant/client, "How do you usually get around inside?"
Do not consider transferring in and out of bed or chair.
Completely able: Able to complete the task independently and without difficulty.
Able with aids/difficulty: Able to complete the task without the assistance of another person, but does so with difficulty, use of equipment, or takes an inordinate amount of time to complete.
Able with helper: Needs another person to assist with the activity, but the individual is able to perform at least half the effort of completing the task.
Unable: Unable to complete or assists minimally (less than half the effort) or is totally dependent on another person to complete the activity.
I need support with this activity because [justify impairment score]
In the narrative box provided, indicate the justification for the impairment in sentence form.
Example: I need support with mobility inside due to overall weakness.
The note may include:
The reasons why this is or is not appropriate for the individual’s circumstances. Indicate if individual has been offered the service but refuses assistance.
Type of equipment used, if any. Any problems with equipment?
I need suport with this task [frequency] times a [week/day/month] in the [morning/night/afternoon/no preference].
In the box provided describe the individuals request for when they would like the task completed and the frequency.
Example: I need assistance with ambulating around the house 5 times a day.
The note may include:
Is individual able to complete the task as frequently as needed or wanted?
[Provider/Natural support] will support me with this task as part of the overall service of [example: personal care, respite care, community supports, etc]. Total units authorized for this overall service are not to exceed [total monthly units you are authorizing for the overall service such as personal care, respite care, community supports, etc.].
In the box provided describe how this need is met.
Who assists with the task?
What service does this task fall under.
Indicate the overall number of units authorized for this service type.
Example: QSP will support me by providing stand by assistance and a gait belt as part of the overall service of personal care. Total units authorized for personal care services are not to exceed 70 units a month.
Indicate the appropriate outcome of the service authorized, if other indicate in the text box the appropriate outcome.
Outcomes
To prevent falls, to maintain independence or access within home environment
To have no or minimal discomfort
Other
[if Other] Describe
Other information you should know about supporting me with mobility in my home:
In this box indicate any other information that the individual may want the provider to know about how or why they prefer cares a certain way.
4. Transfer in/out of bed/chair
This item measures the level of assistance the individual needs in transfers.
Include the ability to reach assistive devices and appliances necessary to ambulate, and the ability to transfer (to/from) between bed and wheelchair, walker, etc.; the ability to adjust the bed or place/remove handrails, if applicable and necessary. Do not consider ambulation, itself, as this is considered under Get Around Inside.
Completely able: Able to complete the task independently and without difficulty.
Able with aids/difficulty: Able to complete the task without the assistance of another person, but does so with difficulty, use of equipment, or takes an inordinate amount of time to complete.
Able with helper: Needs another person to assist with the activity, but the individual is able to perform at least half the effort of completing the task.
Unable: Unable to complete or assists minimally (less than half the effort) or is totally dependent on another person to complete the activity.
I need support with this activity because [justify impairment score]
In the narrative box provided, indicate the justification for the impairment in sentence form.
Example: I need support with mobility inside due to overall weakness.
The note may include:
The reasons why this is or is not appropriate for the individual’s circumstances. Indicate if individual has been offered the service but refuses assistance.
Type of equipment used, if any. Any problems with equipment?
I like to [task] [frequency] times a week/day in the [morning/night/afternoon/no preference].
In the box provided describe the individuals request for when they would like the task completed and the frequency.
Example: I need assistance with ambulating around the house 5 times a day.
The note may include:
Is individual able to complete the task as frequently as needed or wanted?
[Provider/Natural support] will support me with this task as part of the overall service of [example: personal care, respite care, community supports, etc]. Total units authorized for this overall service are not to exceed [total monthly units you are authorizing for the overall service such as personal care, respite care, community supports, etc.].
In the box provided describe how this need is met.
Who assists with the task?
What service does this task fall under.
Indicate the overall number of units authorized for this service type.
Example: QSP will support me by providing stand by assistance with a gait belt as part of the overall service of personal care. Total units authorized for personal care services are not to exceed 70 units a month.
Indicate the appropriate outcome of the service authorized, if other indicate in the text box the appropriate outcome.
Outcomes
To prevent falls, to maintain independence or access within home environment
To have no or minimal discomfort
Other
[if Other] Describe
Other information you should know about supporting me with transferring:
In this box indicate any other information that the individual may want the provider to know about how or why they prefer cares a certain way.
Dress/Undress
This item measures the individual’s ability to dress or undress. Consider individual’s needs of appropriate dress for weather or street attire. Consider ability to get clothes from closets and drawers as well as putting them on. Also include ability to put on prosthesis or assistive devices. Consider fine motor coordination for buttons and zippers, and strength for undergarments or winter coat. Do not include style or color coordination. Do not include tying shoes.
Completely able: Able to complete the task independently and without difficulty.
Able with aids/difficulty: Able to complete the task without the assistance of another person, but does so with difficulty, use of equipment, or takes an inordinate amount of time to complete.
Able with helper: Needs another person to assist with the activity, but the individual is able to perform at least half the effort of completing the task.
Unable: Unable to complete or assists minimally (less than half the effort) or is totally dependent on another person to complete the activity.
I need support with this activity because [justify impairment score]
In the narrative box provided, indicate the justification for the impairment in sentence form.
Example: I need support with dressing after my shower due to overall fatigue and unsteadiness.
The note may include:
The reasons why this is or is not appropriate for the individual’s circumstances. Indicate if individual has been offered the service but refuses assistance.
Type of equipment used, if any. Any problems with equipment?
I need support with this task [frequency] times a [week/day/month] in the [morning/night/afternoon/no preference].
In the box provided describe the individuals request for when they would like the task completed and the frequency.
Example: I need support with dressing after my shower three days a week.
The note may include:
Is individual able to complete the task as frequently as needed or wanted?
[Provider/Natural support] will support me with this task as part of the overall service of [example: personal care, respite care, community supports, etc]. Total units authorized for this overall service are not to exceed [total monthly units you are authorizing for the overall service such as personal care, respite care, community supports, etc.].
In the box provided describe how this need is met.
Who assists with the task?
What service does this task fall under.
Indicate the overall number of units authorized for this service type.
Example: QSP will support me by providing stand by assistance with dressing as part of the overall service of personal care. Total units authorized for personal care services are not to exceed 70 units a month.
Indicate the appropriate outcome of the service authorized, if other indicate in the text box the appropriate outcome.
Outcomes
To maintain appearance and keep odor free
To dress appropriately for weather
To maintain prevent injury
[if Other] Describe
Other information you should know about supporting me dressing/undressing:
In this box indicate any other information that the individual may want the provider to know about how or why they prefer cares a certain way.
Toileting.
This item deals with the individual’s ability to get to the bathroom, get on/off the toilet, clean him/herself, manage clothes, and flush.
Consider frequency of need and need for reminders.
Completely able: Able to complete the task independently and without difficulty.
Able with aids/difficulty: Able to complete the task without the assistance of another person, but does so with difficulty, use of equipment, or takes an inordinate amount of time to complete.
Able with helper: Needs another person to assist with the activity, but the individual is able to perform at least half the effort of completing the task.
Unable: Unable to complete or assists minimally (less than half the effort) or is totally dependent on another person to complete the activity.
I need support with this activity because [justify impairment score]
In the narrative box provided, indicate the justification for the impairment in sentence form.
Example: I need support with dressing after my shower due to overall fatigue and unsteadiness.
The note may include:
The reasons why this is or is not appropriate for the individual’s circumstances. Indicate if individual has been offered the service but refuses assistance.
Type of equipment used, if any. Any problems with equipment?
I need support with this task [frequency] times a [week/day/month] in the [morning/night/afternoon/no preference].
In the box provided describe the individuals request for when they would like the task completed and the frequency.
Example: I need support with toileting 7 times a day.
The note may include:
Is individual able to complete the task as frequently as needed or wanted?
[Provider/Natural support] will support me with this task as part of the overall service of [example: personal care, respite care, community supports, etc]. Total units authorized for this overall service are not to exceed [total monthly units you are authorizing for the overall service such as personal care, respite care, community supports, etc.].
In the box provided describe how this need is met.
Who assists with the task?
What service does this task fall under.
Indicate the overall number of units authorized for this service type.
Example: QSP will support me by physical assistance on and off of the toilet and assisting with readjusting clothing as part of the overall service of personal care. Total units authorized for personal care services are not to exceed ?? units a month.
Indicate the appropriate outcome of the service authorized, if other indicate in the text box the appropriate outcome.
Outcomes
To maintain dryness, keep odor free, and prevent falls
To prevent skin breakdown and keep odor free
To maintain prevent injury
Other information you should know about supporting me with toileting:
In this box indicate any other information that the individual may want the provider to know about how or why they prefer cares a certain way.
Bowel and Bladder Continence
Indicate the individual's bowel and bladder continence level.
Completely able: Able to complete the task independently and without difficulty.
Able with aids/difficulty: Able to complete the task without the assistance of another person, but does so with difficulty, use of equipment, or takes an inordinate amount of time to complete.
Able with helper: Needs another person to assist with the activity, but the individual is able to perform at least half the effort of completing the task.
Unable: Unable to complete or assists minimally (less than half the effort) or is totally dependent on another person to complete the activity.
I need support with this activity because [justify impairment score]
In the narrative box provided, indicate the justification for the impairment in sentence form.
Example: I need support continence to include assistance with changing undergarments and incontinence supplies due to limited strength and impaired ability to bend or move body.
The note may include:
The reasons why this is or is not appropriate for the individual’s circumstances. Indicate if individual has been offered the service but refuses assistance.
Type of equipment used, if any. Any problems with equipment?
I need support with this task [frequency] times a [week/day/month] in the [morning/night/afternoon/no preference].
In the box provided describe the individuals request for when they would like the task completed and the frequency.
Example: I need support with continence three times a day in the morning, afternoon and at bedtime.
The note may include:
Is individual able to complete the task as frequently as needed or wanted?
[Provider/Natural support] will support me with this task as part of the overall service of [example: personal care, respite care, community supports, etc]. Total units authorized for this overall service are not to exceed [total monthly units you are authorizing for the overall service such as personal care, respite care, community supports, etc.].
In the box provided describe how this need is met.
Who assists with the task?
What service does this task fall under.
Indicate the overall number of units authorized for this service type.
Example: QSP will support me by providing physical assistance to change incontinence products and assisting with readjusting clothing as part of the overall service of personal care. Total units authorized for personal care services are not to exceed ?? units a month. Indicate the appropriate outcome of the service authorized, if other indicate in the
Indicate the appropriate outcome of the service authorized, if other indicate in the text box the appropriate outcome.
Outcomes
To be clean, dry and odor free
To maintain dignity
To prevent skin breakdown
Other information you should know about supporting me with continence:
In this box indicate any other information that the individual may want the provider to know about how or why they prefer cares a certain way.
8. If support person cannot assist me with these ADLS, (contingency plan).