(NEW 7/1/07 ML #3088)
BATHING - Measure the individual's ability to bathe, shower or take sponge baths independently for the purpose of maintaining adequate hygiene. Consider minimum hygiene standards, medical prescription, or health related considerations such as incontinence, skin ulcer, lesions, frequent nose bleeds, and balance problems. Consider ability to turn faucets, regulate water temperature, wash and dry completely.
|
0: |
Able to prepare and take a bath or shower independently within a reasonable time. NOTE: If the only help an individual requires is help with shampooing, score this item "0." |
|
1: |
Requires the use of equipment (i.e., tub stool, grab bars, or handle bars) to bathe or shower. Small items such as mitten wash cloths, long-handled brushes or non-slip soap dishes are not considered special equipment. |
|
2: |
Needs another human to assist throughout this activity. This may include cuing. Individual must perform at least half the task. |
|
3: |
Unable to assist or assists minimally (less than half the effort) or is totally dependent on another human to complete the activity. |
DRESSING/UNDRESSING - measure the individual's ability to dress or undress. Consider individual's need 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.
|
0: |
Able to dress independently within a reasonable amount of time. |
|
1: |
Uses aids such as zipper pulls and specially designed clothing (e.g., velcro fasteners) or requires an inordinate amount of time to do so. |
|
2: |
Needs another human to assist with dressing and performs at least half the effort or needs human assistance as a reminder to get dressed or for the laying out of clothes. |
|
3: |
Totally dependent due to physical or cognitive impairment or provides less than half the effort in dressing. |
EATING – measure the individual's ability to feed him/herself including cutting meat and buttering bread. Consider individual's ability to cut food into manageable size pieces, chew and swallow hot and cold foods, and swallow beverages. Do not include meal preparation.
|
0: |
Able to eat independently within a reasonable amount of time. |
|
1: |
Uses special grip utensils or plates or takes an inordinate amount of time to eat. |
|
2: |
Performs at least half the effort required to eat, but receives some assistance from another human. |
|
3: |
Performs less than half the effort. |
TOILETING – measure the individual's ability to use bathroom, commode, bedpan, or urinal, transfer on or off the toilet, flush, cleanse, adjust clothes, and manage ostomy or catheter. Consider frequency of need and need for reminders.
|
0: |
Able to complete activity independently or uses a urinal, bedpan or commode at night only and manages without assistance (including emptying the device). |
|
1: |
Uses grab bars, raised toilet set or transfer board or takes an inordinate amount of time. |
|
2: |
Requires human assistance in completing the activity but performs half the effort. |
|
3: |
Performs less than half the effort. |
CONTINENCE/INCONTINENCE – measure the individual’s ability to control bladder and bowel. Incontinence may have one of several different causes, including specific disease processes, side-effects of medications, and functional difficulty (i.e., inability to reach the bathroom in time to avoid accidents - usually due to poor mobility.)
|
0: |
Complete voluntary control of the bladder/bowel; never incontinent. |
|
1: |
Individual has catheter or other urinary drainage device including absorbent pads. Individual is able to empty, clean, and manage the use of the device without human assistance. Individual has no accidents. Requires stool softeners, suppositories, laxatives, or enema, but does not require human assistance, or has colostomy, but can manage device without human assistance. Individual has no accidents. |
|
2: |
Individual needs human assistance with a device, medications, enemas, or has occasional accidents (with or without a device). |
|
3: |
Cannot control urinary flow or control of bowels, despite aids or assistance. |
TRANSFERRING IN AND OUT OF BED OR CHAIR – measure the level of assistance the individual needs to move to or from bed, chair, wheelchair or standing position. Include the ability to reach assistive devices and appliances necessary to ambulate, and the ability to transfer (from/to) between bed and wheelchair, walker, etc.; the ability to adjust the bed or place/remove handrails, if applicable and necessary. Do not include transferring to toilet.
|
0: |
Able to transfer independently within a reasonable amount of time. |
|
1: |
Special equipment, such as lifts, hospital beds, sliding boards, "trapezes" or pulleys, is used or individual takes an inordinate amount of time to transfer. |
|
2: |
Is supported by human help to transfer or performs half the effort. |
|
3: |
Must be lifted in/out of bed/chair. |
MOBILITY - measure individual's ability to move about inside the home. Do not consider transferring in and out of bed or chair.
|
0: |
Able to get around inside independently within a reasonable amount of time. |
|
1: |
Uses aid such as walker, wheelchair, cane, crutches, or furniture to get around. |
|
2: |
Needs human assistance to get around. |
|
3: |
Individual is bedbound. |