(NEW 7/1/07 ML #3088)
The scale used to measure independence in ADLs uses ratings from 0 through 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 the amount of help they may or may not be receiving at present. Scoring is based on how individual usually performs a task.
Two general concepts govern the manner in which an individual is compared with the assessment criteria. First, the individual is considered as a "whole entity." The Case Manager does not measure physical capacity or 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 that prevent him/her from doing so, that person cannot complete it. Secondly, the Case Manager must measure 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 of the parts of a task in order to complete the task.
Information regarding ADL impairments can be obtained by observation, interview with family or friends, or by direct self-report of the individual. Narratives must be included in the case file for each ADL identified as an impairment. Narratives must include:
For each functional impairment identified for which a service has been authorized, a desired outcome and the assistance required to achieve the outcome must be addressed in the notes/narrative section of the comprehensive assessment. An ADL or IADL must be scored impaired before a service or task related to the activity is authorized.
For each ADL or IADL that is scored impaired and no services have been authorized, document how the need is being met.
The scale used to rate each ADL has four basic categories of functioning:
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0: |
Completely Able - Activity completed under ordinary circumstances without modification, and within reasonable time. (A "reasonable time" involves an amount of time the individual 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 individual's age, health condition, (e.g. arthritis) and situation. |
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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. |
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2: |
Able with Helper - Activity completed only with help or assistance of another person, or under another person's supervision by cuing. Individual performs at least half the effort to complete the activity. |
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3: |
Unable - Individual assists minimally (less than half of effort), or is totally dependent. |