(Revised 10/01/2024 ML #3871)
INSTRUMENTAL ACTIVITIES OF DAILY LIVING
This section deals with an individual’s ability to carry out tasks which may not need to be done every day but are important for living independently. Intervention may be required to help an individual adapt to difficulties experienced in performing IADL activities. IADL items include meal preparation, housework, laundry, shopping, taking medicines, getting around outside, transportation, money management, and communication. Performance of IADL items requires mental as well as physical capacity. For example, taking medications and managing money require memory, judgment, and intellectual ability. The IADL scale measures the functional impact of emotional, intellectual, and physical impairments.
Not all individuals have the opportunity to perform IADL tasks. For example, an individual who lives with a relative or spouse might not prepare meals simply because another person routinely does this task. Similarly, some individuals do not manage their own money because a spouse does it. However, the IADL scale is designed to measure an individual’s physical and cognitive ability to perform these tasks, regardless of the individual's opportunity to perform them. In asking individuals about IADL tasks, case managers must stress what the person can do rather than what he/she is doing, for example: "Can you prepare meals, do housework, shop, etc.?"
The Case Manager will want to know how the individual usually performs a task, i.e., most of the time. Individuals who have occasional difficulty should be scored based on their usual performance, noting occasional difficulties in the narrative/note.
The case manager obtains information regarding IADL impairments by observation, interview with family or friends, or by direct self-report of the client. The scale used to rate each IADL task differs slightly from the ADL scale.
It includes three basic categories of functioning:
|
0: |
Without help. Without help. Applicant/client is able to perform task independently, without supervision, reminder or assistance. |
|
1: |
With help. Applicant/client is able to perform task only with assistance, reminder, cuing or supervision. |
|
2: |
Can't do at all. Applicant/client is not able to perform task at all, even with assistance. |
In IADL score it is especially valuable to look at each task as the sum of its parts. Doing the laundry, for example, includes requirements of the physical ability to carry the wash to the washing machine, the cognitive ability to operate the washing machine including the measuring of soap and setting of controls, the physical ability to move clothes from washer to dryer, the cognitive ability to operate the dryer, the skill to fold and physical ability to carry the clean laundry back from the machine. If one can operate the washer and dryer but cannot carry the clothes to or from the machines, this person rates a #1, "with help."
SCORES OF 1 OR 2 IN ASSESSMENT OF AN IADL INDICATES AN IMPAIRMENT
Standard Definitions for each IADL item are as follows:
9. Meal preparation
The case manager may ask the individual, "Can you prepare your own meals?" Regardless of whether the individual actually does prepare meals, ask whether they can.
Consider the individual’s ability to prepare hot and/or cold meals that are nutritionally able to sustain the client or therapeutic, as necessary. Consider individual’s cognitive ability, such as ability to remember to prepare meals, individual’s ability to prepare food, to open containers, to properly store and maintain foods, and to use kitchen appliances. Do not consider clean up because it is part of housework. Do not include canning of produce or baking of such items as cookies, cakes, and bread.
Without help: Able to complete the task without the assistance of another person.
With help: Needs some assistance from another person to complete the task.
Cannot do at all: 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 meal preparation due to overall fatigue and I cannot stand for any length of time.
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 meal preparation, the need for meal preparation is met by receiving home delivered meals for 7 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: HDM’s supports me by providing a meal 7 days a week. Total units authorized for home delivered meals 31 units a month.
Indicate the appropriate outcome of the service authorized, if other indicate in the text box the appropriate outcome.
Outcomes
To maintain proper nutrition & hydration.
To ensure compliance with special diet or weight control.
To prevent injury
Other information you should know about supporting me eating:
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.
10. Communication
This item refers to the individual’s ability to use the telephone, as well as comprehend oral and written communication. Include getting telephone numbers and placing calls. The individual must be able to reach and use the telephone, answer the telephone, dial, articulate and comprehend. If the individual uses special adaptive telephone equipment, score the client based on the ability to perform this activity with that equipment.
In scoring communication, the case manager must look at each task as the sum of its parts. In determining an individual's functional impairment, we must consider whether the individual is impaired in communication using their primary language. For example, an individual who may not be able to fluently speak or understand English, but is able to communicate in their primary language, would not be considered impaired. However, if the individual’s physical and cognitive ability to perform these tasks in their native language is impaired, the individual would be scored according to their level of impairment.
Special equipment in common use includes:
amplifiers for people with speech and hearing impairments.
enlarged dials or number stickers for the visually impaired.
modified telephones for those with hearing aids.
telephones hooked up to teletypewriters for those with speech impairments.
signals (tone ringers, loud bells or lights) to indicate that the telephone is ringing.
speaker telephones and headsets for persons who cannot hold receivers.
(NOTE: The use of an emergency response system device should not be considered when scoring this item because it can only be used for emergencies and does not enable its user to make or receive other essential calls such as arranging physician appointments or grocery deliveries.)
The tasks of routine writing/reading fall within the scope of the IADL of communication. Include the ability to understand and effectively respond to business mail, such as insurance mailings, applications for benefits, etc. If the individual needs a routine regimen of assistance with routine writing or reading of correspondence, this functional impairment may be documented within the scope of the IADL of communication. Again, when determining whether an individual is scored as impaired in communication, the case manager must consider the ability of the individual to complete related tasks involving their primary language.
If an individual has no telephone, ask about his/her ability to use a telephone elsewhere (i.e., at a neighbor's home).
Without help: Able to complete the task without the assistance of another person.
With help: Needs some assistance from another person to complete the task.
Cannot do at all: Unable to complete or assists minimally (less than half the effort), or is totally dependent on another person to complete the activity. (2)
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 communication to organize my mail and assist with arranging appointments as it is challenging to organize my thoughts and tasks since my last hospitalization.
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?
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 assistance with mail and making appointments as part of the overall service of homemaker. Total units authorized for homemaker 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 social interaction with family and friends.
To access emergency assistance and maintain independent living
To maintain services
Other information you should know about supporting me communication:
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.
11. Laundry
This item measures the individual’s ability to do his/her laundry.
Can the applicant/client sort, carry, load and unload, fold and put away clothes? Consider the ability to work a coin-operated machine. Do not score if the only problem is that laundry facilities are located outside the home as the need for transportation is covered in Transportation. Consider the individual’s cognitive ability to complete these tasks. Consider individual’s physical and cognitive ability to complete these tasks even if applicant/client lives with others who do them for the individuals.
Without help: Able to complete the task without the assistance of another person.
With help: Needs some assistance from another person to complete the task.
Cannot do at all: Unable to complete or assists minimally (less than half the effort) or is totally dependent on another person to complete the activity. (2)
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 laundry due to overall weakness and difficulties bending, lifting and carrying laundry.
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 laundry on.
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 washing laundry once a week. Total units authorized for homemaker 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 keep clothing and linens clean and odor free
To maintain health and hygiene
To prevent injury
Other information you should know about supporting me with laundry:
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.
12. Taking Medication
This item measures the ability of the individuals to take medicine by oneself. This is defined as: remembering to take medicine; getting the medicine from the place it is kept within the home; measuring the proper amounts; swallowing the pill; applying the ointment; or giving oneself injections (including the filling of syringe).
Score 0 for individuals who has no needs for medication or who perform tasks independently. Score according to client's ability to perform the task even if commonly done by others. Score need for service monitoring of medications due to possibility of overdose as a (2.) Do not include obtaining of medication from pharmacy as this is covered under Transportation.
Without help: Able to complete the task without the assistance of another person.
With help: Needs some assistance from another person to complete the task.
Cannot do at all: Unable to complete or assists minimally (less than half the effort or is totally dependent on another person to complete the activity. (2)
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 with medication due to overall weakness and diminished dexterity.
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 medication twice 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 opening my pill container and bringing me a glass of water. 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 ensure access to medications
To maintain medication health
To prevent injury
Other
Other information you should know about supporting me with medications:
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.
13. Shopping
This item measures the individual ability to shop for groceries and other essentials assuming transportation or delivery is available.
Consider ability to make shopping lists, to function within the store, to locate and select items, to reach and carry purchases, to handle shopping carts, to communicate with store clerks, and to put purchases away. Do not consider banking, posting mail, monetary exchanges, or availability of transportation in scoring this item. Individual’s ability to access transportation is measured under Transportation and ability to manage money is measured under Management of Money.
Without help: Able to complete the task without the assistance of another person.
With help: Needs some assistance from another person to complete the task.
Cannot do at all: Unable to complete or assists minimally (less than half the effort) or is totally dependent on another person to complete the activity. (2)
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 carrying my items with shopping as I cannot bend lift and carry due to pain and 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 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 shopping one times 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 physical assistance with shopping under the overall service of homemaker. Total units authorized for homemaker 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 independent living
To obtain needed items, supplies and groceries
To prevent injury
Other information you should know about supporting me with shopping.
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.
14. Mobility outside the home.
This item refers to the individual’s ability to move around outside, to walk or get around by some other means (i.e., wheelchair), and to do so without assistance. Consider ability to negotiate stairs, streets, porches, sidewalks, and entrances and exits of residence and destination.
Without help: Able to complete the task without the assistance of another person.
With help: Needs some assistance from another person to complete the task.
Cannot do at all: 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 mobility outside the home to access essential services such as shopping, due to overall weakness and needing assistance with my wheelchair.
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 mobility outside the home one time per 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 physical assistance to get outside my home to push my wheelchair 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 independent health and living.
To ensure safe arrival and departure
To prevent injury or getting lost.
Other information you should know about supporting me with mobility outside of 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.
15. Transportation
This item measures an individual’s ability to use transportation. For this question only, ability to use transportation includes access to a means of transportation.
Consider ability to negotiate entering and exiting of vehicle. Consider the ability to secure appropriate and available transportation and to know locations of home and essential places. Lack of appropriate and available transportation as needed, will increase the score. Consider cognitive as well as physical ability to use transportation.
Without help: Able to complete the task without the assistance of another person.
With help: Needs some assistance from another person to complete the task.
Cannot do at all: Unable to complete or assists minimally (less than half the effort) or is totally dependent on another person to complete the activity. (2)
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 accessing transportation by scheduling transportation for appointments and navigating getting in and out of the vehicle due to weakness and confusion with organizing tasks.
*(For DD - This section is used to gather information as a part of the Person-Centered Planning Process. It is used to identify other needs the individual may need to be linked with, but cannot be authorized under Medicaid State Plan)
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 transportation one time per 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 physical assistance scheduling appointments 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 health and independent living
To access community services
To prevent injury
Other information you should know about supporting me transportation:
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.
16. Housework
This item refers to the individual’s ability to do routine housework.
The HCBS case manager might ask the individual "Are you able to do routine housework (such as dusting)?" and "Are you able to do heavy housework (such as washing floors)?" Again, be sure to stress ability, physical and cognitive, rather than actual performance.
Consider minimum hygienic conditions required for individual’s health and safety. Do not include laundry. Do not include refusal to do tasks if refusal is unrelated to the impairment.
Without help: Able to complete the task without the assistance of another person.
With help: Needs some assistance from another person to complete the task.
Cannot do at all: Unable to complete or assists minimally (less than half the effort) or is totally dependent on another person to complete the activity. (2)
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 housework due to overall weakness and fatigue.
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 housework once a week for 2 hours.
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 housework as part of the overall service of homemaker. 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 injury
To maintain a safe and healthy environment
Other [if Other] Describe
Other information you should know about supporting me housework:
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.
17. Money Management
This item refers to the individual’s ability to handle money and pay bills.
Consider client's ability to plan, budget, write checks or money orders, and exchange currency and coins. Include the ability to count and to open and post mail. Do not increase the score based on insufficient funds.
Some individuals may have a legal representative (guardian, conservator or representative payee).
Without help: Able to complete the task without the assistance of another person.
With help: Needs some assistance from another person to complete the task.
Cannot do at all: Unable to complete or assists minimally (less than half the effort) or is totally dependent on another person to complete the activity. (2)
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 money management and organizing the associated paperwork due to confusion and inability to track tasks that need to be completed.
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 money management one time per 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 assistance with going through my mail and paperwork as part of the overall service of homemaker. 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 independence
To ensure timely and accurate payment of bills
other
Other information you should know about supporting me money management:
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.
18. If Support person cannot assist me with these IADLS, (contingency plan).