LTCFS Instructions Module 5 - Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs)

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Contents

Objectives

By the end of this module the screener should be able to:

  • Define the six activities that make up the Activities of Daily Living (ADL) section.
  • Define the six activities that make up the Instrumental Activities of Daily Living (IADL) section.
  • Describe how to apply the coding for level of help needed, and properly code “who will help in the next 8 weeks” for each ADL/IADL.
  • Identify the adaptive equipment items that are included in the ADL section of the Long Term Care Functional Screen (LTCFS).
  • Define significant, negative health outcomes and provide examples of simple, reasonable adaptations.
  • Identify and correctly enter primary and secondary diagnoses that cause any need identified in this module.

5.1 General Guidance for ADLs/IADLs

Definitions

Cognitive impairment: A cognitive impairment in the LTCFS is defined as a permanent impairment of thought due to a severe and persistent mental illness, dementia, brain injury, intellectual/developmental disability, or other organic brain disorder.

  • A cognitive impairment does not include temporary impairment due to medications and/or substance use intoxication.
  • A cognitive impairment does not include temporary impairment due to a temporary medical condition such as infection, electrolyte imbalance, or dehydration.

Competent refusal: In the LTCFS, “competently” means the person does not have a guardian or activated power of attorney for health care and is not a current concern for adult protective services. The person does not need help from another person if he or she is competently choosing to not accept the service, or is not accepting that the task be completed at all, has not had a negative health outcome, and is able to perceive and recognize the risk.

Memory loss: Definition is found in Module 8.3.

Safely: Means without significant risk of harm to oneself or others. Wis. Admin. Code § DHS 10.33(1)(d).

Significant, negative health outcome: A significant, negative health outcome has occurred when a person experiences any of the following symptoms: shortness of breath, dizziness, chest pain, exhaustion, falls, incontinence, or debilitating pain to the point where the individual is unsafe and another person should be present to help with some or all of the components of a task. Requiring additional time to complete a task is not a significant, negative health outcome in and of itself.

A determination that an individual is limited in his or her capacity to perform an ADL or IADL task should always equate with a cognitive, physical, or memory loss impairment.

  • The screener should select the level of assistance needed based on the level of help needed from another person.
  • The screener should indicate the amount of help the person currently needs from another person, no matter who is providing the help. The only exception to this is when a person changes residence, the screener should estimate what assistance the person will need in his/her new residence.
  • Screeners should select the level of assistance needed based on need and not solely on a diagnosis.
  • When a screener identifies a level of help needed in an ADL or IADL, the screener will select the diagnosis that correlates to the deficit.
  • If an individual has never performed an activity or a task, a screener should not assume that the individual is physically or cognitively capable or incapable of doing so.
  • A lack of experience is not the same as the inability to perform a task due to a physical, cognitive, or memory loss impairment.

The screener should select the most accurate answer that most closely describes the person's NEED for “help from another person,” whether the person is actually receiving that assistance or not.

  • Help from another person is defined as supervision, cueing, and/or hands-on assistance (partial or complete).
  • If an individual has an identified need, but is not currently receiving assistance, such as medication set-up, the screener should still capture the individual’s need for the assistance.
  • If a person has an identified need, but competently refuses assistance, the screener should not record a need for assistance with that task.
  • Although an individual may be currently receiving assistance with a task, he or she may be able to perform the activity independently or with limited assistance if given the opportunity and training.
  • For a person living in a residential facility, screeners should assess the person’s actual need for assistance. Screeners should not select the level of help needed based on the services or equipment available as part of the residential facility package.

If a person can complete a task independently, but it takes him/her a very long time, a screener should consider if the person needs any help with that task to complete it safely.

  • If it takes so much time for the person to complete a task independently and that results in a significant, negative health outcome, then it would be justified to indicate the person has a need for help completing the task.
  • If an identified need is due to a significant, negative health outcome, the screener should write a note describing the significant, negative health outcome.

When an individual’s conditions and abilities fluctuate over time, reference Module 1.11 Screening Limitations and Strategies to Mitigate Limitations, Abilities Fluctuate, for assistance on how to complete the LTCFS.

An individual’s need for assistance with personal hygiene, such as grooming and mouth care, is not captured on the LTCFS. This information, as well as hygienic conditions of the home, can be captured in the notes section.

It is not uncommon for an individual to underrate his or her need for help or overstate his or her independence. Screeners should use the following steps when assessing an individual’s level of help needed:

  • Select the level of assistance required based on need and not solely on the report of the individual.
  • Seek more details and consider asking for a demonstration on how a task is completed.
  • Seek collateral informants, other people you could ask for additional information.
  • Use your professional judgment and assessment skills to select the best answer. Follow the definitions and instructions for the screen.

Example: Bert tells you he does not need any help with bathing. He lives alone. He is unkempt and has body odor. He walks very unsteadily with a cane and is bent over. It is quite clear to you that he is not able to safely get in and out of his bathtub and that he, in fact, has not bathed for many weeks.

  • Step 1: Seek more details: You ask him if you can see his bathroom, where you notice he has a claw-foot bathtub with sides about two feet high off the floor (with no grab bars, bench, or non-slip mats). You observe his ambulation and ask him to lift his foot high for you. He lifts it about four inches. You ask him for details on how he gets in and out of the bathtub.
  • Step 2: Seek collateral informants: Bert’s daughter referred him to the aging and disability resource center (ADRC) and is present during the screen interview. With Bert’s approval, you speak to her privately on the way out to get her perspective on her dad’s functioning. She says he is lying now because he is afraid, but he has admitted to her that he is unable to get into the bathtub.
  • Step 3: Use your professional judgment to select the best answer: You can see from Bert’s general body movement that he would need help with all aspects of bathing and would require his helper to be present throughout the entire task. For Bathing, select box 2, “Helper needs to be present throughout the task.”

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5.2 Communal Living Situations

A screener may encounter a person living in a communal living situation or congregate living arrangement, like a dormitory, convent, or monastery. This person may lack experience performing certain tasks. Socioeconomic barriers, religious beliefs, or cultural norms may be factors that result in this person having fewer opportunities to perform select IADLs (e.g., making phone calls, managing a checkbook, driving, or food preparation). In a communal living situation, activities are often centralized and tasks assigned to certain individuals for the convenience of the community or setting.

When a person resides in a communal living situation, do not presume ADL and IADL tasks cannot be performed by the person unless a physical, cognitive, or memory loss impairment is evident. Assume the person can be independent when the opportunity and training are provided to learn new tasks. When a person is receiving assistance with an ADL/IADL task, or has no experience performing the task, the screener must:

  1. Ascertain whether a communal living situation, socioeconomic barriers, religious beliefs, or cultural norm factors result in the individual receiving assistance or lacking experience with a task.
  2. Determine (if such factors are evident) whether there is a physical, cognitive, or memory loss impairment limiting the person's capacity to perform the task.

Examples:

  • A college student living in a dormitory who has relied on his parents to manage his financial matters. Do not assume this student is unable to manage money and pay bills unless he has a physical, cognitive, or memory loss impairment limiting his ability to do so.
  • A nun has taken a vow of poverty and has spent her adult life in a convent. Financial resources have always been pooled and bills paid centrally. Money available to her has been limited to a small stipend. Do not assume this nun is unable to manage money and pay bills unless she has a physical, cognitive, or memory loss impairment limiting her ability to do so.
  • A large farm cooperative is managed by a religious order of monks living at the farm in a monastery. The monks have experience with farming tasks but not driving, shopping, or food preparation. When determining a monk's ability to perform these IADL tasks, assess for any functional or cognitive limitations that may diminish his capacity to perform these IADL tasks, not the inexperience or lack of training opportunities.

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5.3 Coding for Who Will Help in the Next Eight Weeks

The LTCFS requires screeners to indicate who will help in the next eight weeks for each ADL and most of the IADLs. The codes for this section are below. Screeners should check all that apply.

  • U: Current UNPAID caregiver will continue
  • PF: Current PUBLICLY FUNDED paid caregiver will continue
  • PP: Current PRIVATELY PAID caregiver will continue
  • N: Need to find new or additional caregiver(s)

If the level of assistance needed for a particular ADL/IADL task is selected as “0 – Independent” or “NA – Has no medications,” the boxes for "Who Will Help in the Next 8 Weeks?" should be left blank.

If it is determined that the person needs assistance with a task, it is mandatory to complete the "Who Will Help in the Next 8 Weeks?" category. In other words, if the “Level of Help Needed” is indicated for an ADL or IADL task as “1” or greater, the screener must select at least one of the “Who Will Help in the Next 8 Weeks?” boxes.

“PP – Current PRIVATELY PAID caregiver will continue” means non-public funding, including the person's own money, that of a family member or friend, etc., private insurance (including long-term care insurance benefits), or a trust fund.

“PF – Currently Publicly Funded paid caregiver will continue” means funded with public program assistance including but not limited to services funded by Medicare, Medicaid, waiver programs, Veterans Affairs, and any other federal, state, or county funding sources.

Nursing Home or Hospital Resident
If a person resides in a nursing home or hospital and discharge is not expected in the next eight weeks, indicate how the nursing home is being paid (Privately Paid or Publicly Funded). If the person is expected to be discharged within the next eight weeks, try to be as accurate as possible with the "Who Will Help in the Next 8 Weeks?" boxes. Record the help the person will need once at home. Many individuals are discharged to their own homes with a mixture of public, private, and unpaid care giving services.

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5.4 Identifying Primary and Secondary Diagnoses

For each need or additional support identified in this section, the diagnoses that cause the need or necessary support must be selected from options prepopulated in a drop-down menu. Only diagnoses that were previously identified on the Diagnoses Table will be pre-populated in the drop-down menus. These diagnoses will be used by the functional screen application (FSIA) to build the correct target group assignment for each individual who is being screened.

In regard to assignment of target group by FSIA, primary and secondary diagnoses carry equal weight. A primary diagnosis must be identified for each need or support identified in FSIA. A secondary diagnosis is not mandatory for each need or support that is identified. When a secondary diagnosis is not identified, the screener must select “None” from the drop-down menu that appears after each need or support that is identified.

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5.5 Activities of Daily Living (ADLs)

The six ADLs include:

  • Bathing
  • Dressing
  • Eating
  • Mobility in Home
  • Toileting
  • Transferring

ADL Coding for Level of Help Needed
All of the ADLs have the same rating system for “Coding for Level of Help Needed to Complete the Task Safely.” When recording the level of help an individual needs to safely complete an ADL, a screener should select only one rating of “Level of Help Needed” with each ADL. The rating system used for ADLs in the LTCFS is below.

  • 0 – Person is independent in completing the activity safely.
  • 1 – Help is needed to complete the task safely but helper DOES NOT have to be physically present throughout the task. “Help” can be supervision, cueing, or hands-on assistance.
  • 2 – Help is needed to complete the task safely and helper DOES need to be physically present throughout the task. “Help” can be supervision, cueing, or hands-on assistance.

ADL Adaptive Equipment Guidance
Adaptive equipment is defined as specific types of equipment captured on the LTCFS that an individual may use to safely complete an ADL.

Four of the ADLs (Bathing, Mobility in Home, Toileting, and Transferring) have some adaptive equipment options. Screeners should select only equipment the person currently needs, has, and is using. The only exception to “need, have, and use” is prosthesis in 5.9 Mobility in Home. Prosthesis should be selected if the person has a prosthesis; regular use is not a requirement.

Do not select one of the equipment options if a person uses an improvised or homemade item as a substitute for the equipment on the list. For example, a person may use a sturdy object to sit on during bathing instead of a tub bench. In this instance, you would not select “Uses tub bench” in the Bathing equipment box, because the object is a substitute for a tub bench.

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5.6 Bathing

LTCFS ITEM DEFINITION:

Bathing: The ability to safely shower, bathe, or take a sponge bath for the purpose of maintaining adequate hygiene. The task of Bathing consists of the following components:

  • Getting in and out of the bathtub/shower
  • Turning on and off the faucets
  • Regulating the water temperature
  • Washing and drying self
  • Shampooing hair

The need for assistance with transferring to bathe is included in this task.

If a person needs assistance with only accessing the bathroom, this need is captured in Module 5.9, Mobility in Home, not the Bathing task.

CODING FOR LEVEL OF HELP NEEDED

  • 0 – Person is independent in completing the activity safely.
  • 1 – Help is needed to complete the task safely but helper DOES NOT have to be physically present throughout the task. “Help” can be supervision, cueing, and/or hands-on assistance.
  • 2 – Help is needed to complete the task safely and helper DOES need to be present throughout the task. “Help” can be supervision, cueing, and/or partial or complete hands-on assistance.

ADAPTIVE EQUIPMENT

Adaptive equipment is defined as specific types of equipment captured on the LTCFS that an individual may use to safely complete an ADL. Screeners should only select the adaptive equipment the person currently needs, has, and is using.

Adaptive equipment options for Bathing include:

  • Uses Grab Bar(s)
  • Uses Shower Chair
  • Uses Bathtub Bench
  • Uses Mechanical Lift

Do not select one of the equipment options if a person uses an improvised or homemade item as a substitute for the equipment on the list. For example, a person may use an object to sit on during bathing instead of a bathtub bench. In this instance, you would not select “Uses Bathtub Bench” in the Bathing equipment box, because the object is a substitute for a bathtub bench.

BATHING-SPECIFIC RESPONSE GUIDANCE:

The “Check 0, 1, 2” list contains common, illustrative examples. This list is not an all-inclusive list of examples.

Check “0” (“Person is independent in completing the activity safely”) for a person who:

  • Has no physical, cognitive, or memory loss impairments affecting his or her ability to complete the task of Bathing independently.
  • Bathes independently with the use of adaptive equipment.
  • Bathes independently with the use of simple, reasonable adaptations such as a hand-held washing aid, hand-held shower attachment, or a shampoo dispenser.
  • Is able to maintain adequate hygiene by bathing on good days.
  • Bathes independently but it takes additional time to do so and there are NO significant, negative health outcomes.
  • Uses an improvised or homemade item and without it, he or she would NOT need assistance from another person to complete the task. Do not check the use of any adaptive equipment if an improvised or homemade item is being used, since this is not considered adaptive equipment.
  • Requires assistance with grooming only (such as shaving, brushing hair, mouth care, nail care). Grooming is not considered an ADL on the LTCFS.
  • Prefers a sponge bath and can do so independently and maintains adequate hygiene.
  • Bathes independently but is unable to wash his or her back.
  • Bathes independently but chooses not to do so unless a family member or staff is present somewhere in the home, "just in case."
  • Bathes independently but needs toiletries (such as shampoo, soap, towels) selected, retrieved, and/or laid out for him or her. These needs are captured in Module 5.16, Laundry and/or Chores.
  • Has a seizure disorder with no seizures in the last three months and there is no intervention needed; however, family or staff is present "just in case."

Check “1” (“Help is needed to complete the task safely but helper DOES NOT have to be physically present throughout the task”) for a person who:

  • Due to a physical, cognitive, or memory loss impairment requires supervision, cueing, and/or hands-on assistance with at least one but not all of the components of Bathing.
  • Bathes independently but doing so results in a significant, negative health outcome and another person should be present to help with SOME of the components of the task.
  • Uses an improvised or homemade item and without it, he or she would need assistance from another person to complete at least one but not all of the components of Bathing. Do not check the use of any adaptive equipment if an improvised or homemade item is being used, since this is not considered adaptive equipment.
  • Bathes independently but, due to a cognitive impairment, regularly requires cueing or else he or she would not initiate the task of bathing.
  • Prefers to sponge bathe but does not maintain adequate hygiene due to a physical, cognitive, or memory loss impairment.

Check “2” (“Help is needed to complete the task safely and helper DOES need to be present throughout the task”) for a person who:

  • Due to a physical, cognitive, or memory loss impairment requires supervision, cueing, and/or partial or complete hands-on assistance with ALL of the above components of Bathing.
  • Bathes independently but doing so results in a significant, negative health outcome and another person should be present to help with ALL of the components of the task.
  • Uses an improvised or homemade item and without it, he or she would need assistance from another person to complete ALL of the components of Bathing. Do not check the use of any adaptive equipment if an improvised or homemade item is being used, since this is not considered adaptive equipment.
  • Requires assistance with ALL of the components of Bathing but he or she can be left alone to soak in the bathtub (without negative health and/or safety concerns). Soaking in the bathtub is not a component of the Bathing ADL.
  • Requires supervision due to having an uncontrolled seizure disorder, evidenced by one or more seizures in the last three months AND requires standby assistance* during the entire task of Bathing.

*Standby assistance for seizure is defined as the need for a person to be next to the individual (within arm’s length) in order to be readily available to help the individual in the event he/she experiences a seizure.

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5.7 Dressing

LTCFS ITEM DEFINITION:

Dressing: The ability to safely dress and undress as necessary. The task of Dressing consists of the following components:

  • Dressing/undressing the top half of body (includes putting on undergarments)
  • Dressing/undressing the bottom half of body (includes putting on undergarments)
  • Getting shoes and socks on and off
  • Putting on or removing prostheses, orthotic devices, anti-embolism hose (TED hose), compression products or devices (stockings, bandages, pumps), and/or pressure relieving devices.
  • Choosing the appropriate clothing to maintain health and safety for the environment and setting.

CODING FOR LEVEL OF HELP NEEDED

  • 0 – Person is independent in completing the activity safely.
  • 1 – Help is needed to complete the task safely but helper DOES NOT have to be physically present throughout the task. “Help” can be supervision, cueing, and/or hands-on assistance.
  • 2 – Help is needed to complete the task safely and helper DOES need to be present throughout the task. “Help” can be supervision, cueing, and/or partial or complete hands-on assistance.

ADAPTIVE EQUIPMENT

This is not applicable for this ADL. There are no adaptive equipment options listed under “Dressing.”

DRESSING-SPECIFIC RESPONSE GUIDANCE:

The “Check 0, 1, 2” list contains common, illustrative examples. This list is not an all-inclusive list of examples.

Check “0” (“Person is independent in completing the activity safely”) for a person who:

  • Has no physical, cognitive, or memory loss impairments affecting his or her ability to complete the task of Dressing independently.
  • Dresses independently with the use of simple, reasonable adaptations such as wearing pullover sweaters, elastic-waist pants, front-clasp bra, slip-on shoes, or use of a sock aid.
  • Dresses independently but it takes additional time to do so and there are NO significant, negative health outcomes.
  • Requires assistance only with a zipper or button(s).
  • Dresses independently, has no cognitive impairment and chooses not to wear appropriate clothing for the environment or setting.
  • Dresses independently and has no cognitive impairment, but refuses to change his or her clothes, even when clothes are stained or carry an odor.
  • Dresses independently but may mismatch clothes.
  • Dresses independently but needs clothes selected, retrieved, and/or laid out for him or her. These needs are captured in Module 5.16, Laundry and/or Chores.
  • Has a seizure disorder with no seizures in the last three months and there is no intervention needed; however, family or staff is present “just in case.”

Check “1” (“Help is needed to complete the task safely but helper DOES NOT have to be physically present throughout the task”) for a person who:

  • Due to a physical, cognitive, or memory loss impairment requires supervision, cueing, and/or hands-on assistance with at least one but not all of the components of Dressing.
  • Dresses independently but doing so results in a significant, negative health outcome and another person should be present to help with SOME of the components of the task.
  • Dresses independently but, due to a cognitive impairment, regularly requires cueing or else he or she would not dress.
  • Dresses independently but, due to a cognitive impairment, does not wear appropriate clothing for the environment or setting.
  • Dresses independently but, due to a cognitive impairment, refuses to change his or her clothes, when clothes are stained or carry an odor.
  • Needs assistance from another person to either get dressed OR undressed, but not both.

Check “2” (“Help is needed to complete the task safely and helper DOES need to be present throughout the task”) for a person who:

  • Due to a physical, cognitive, or memory loss impairment requires supervision, cueing, and/or partial or complete hands-on assistance with ALL of the above components of Dressing.
  • Dresses independently but doing so results in a significant, negative health outcome and another person should be present to help with ALL of the components of the task.
  • Requires supervision due to having an uncontrolled seizure disorder, evidenced by one or more seizures in the last three months AND requires standby assistance* during the entire task of Dressing.*
  • Needs assistance from another person to get dressed AND undressed.

*Standby assistance for seizure is defined as the need for a person to be next to the individual (within arm’s length) in order to be readily available to help the individual in the event he/she experiences a seizure.

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5.8 Eating

LTCFS ITEM DEFINITION:

Eating: The act of getting food or drink from a plate/bowl or cup to the mouth (chewing if necessary and swallowing) using routine or adaptive utensils.

Examples of adaptive utensils include weighted and/or built up eating utensils, scooper plates/bowls, food bumpers, special cups.

CODING FOR LEVEL OF HELP NEEDED

  • 0 – Person is independent in completing the activity safely.
  • 1 – Help is needed to complete the task safely but helper DOES NOT have to be physically present throughout the task. “Help” can be supervision, cueing, and/or hands-on assistance.
  • 2 – Help is needed to complete the task safely and helper DOES need to be present throughout the task. “Help” can be supervision, cueing, and/or partial or complete hands-on assistance.

ADAPTIVE EQUIPMENT

This is not applicable for this ADL. There are no adaptive equipment options listed under “Eating.”

EATING-SPECIFIC RESPONSE GUIDANCE:

The “Check 0, 1, 2” list contains common, illustrative examples. This list is not an all-inclusive list of examples.

Check “0” (“Person is independent in completing the activity safely”) for a person who:

  • Has no physical, cognitive, or memory loss impairments affecting his or her ability to complete the task of Eating independently.
  • Eats independently with the use of simple, reasonable adaptations.
  • Has no cognitive impairment and chooses not to eat.
  • Has a history of choking or has a risk of choking and there is no intervention in place but is monitored “just in case.”
  • Needs portion control for weight reduction.
  • Is on a special diet (such as diabetic, low-calorie, low-sugar, or low fat).
  • Eats independently but must have food pureed or minced, or follows a mechanical soft diet. This need is captured in Module 5.13 Meal Preparation.
  • Eats independently but requires assistance with the placement of food on the plate or table (serving) or with carrying a plate/cup to the table. This need is captured in Module 5.13, Meal Preparation.
  • Needs to have a plate “set up” with food due to his or her visual impairment. This need is captured in Module 5.13, Meal Preparation.
  • Is a messy eater.
  • Takes other people’s food.
  • Needs the refrigerator, pantry, or other storage area to be locked to deter snacking or stealing (except for a person with Prader-Willi syndrome).
  • Eats independently but requires assistance from another person to cut food. This need is captured in Module 5.13, Meal Preparation.
  • Eats independently but requires assistance to locate the dining area. This need is captured in Module 8.4, Cognition.
  • Has pica or polydipsia. These needs are captured in Module 9, Behavioral Health, as self-injurious behaviors.
  • Is fed via tube feedings or total parenteral nutrition (TPN) and can independently complete the task.
  • Has a seizure disorder with no seizures in the last three months and there is no intervention needed; however, family or staff is present “just in case.”

Check “1” (“Help is needed to complete the task safely but helper DOES NOT have to be physically present throughout the task”) for a person who:

  • Due to a physical, cognitive, or memory loss impairment requires supervision, cueing, and/or hands-on assistance with the task of Eating SOME of the time.
  • Eats independently but doing so results in a significant, negative health outcome and another person should be present to help with the task of Eating SOME of the time.
  • Eats independently but, due to a cognitive impairment, requires cueing to initiate eating.
  • Eats independently but requires assistance to put on or remove a splint (or other device such as a universal cuff) with which the person can then hold a utensil and independently feed him or herself.
  • Is fed via tube feedings or total parenteral nutrition (TPN) and requires assistance from another person to complete the task of Eating SOME of the time. Also, see Module 7.22, Tube Feedings and Module 7.19, TPN.

Check “2” (“Help is needed to complete the task safely and helper DOES need to be present throughout the task”) for a person who:

  • Due to a physical, cognitive, or memory loss impairment requires supervision, cueing, and/or partial or complete hands-on assistance with the task of Eating ALL of the time.
  • Eats independently but doing so results in a significant, negative health outcome and another person should be present to help with the task of Eating ALL of the time.
  • Eats independently but, due to a cognitive impairment, requires cueing to eat throughout the task of Eating.
  • Is fed via tube feedings or total parenteral nutrition (TPN) and he or she requires assistance from another person to complete the task ALL of the time. Also, see Module 7.22, Tube Feedings and Module 7.19, TPN.
  • Has Prader-Willi syndrome.
  • Requires supervision due to having an active risk of choking and requires standby assistance* during the entire task of Eating.
  • Requires supervision due to having an uncontrolled seizure disorder, evidenced by one or more seizures in the last three months AND requires standby assistance** during the entire task of Eating.

*Standby assistance for choking is defined as the need for a person to be next to the individual (within arm’s length) in order to be readily available to help the individual in the event he/she were to begin choking.

**Standby assistance for seizure is defined as the need for a person to be next to the individual (within arm’s length) in order to be readily available to help the individual in the event he/she experiences a seizure.

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5.9 Mobility in Home

LTCFS ITEM DEFINITION:

Mobility in Home: The ability to move between locations (including stairs) in the individual's living space. Living space is defined as kitchen/dining room, living room, bathroom, and sleeping area.

A person’s living space does not include the basement, attic, garage, yard, and places outside of the home, including any stairs to enter the home.

Excluded from Mobility in Home is the task of transferring, which includes the ability to move from a bed, usual sleeping place, or chair to a wheelchair, or up to a standing position. The need for assistance to transfer to bathe or use a toilet is captured in Module 5.6, Bathing or Module 5.10, Toileting.

CODING FOR LEVEL OF HELP NEEDED

  • 0 – Person is independent in completing the activity safely.
  • 1 – Help is needed to complete the task safely but helper DOES NOT have to be physically present throughout the task. “Help” can be supervision, cueing, and/or hands-on assistance.
  • 2 – Help is needed to complete the task safely and helper DOES need to be present throughout the task. “Help” can be supervision, cueing, and/or partial or complete hands-on assistance

ADAPTIVE EQUIPMENT

Adaptive equipment is defined as specific types of equipment captured on the LTCFS that an individual may use to safely complete an ADL. Screeners should only select the adaptive equipment the person currently needs, has, and is using.

Adaptive equipment options for Mobility in Home include:

  • Uses Cane in Home*
  • Uses Wheelchair or Scooter in Home
  • Has Prosthesis
  • Uses Quad-Cane in Home*
  • Uses Crutches in Home
  • Uses Walker in Home

*A cane or quad-cane intended solely as a probe to identify obstacles or as an indicator of visual impairment does not count as an aid for Mobility in Home.

Do not select one of the equipment options if a person uses an improvised or homemade item as a substitute for the equipment on the list. For example, a person may use a chair with wheels instead of a wheeled walker. In this instance, you would not select “Uses Walker in Home” in the mobility equipment box because the object is a substitute for a walker.

Do not include the following types of equipment or medical supplies used by an individual as a type of adaptive equipment counted under Mobility in Home:

  • Ace bandage
  • Orthotic devices such as splints or braces
  • Anti-embolism hose
  • Neoprene Wrap
  • Orthotic shoes
  • Walker, cane, crutches, wheelchair, scooter, prostheses only used when ambulating outside of his or her home.

MOBILITY IN HOME-SPECIFIC RESPONSE GUIDANCE:

The “Check 0,1,2” list contains common, illustrative examples. This list is not an all-inclusive list of examples.

Check “0” (“Person is independent in completing the activity safely”) for a person who:

  • Has no physical, cognitive, or memory loss impairments affecting his or her ability to complete the task of Mobility in Home independently.
  • Walks (or wheels) him/herself independently with the use of adaptive equipment.
  • Walks (or wheels) him/herself but it takes additional time to do so and there are no significant, negative health outcomes.
  • Uses an improvised or homemade item and without it, he or she would not need assistance from another person to complete the task. Do not check the use of any adaptive equipment if an improvised or homemade item is being used since this is not considered adaptive equipment.
  • Has a risk of falling only due to environmental conditions such as clutter, rugs, or uneven flooring.
  • Walks (or wheels) him/herself independently but needs direction on where to go due to a cognitive impairment. This need is captured in Module 8.4, Cognition.
  • Walks (or wheels) him/herself independently but has a vision impairment.
  • Walks (or wheels) him/herself independently but has a fear of falling.
  • Walks (or wheels) him/herself independently but does so slowly and safely.
  • Walks (or wheels) him/herself independently but has a shuffling gait and walks safely.
  • Walks (or wheels) him/herself independently but needs assistance outside of the living space including using steps or ramp to get into the home.
  • Walks (or wheels) him/herself independently but does not get up and walk in the home unless a family member/staff is present somewhere in the home, “just in case.”
  • Walks (or wheels) him/herself independently but needs assistance putting on or taking off orthotic devices (such as braces, shoe inserts, ankle foot orthosis (AFOs), anti-embolism hose, or orthotic shoes). These needs are captured in Module 5.7, Dressing.
  • Prefers to crawl and can do so independently and there are no significant, negative health outcomes.
  • Is unable to access the laundry because it is located outside of the living space. This need is captured in Module 5.16, Laundry and/or Chores.
  • Uses walls, furniture, or railings for guidance or reassurance only.
  • Has a seizure disorder with no seizures in the last three months and there is no intervention needed; however, family or staff is present “just in case.”

Check “1” (“Help is needed to complete the task safely but helper DOES NOT have to be physically present throughout the task”) for a person who:

  • Due to a physical, cognitive, or memory loss impairment requires supervision, cueing, and/or hands-on assistance with the task of Mobility in Home SOME of the time.
  • Walks (or wheels) him/herself independently but doing so results in a significant, negative health outcome and another person should be present to help with the task.
  • Uses an improvised or homemade item and without it, he or she would need assistance from another person to complete the task of Mobility in Home some of the time. Do not check the use of any adaptive equipment if an improvised or homemade item is being used since this is not considered adaptive equipment.
  • Walks independently but, due to a cognitive impairment, requires a cue to use adaptive equipment.
  • Walks independently throughout his or her living space but must lean on walls, furniture, or railings or would otherwise require the assistance of equipment or another person.
  • Needs assistance only to use steps in his or her living space or if the person needs and uses a stair lift.
  • Needs assistance only to access the bathroom.
  • Requires standby* or hands-on assistance with mobility SOME of the time.

Check “2” (“Help is needed to complete the task safely and helper DOES need to be present throughout the task”) for a person who:

  • Due to a physical, cognitive, or memory loss impairment requires supervision, cueing, and/or partial or complete hands-on assistance with the task of Mobility in Home ALL of the time.
  • Walks (wheels) him/herself independently but doing so results in a significant, negative health outcome and another person should be present to help with the task of Mobility in Home ALL of the time.
  • Uses an improvised or homemade item and without it, he or she would need assistance from another person to complete the task of Mobility in Home all of the time. Do not check the use of any adaptive equipment if an improvised or homemade item is being used since this is not considered adaptive equipment.
  • Requires standby* or hands-on assistance with mobility ALL of the time.
  • Requires supervision due to having an uncontrolled seizure disorder, evidenced by one or more seizures in the last three months and requires standby assistance** during the entire task of Mobility in Home.

*Standby assistance for mobility is defined as the need for a person to walk next to the individual (within arm’s length) in order to be readily available to help the individual in the event he/she falls or loses balance.

**Standby assistance for seizure is defined as the need for a person to be next to the individual (within arm’s length) in order to be readily available to help the individual in the event he/she experiences a seizure.

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5.10 Toileting

LTCFS ITEM DEFINITION:

Toileting: The ability to use the toilet, commode, bedpan, or urinal for bowel and/or bladder management in the home. The activity of Toileting consists of the following components:
Locating the bathroom facility

  • Transferring on or off the toilet, commode, bedpan, or placing a urinal
  • Maintaining regular bowel program*
  • Cleansing of perineal (peri) area
  • Changing of menstrual products and/or incontinence products
  • Managing a condom catheter or the ostomy or urinary catheter collection bag (including emptying and/or rinsing the collection bag)
  • Redressing the bottom half of the body
  • Emptying the commode, bedpan, or urinal container
  • Flushing the toilet

The cleaning of the bathroom after incidental soiling during toileting is captured in Module 5.16, Laundry and/or Chores.

Hand washing after toileting is not a component of Toileting.

*A regular bowel program includes using suppositories, enemas, and digital/manual stimulation with the goal of having regular bowel movements at a predictable time and frequency. This does not include the use of oral laxatives such as Metamucil, Ex-lax, stool softeners, or fiber used by a person not on a formal bowel program.

If the individual has an ostomy or indwelling or straight urinary catheter, screeners should review Module 7.15 and Module 7.25, Health-Related Services (HRS),  to ensure the individual’s needs have been accurately identified.

CODING FOR LEVEL OF HELP NEEDED

  • 0 – Person is independent in completing the activity safely.
  • 1 – Help is needed to complete the task safely but helper DOES NOT have to be physically present throughout the task. “Help” can be supervision, cueing, and/or hands-on assistance.
  • 2 – Help is needed to complete the task safely and helper DOES need to be present throughout the task. “Help” can be supervision, cueing, and/or partial or complete hands-on assistance.

ADAPTIVE EQUIPMENT

Adaptive equipment is defined as specific types of equipment captured on the LTCFS that an individual may use to safely complete an ADL. Screeners should only select the adaptive equipment the person currently needs, has, and is using.

Adaptive equipment options for Toileting include:

  • Uses Toilet Grab Bars/Rails
  • Uses Commode or Other Adaptive Equipment, including:
    • High rise/accessible toilet
    • Elevated or adaptive toilet seat
    • Bed pan
    • Urinal
    • Transfer board or other transfer aids that assist the person to get on or off the toilet
    • Ostomy or catheter collection bags
  • Uses Urinary Catheter
  • Has Ostomy
  • Receives regular bowel program

Do not select one of the equipment options if a person uses an improvised or homemade item as a substitute for the equipment on the list. For example, a person may use a container as a urinal. In this instance, you would not select “Uses Commode or Other Adaptive Equipment” in the equipment box because the object is a substitute.

TOILETING-SPECIFIC RESPONSE GUIDANCE:

The “Check 0, 1, 2” list contains common, illustrative examples. This list is not an all-inclusive list of examples.

Check “0” (“Person is independent in completing the activity safely”) for a person who:

  • Has no physical, cognitive, or memory loss impairments affecting his or her ability to complete the task of Toileting independently.
  • Toilets independently with the use of adaptive equipment.
  • Toilets independently with the use of simple, reasonable adaptations such as a self-wipe toilet aid.
  • Uses an improvised or homemade item and without it, he or she would not need assistance from another person to complete the task some of the time. Do not check the use of any adaptive equipment if an improvised or homemade item is being used, since this is not considered adaptive equipment.
  • Is incontinent and is independent with managing incontinence products; however, select the appropriate frequency related to the person’s incontinence in the sub-section addressing incontinence.
  • Only requires assistance with skilled tasks associated with ostomy or urinary catheter care. These needs are captured in Module 7.15, Ostomy-Related Skills Services and Module 7.25, Urinary Catheter-Related Skilled Tasks.
  • Utilizes oral laxatives, fiber, or other bowel medications.
  • Needs assistance or reminders about the amount of toilet paper to use or not to flush inappropriate objects.
  • Uses the sink or countertop to get to a standing position from the toilet with no significant, negative health outcomes.
  • Requires supervision only for offensive or violent behaviors related to toileting such as urinating or defecating in inappropriate places (for example a living room or front porch), or on another person, or the act of spreading urine or feces. These needs are captured in Module 7.10, Behaviors Requiring Interventions and Module 9.4, Offensive or Violent Behavior to Others.
  • Toilets independently but chooses not to do so unless a family member/staff is present somewhere in the home, “just in case.”
  • Has a seizure disorder with no seizures in the last there months and there is no intervention needed; however, family or staff is present “just in case.”

Check “1” (“Help is needed to complete the task safely but helper DOES NOT have to be physically present throughout the task”) for a person who:

  • Due to a physical, cognitive, or memory loss impairment requires supervision, cueing, and/or hands-on assistance with at least one but not all of the components of Toileting.
  • Toilets independently but doing so results in a significant, negative health outcome and another person should be present to help with SOME of the components of the task.
  • Uses an improvised or homemade item and without it, he or she would need assistance from another person to complete at least one but not all of the components of Toileting. Do not check the use of any adaptive equipment if an improvised or homemade item is being used since this is not considered adaptive equipment.
  • Toilets independently but, due to a cognitive impairment, requires cueing or he or she would be incontinent.

Check “2” (“Help is needed to complete the task safely and helper DOES need to be present throughout the task”) for a person who:

  • Due to a physical, cognitive, or memory loss impairment requires supervision, cueing, and/or partial or complete hands-on assistance with ALL of the above components of Toileting.
  • Is able to toilet independently but doing so results in a significant, negative health outcome and another person should be present to help with ALL of the components of the task.
  • Requires supervision due to having an uncontrolled seizure disorder, evidenced by one or more seizures in the last three months and requires standby assistance* during the entire task of Toileting.

*Standby assistance for seizure is defined as the need for a person to be next to the individual (within arm’s length) in order to be readily available to help the individual in the event he/she experiences a seizure.

INCONTINENCE

Select the applicable level of bowel and/or bladder incontinence in this section. Urge incontinence is the sudden uncontrollable urge to frequently urinate. Do not count stress incontinence, which is leakage of urine during sneezing, coughing, or other exertion. Incontinence options include:

  • Does not have incontinence
  • Has incontinence less than daily but at least once per week
  • Has incontinence daily

If there are interventions to prevent the incontinence, such as cueing or scheduled toileting, indicate the frequency of the intervention being provided under Toileting. Do not select incontinence.

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5.11 Transferring

LTCFS ITEM DEFINITION:

Transferring: The physical ability to move between surfaces. The task of Transferring includes the ability to get up to a standing position and down to a sitting position from a bed, usual sleeping place, chair, or wheelchair. Excluded from the task of Transferring is the need for assistance with a transfer to bathe or use a toilet. These needs are captured in Module 5.6, Bathing and 5.10, Toileting.

CODING FOR LEVEL OF HELP NEEDED

  • 0 – Person is independent in completing the activity safely.
  • 1 – Help is needed to complete the task safely but helper DOES NOT have to be physically present throughout the task. “Help” can be supervision, cueing, and/or hands-on assistance
  • 2 – Help is needed to complete the task safely and helper DOES need to be present throughout the task. “Help” can be supervision, cueing, and/or partial or complete hands-on assistance.

ADAPTIVE EQUIPMENT

Adaptive equipment is defined as specific types of equipment captured on the LTCFS that an individual may use to safely complete an ADL. Screeners should only select the adaptive equipment the person currently needs, has, and is using.

Adaptive equipment options for Transferring include:

  • Uses mechanical lift or power stander
  • Uses transfer board or pole
  • Uses grab bars, bed bar, or bed railing (if used for transferring)
  • Uses trapeze

Do not select one of the equipment options if a person uses an improvised or homemade item as a substitute for the equipment on the list. For example, a person may use sturdy furniture, such as a nightstand, to transfer out of bed. In this instance, do not select “grab bars, bed bar, or bed railing” in the Transferring equipment box because the object is a substitute for a grab bar.

Under Transferring, do not count a lift chair or an electric hospital bed as a mechanical lift. However, a screener may select a need for transfer assistance for a person who uses a lift chair or electric hospital bed, if the person is unable to transfer from the chair or bed without them.

TRANSFERRING-SPECIFIC RESPONSE GUIDANCE:

The “Check 0, 1, 2” list contains common, illustrative examples. This list is not an all-inclusive list of examples.

Check “0” (“Person is independent in completing the activity safely”) for a person who:

  • Has no physical, cognitive, or memory loss impairments affecting his or her ability to complete the task of Transferring independently.
  • Transfers independently with the use of adaptive equipment.
  • Transfers independently but it takes additional time to do so and there are no significant, negative health outcomes.
  • Uses an improvised or homemade item and without it, he or she would not need assistance from another person to complete the task. Do not check the use of any adaptive equipment if an improvised or homemade item is being used since this is not considered adaptive equipment.
  • Has a lift chair or other mechanical device (such as an electric hospital bed), but can independently transfer without it.
  • Is independent with transfers by pushing on chair arms, other furniture, wheelchair, walker, or cane with no significant, negative health outcome.
  • Is independent with transfers after rocking back and forth to gain momentum to get up from a seated position with no significant, negative health outcome.
  • Requires transfer assistance getting in or out of a vehicle.
  • Transfers independently but has a fear of falling.
  • Transfers independently but does so slowly and safely.
  • Transfers independently but does not unless a family member/staff member is present somewhere in the home, “just in case.”
  • Transfers independently but needs assistance putting on or taking off orthotic devices (such as braces, shoe inserts, ankle foot orthosis (AFOs), anti-embolism hose, or orthotic shoes). These needs are captured in Module 5.7, Dressing.
  • Has a seizure disorder with no seizure in the last three months and there is no intervention needed; however, family or staff is present “just in case.”

Check “1” (“Help is needed to complete the task safely but helper DOES NOT have to be physically present throughout the task”) for a person who:

  • Due to a physical, cognitive, or memory loss impairment requires supervision, cueing, and/or hands-on assistance with the task of Transferring SOME of the time.
  • Transfers independently but doing so results in a significant, negative health outcome and another person should be present to help with the task SOME of the time.
  • Uses an improvised or homemade item and without it, he or she would need assistance from another person to complete the task of Transferring SOME of the time. Do not check the use of any adaptive equipment if an improvised or homemade item is being used since this is not considered adaptive equipment.
  • Transfers independently but, due to a cognitive impairment, requires a cue to initiate the transfer.
  • Transfers independently but, due to a cognitive impairment, requires a cue to use adaptive equipment to transfer.
  • Has a lift chair or other mechanical device (such as an electric hospital bed), and cannot independently transfer without it.
  • Transfers independently for some of the day, but needs assistance from another person for other parts of the day. For example, this includes a person who is able to transfer independently in the morning but in the evening if, for example, is fatigued, needs assistance with the task of Transferring some or all of the time.

Check “2” (“Help is needed to complete the task safely and helper DOES need to be present throughout the task”) for a person who:

  • Due to a physical, cognitive, or memory loss impairment requires supervision, cueing, and/or partial or complete hands-on assistance with the task of Transferring ALL of the time.
  • Transfers independently but doing so results in a significant, negative health outcome and another person should be present to help with the task ALL of the time.
  • Uses an improvised or homemade item and without it, he or she would need assistance from another person to complete the task of Transferring all of the time. Do not check the use of any adaptive equipment if an improvised or homemade item is being used since this is not considered adaptive equipment.
  • Needs step-by-step directions to transfer.
  • Needs hands-on or standby assistance* to complete safe transfers.
  • Needs to wear a gait belt that is used during transfers.
  • Requires supervision due to having an uncontrolled seizure disorder, evidenced by one or more seizures in the last three months AND requires standby assistance** during the task of Transferring.

*Standby assistance for transferring is defined as the need for a person to stand next to the individual (within arm’s length) in order to be readily available to help the individual in the event he/she falls or loses balance.

**Standby assistance for seizure is defined as the need for a person to be next to the individual (within arm’s length) in order to be readily available to help the individual in the event he/she experiences a seizure.

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5.12 Instrumental Activities of Daily Living (IADLs)

The six IADLs include:

  • Meal Preparation
  • Medication Administration and Medication Management
  • Money Management
  • Laundry and/or Chores
  • Telephone
  • Transportation

IADL Coding for Level of Help Needed
Each of the IADLs has a separate rating system to capture the level of help needed specific to each IADL. When recording the level of help an individual needs to safely complete an IADL, a screener should select only one rating of “Level of Help Needed” with each IADL.

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5.13 Meal Preparation

Definition: The physical and cognitive ability to obtain and prepare basic routine meals, including the task of grocery shopping. What constitutes a meal is an individual choice. Meal Preparation includes the ability to make a simple meal, such as cereal, sandwich, heat frozen foods, or reheat food prepared by others.

Meal Preparation does not include needed transportation to and from a grocery store or assistance with the money transaction to pay for the groceries. (These needs are captured in Module 5.18 Transportation and Module 5.15 Money Management.)

REMINDER: A person may request assistance with Meal Preparation due to a gender, age, or cultural norm. To select a need for assistance with Meal Preparation, a person needs to have a physical, cognitive, or memory loss impairment limiting his/her ability to complete the task independently.

REMINDER: A screener should not automatically assume assistance is needed because a person makes food choices consistent with his/her lifestyle and values, even if those food choices are not in agreement with professionals' advice and nutritional goals for the person.

REMINDER: When there is a need for assistance with grocery shopping only, the frequency of assistance should be selected as a 1: (Needs help from another person weekly or less often), as more frequent grocery shopping is not necessary.

The activity of Meal Preparation may include the following components:

  • Opening food containers
  • Opening the refrigerator and freezer
  • Safely using kitchen appliances
  • Preparing a simple meal, such as cereal, sandwich, heat frozen foods, or reheat foods prepared by others
  • Safely placing food on a plate or in a cup, and carry it to a table
  • Proper food preparation and storage
  • Obtaining groceries

The activity of obtaining groceries may include the following components:

  • Selecting the food from the store shelves
  • Moving items between a basket or cart to the checkout counter
  • The money transaction to pay for the groceries. (This need is captured in Module 5.15 Money Management).
  • Bagging the food
  • Getting the bags to a vehicle
  • Getting the bags into the home
  • Putting the groceries away

MEAL PREPARATION RATING SYSTEM

  • 0: Independent
  • 1: Needs help from another person weekly or less often
  • 2: Needs help 2 to 7 times a week
  • 3: Needs help with every meal

Check this for a person who:

  • Has a physical, cognitive, or memory loss impairment limiting his/her ability to complete the task of Meal Preparation independently.
  • Is able to independently complete the tasks involved in preparing a meal and grocery shopping but doing so results in a significant, negative health outcome. A significant, negative health outcome has occurred when a person experiences any of the following symptoms: shortness of breath, dizziness, chest pain, exhaustion, falls, incontinence, or debilitating pain, to the point where the individual is unsafe and another person should be present to help with some or all of the components of a task.
  • Needs assistance to have food pureed, minced, thickened, or to prepare a mechanical soft diet.
  • Needs assistance preparing his/her liquid nutrition for his/her tube or intravenous feedings.
  • Needs assistance placing food on plate or table (serving) or with carrying a plate and/or cup to the table.
  • Needs assistance to open food containers, even with adaptive aids (e.g., electric can opener).
  • Due to a physical impairment, needs assistance opening his/her refrigerator or freezer, even with adaptive aids.
  • Needs assistance preparing meals due to his/her inability to stand long enough to cook food, even when taking breaks to sit down during the task of making a meal.
  • Is unable to safely use at least one of his/her appliances to cook or heat food.
  • Has Prader-Willi syndrome.
  • Needs assistance with Meal Preparation tasks due to a cognitive impairment related to his/her severe and persistent mental illness.
  • Is unable to determine when food is spoiled.
  • Needs to have a plate “set up” with food due to his or her visual impairment.
  • Needs assistance to cut food.

Do NOT check this for a person who:

  • Does not have a physical, cognitive, or memory loss impairment limiting his/her ability to complete the task of Meal Preparation independently.
  • Chooses to only eat cold foods.
  • Is able to independently complete the tasks involved in preparing a meal and grocery shopping, but it takes additional time to do so WITHOUT causing a significant negative, health outcome.
  • Needs assistance planning a menu, making a grocery shopping list, requires transportation to the grocery store, or wants to grocery shop more than once a week.
  • Receives home-delivered meals (HDM), but is cognitively or physically able to prepare meals. There is a variety of reasons why a person may receive HDMs that do not relate to a cognitive or physical limitation to prepare meals independently.
  • Can make a simple meal (cereal, sandwich, etc.); can heat food (frozen, leftovers, or food prepared by others).
  • Needs to use the grocery store's scooter or wheelchair to shop.
  • Needs assistance from a grocery store employee or fellow shopper to retrieve items from high or low shelves because he/she cannot reach the items without assistance.
  • Can shop independently when groceries are bagged in smaller and lighter bags so he/she can manage them.
  • Chooses not to eat according to the food pyramid, eats more than three meals a day, or eats fewer than three meals per day.
  • Resides in a substitute care setting or nursing home and, solely because of where the person resides, he/she is not allowed to use the kitchen to prepare meals.
  • Does not prepare his/her meals solely because meals are provided as part of the services in the facility where the person resides.
  • Only needs assistance getting food out of a refrigerator or freezer located in his/her garage or basement.
  • Can prepare a meal if he/she takes breaks to sit down during the task.
  • Is only able to cook or heat up food in a microwave oven.
  • Needs assistance cleaning up after a meal. (This need is captured in Module 5.16 Laundry and/or Chores.)
  • Is on a special diet (diabetic, low-cal, low-sugar, low-sodium, etc.).
  • Needs to have his/her food pureed, minced, cut, or thickened and can do so independently with or without adaptive aids.
  • Has a vision impairment that does not affect his/her ability to independently prepare meals.
  • Needs assistance cleaning the inside of his/her refrigerator, including the removal of spoiled food. (This need is captured in Module 5.16 Laundry and/or Chores.)
  • Receives nutrition by tube or intravenous feedings and can independently prepare his/her liquid nutrition.
  • Has fluctuating abilities and grocery shops on his/her good days. For additional information on screening a person with fluctuating abilities, review Module 1.11 Strategies to Minimize Screening Limitations, Abilities Fluctuate.
  • Could prepare meals safely and independently using a toaster oven, toaster, stove top, stove, oven, microwave oven, or electric frying pan, but he/she doesn't currently have any of these appliances.
  • Needs assistance with the money transaction to pay for the groceries with cash, credit card, debit card, gift card, personal check, or by store charge account. (This need is captured in Module 5.15 Money Management.)
  • Independently orders his/her groceries online, calls-in, or emails in his/her grocery order for convenience.

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5.14 Medication Administration and Medication Management

Definition of a medication: A medication is a drug used to treat disease, symptoms, or injury that enters the body in the prescribed manner. The type of regularly scheduled and frequently taken medications prescribed for the person can be brand name, generic, or over-the-counter (OTC). A medication on the LTCFS must meet these three criteria:

  1. Approved by the U.S. Food and Drug Administration.
  2. Prescribed by a Medicaid-recognized prescriber (physician, psychiatrist, nurse practitioner, physician's assistant, optometrist, or dentist).
  3. Regularly scheduled and used. Regularly scheduled medications are typically taken daily, four times a day, or every eight hours. Excluded as a regularly scheduled and used medication is an as needed (PRN) medication. A PRN medication is taken only when needed based on symptoms.

Exceptions:

  1. Sliding scale insulin (where the exact dosage is adjusted according to the blood glucose level) can be treated as a regularly scheduled medication, because it is regularly given, with the dose merely adjusted to blood glucose level.
  2. If a person has a standing order for a medication to be taken regularly and frequently, then it can be treated the same as a regularly scheduled medication on the LTCFS. An example of this is pain medicine ordered PRN but taken every four to six hours, every day.

REMINDER: Over-the-counter medications are included if they meet the three criteria listed in the definition of a medication.

REMINDER: On the LTCFS, a vitamin is a medication only if it is injected (e.g., vitamin B-12 injection).

A medication on the LTCFS DOES NOT include the following:

  • Vitamin (unless injected), mineral, supplement, and alternative or complementary medicines, even if prescribed by a Medicaid-recognized prescriber (physician, psychiatrist, nurse practitioner, physician's assistant, optometrist, or dentist).
  • Non-vitamin, non-mineral natural substances such as omega 3 or fish oil, glucosamine, ginkgo, anti-oxidants, ginseng, echinacea, chondroitin, coenzyme Q10, flaxseed, cranberry, garlic, soy, melatonin, green tea, saw palmetto, grape seed, milk thistle, lutein, barkwater, shark cartilage, etc., even if prescribed by a Medicaid-recognized prescriber (physician, psychiatrist, nurse practitioner, physician's assistant, optometrist, or dentist).
  • Other complementary or alternative medicines such as a homeopathic, naturopathic, or herbal therapy; or other treatment such as aromatherapy, flower remedies, crystal or magnet therapy, chelation, bowel cleansing, detoxifier, acupuncture, acupressure, etc.
  • Other dietary supplements with calories, minerals, vitamins, and/or other additives.

If the person needs someone to give them his/her medications, there are three general possibilities that are included under this row:

  1. Medication Administration: This is a skilled task in which the nurse or someone trained by a nurse administers the medications.
  2. Assistance with Pre-Selected Medications: An unskilled person (without the judgment about giving or holding a medication) can "assist" with medications that have been pre-selected—that is, the proper medication and dosage have been selected in advance by a pharmacist, nurse, or someone trained by a nurse. Qualifying assistance here could include a son calling his elderly mother to remind her to take her medications. Verbally cueing a person to take his/her medication, due to a physical, cognitive, or memory loss impairment, is a need for assistance with Medication Administration.
  3. Assistance with Self-Medication: This is when a self-directing person has the cognitive ability to select the proper medication and dosage.

I.) MEDICATION ADMINISTRATION

Definition of Medication Administration: A person's need for assistance from another person to take or be given a medication by any route except intravenously (IV). This could be by mouth, under the tongue, injection, onto or into the body, rectally, vaginally, or by feeding tube. The person's need for assistance from another person in order to use a prescribed medication that is regularly scheduled and used should be captured here.

The person's need for assistance from another person in order to use a prescribed as needed (PRN) medication, that is regularly and frequently taken, can also be treated the same as a regularly scheduled and used prescription medication, and should be captured here. Conversely, a person's need for assistance from another person in order to use a prescribed PRN medication, that is not regularly and frequently taken, should not be captured here.

II.) MEDICATION MANAGEMENT

Definition of Medication Management: A person's need for assistance from another person to set up or monitor his/her prescribed and regularly taken medications.

Definition of Medication Set-Up: To separate out the proper dosage and set it aside in an assigned place for later use.

Medication set-up is completed for two reasons. One reason is to ensure the proper medication, at the proper dosage is selected when the individual is unable to select it due to a physical, cognitive, or memory loss impairment. The second reason is to arrange the medications to help the person remember to take them at proper times and to make it easier to tell that medications were or were not taken.

Examples of medication set-ups:

  • Medication boxes with compartments labeled for different times and each day of the week, into which pills are placed.
  • Any other "set-up" system in which medications and dosages are pre-selected by another person.
  • Medication dispensing machines (e.g., a CompuMed) that can be programmed (often weekly) to dispense pills.
  • Pre-filling of syringes (e.g., insulin syringes).

Medication Boxes
A medication box is commonly used for convenience in organizing and remembering one's medications, even by people with no physical, cognitive, or memory loss impairments. When a person uses a medication box, the screener needs to determine whether due to a physical, cognitive, or memory loss impairment the person needs to use the medication box, and/or needs the assistance of another person to fill it.

REMINDER: The filling of a medication box should typically be indicated at the "1 to 3 times/month" frequency, since two or more medication boxes can be pre-filled at one time. If this usual method does not work well for an individual, more frequent medication set-up may be necessary.

REMINDER: Pre-filling insulin syringes can typically be completed weekly, since pre-filled syringes can be stored in the refrigerator for a week. This task should be indicated at the "Weekly" frequency.

Medication Monitoring
Medication monitoring includes two components:

  1. Being cognitively capable of reporting a problem that is likely related to medication use, should it arise; and
  2. The ability to collect medication-related data as ordered by the prescriber, such as vital signs, weights, blood glucose level, response to pain medications, etc. Data collection also includes in-home assistance to draw blood for a lab test.

A need for assistance with medication monitoring may be indicated when a person has an uncontrolled seizure disorder, evidenced by one or more seizures in the last three months that require standby assistance. Standby assistance for seizure is defined as the need for a person to be next to the individual (within arm’s length) in order to be readily available to help the individual in the event he/she experiences a seizure.

Frequency of Medication Monitoring
The frequency of medication monitoring is usually lower than the frequency of medication administration.

If the person's condition is unstable and medication is frequently adjusted, then the need for medication monitoring may be several times per week or even daily. It is expected the condition or treatment will stabilize over several weeks, and the frequency of medication monitoring will drop. A Rescreen should be completed when a person's condition stabilizes to reflect this and other changes.

Most data collection for medication monitoring is completed less often than daily. One exception to this is blood glucose checks, which are commonly completed three or four times a day.

Pain Management
A person's need for assistance from another person to adjust his/her medications, in the person's residence, in order to manage pain. This does not include chiropractic care, care at a pain clinic, or non-prescription medications, (e.g., an occasional Tylenol for arthritis pain).

Blood Levels
A person's need for assistance from another person to draw blood samples, in his/her residence, for laboratory tests. The majority of these tasks are related to medications (e.g., Pro-Times to regulate Coumadin administration, or potassium levels for a person on diuretics). Blood levels also include "finger-sticks" for capillary blood to test blood glucose levels.

Tip: The LTCFS application will check to ensure that the level of help indicated in the IADL Medication Administration and Medication Management correlates with the Medication Administration and Medication Management tasks on the HRS Table. If the level of help does not correlate between that IADL task and the Medication Administration and Medication Management tasks on the HRS Table, the screener will receive an error message to prompt correction.

III.) MEDICATION ADMINISTRATION and MEDICATION MANAGEMENT RATING SYSTEM

  • NA: Has no medications
  • 0: Independent (with or without assistive devices).
  • 1: Needs help 1 to 2 days a week or less often. Includes having someone set-up medications, pre-fill syringes, or the administration of medication.
  • 2a: Needs help at least once a day 3-7 days per week--CAN direct the task and can make decisions regarding each medication.
  • 2b: Needs help at least once a day 3-7 days per week--CANNOT direct the task; is cognitively unable to follow through without another person to administer each medication.
  • N/A: Has no medications.

Check this for a person who:

  • Takes no medications.
  • Does not take regularly scheduled medication but needs assistance from another person with an infrequently taken prescription PRN medication. Such a PRN medication does not meet the LTCFS definition of a medication.
  • Competently refuses to take any prescribed medications. In this situation, the person has no need for Medication Administration or Medication Management assistance.

0: Independent.

Check this for a person who:

  • Receives assistance with his/her prescribed and regularly taken medication, but there is not a physical, cognitive, or memory loss impairment limiting the person's independence. For example, a person without a physical or cognitive impairment who receives assistance with his/her medications based on age, gender, cultural norm, or due to the facility's licensing requirements.
  • Takes medication as directed and has medication monitoring done outside the person's residence at his/her physician's office, clinic, pharmacy, or health care facility.
  • Requires Medication Administration or Medication Management assistance less often than monthly.
  • Takes medication as directed and is able to contact the prescriber with concerns and follow the prescriber's recommendations.
  • Independently sets-up and uses his/her medication box.
  • Independently uses a medication box primarily as a convenience.
  • Is limited solely by a language barrier or illiteracy, not a physical, cognitive, or memory loss impairment.
  • Is independent using adaptations such as large-print or Braille labels, "talking" glucometer, easy-open pill bottles, etc.
  • Has an unorthodox system of organizing medications, but has no history of medication misuse or errors.
  • Has blood drawn at his/her physician's office, clinic, health care facility, or laboratory, and follows through with any changes as instructed by the prescriber.
  • Takes medication as instructed and is able to independently check his/her blood glucose level, blood pressure, weights, pulse, etc.
  • On a regular basis receives routine monitoring for general health, behavior, etc., by agency/facility staff because that monitoring is provided to all residents.
  • Uses an automated pill dispenser (e.g., CompuMed) to independently take his/her medications.
  • Needs assistance reordering or obtaining medication refills. This includes assistance to arrange for a medication refill (e.g., telephone call in request to the pharmacy, picking up the refilled medication at the pharmacy, etc.). This assistance is captured in the Laundry and/or Chores IADL (see Module 5.16 Laundry and/or Chores).
  • Uses a lockbox to store his/her medication:
    • Due to the policy of the person's provider agency (e.g., hospice agency, personal care provider agency, etc.).
    • To prevent someone living with him/her or even a pet from having access to the medication.
    • Although the person is not presently suicidal and is not at risk of overdosing on his/her medication.
    • Although the person does not have a current substance use issue and is not at risk of taking his/her medication other than as prescribed.

1: Needs help 1 to 2 days per week or less often.

The minimum frequency of needed assistance is once a month. A frequency less than once a month should not be indicated on the LTCFS, but could be recorded in the Notes section.

Check this for a person who:

  • Due to a physical, cognitive, or memory loss impairment, needs someone to assist him/her with prescribed and regularly taken medication (e.g., help filling medication boxes).
  • Has an unstable condition and medication is frequently adjusted, and due to a cognitive impairment, the person needs someone to monitor him/her for specific medication effects and side effects and report those to the prescriber.

Do NOT check this for a person who:

  • Is able to fill his/her own medication box(es) or could take medications without using a medication box.
  • Takes his/her medication independently and does not need frequent monitoring for medication effects or side effects.
  • Has blood drawn at his/her physician's office, clinic, health care facility, or laboratory, and follows through with any changes as instructed by the prescriber.
  • Is able to monitor and report effects and side effects himself or herself.
  • Is given medication by IV only. This is captured on the IV Medications row (see Module 7.12).
  • If the person only takes as needed (PRN) medications that are not regularly and frequently taken (e.g., aspirin or ibuprofen for occasional headaches).
  • Has a contraception medication (e.g., Depo-Provera) injected every three months or a birth control implant (e.g., Implanon).
  • Receives vitamin B-12 injections outside his/her residence (e.g., at a clinic).
  • Is left a written reminder from another person as a cue to take his/her medications.

2a: Needs help at least once a day 3-7 days per week—CAN DIRECT the task.

Check this for a person who:

  • Due to a physical impairment, needs someone to assist him/her with prescribed and regularly taken medication.
  • Is self-directing and has the cognitive ability to select the proper medication and dosage and also has the judgment to understand the medication's purpose, side effects, and report problems, but needs someone to physically assist with the medication. An example of this is a person with quadriplegia who instructs his/her helper, "Please put one of those three pills on my tongue and give me a drink."
  • Needs assistance to crush his/her medication or assistance to put his/her medication in food (e.g., applesauce) in order for it to be taken.

Do NOT check this for a person who:

  • Needs help taking his/her prescribed and regularly taken medication and is cognitively unable to instruct his/her helpers.
  • Is unable to communicate in order to direct his/her helpers.
  • Is non-English speaking and is unable to communicate with his/her helper(s) in order to direct the helper(s).
  • Is able to take medication with less frequent assistance. An example of this is a person able to independently take his/her medication once another person assists him/her in setting up the medication box(es). In this case, select 1: (Needs help 1 to 2 days a week or less often.)
  • Needs a call or cue from another person, to take his/her medication or to check if the person has or has not taken his/her medication, if that call or cue is NOT timely enough for the person to take the missed dose. To be timely, the call or cue would typically need to be within an hour of when the dose is to be taken.
  • Is given medication by IV only. This is captured on the IV Medications row (see Module 7.12).
  • Is left a written reminder from another person as a cue to take his/her medications.

Considering "can direct the task" versus "cannot direct the task"
As listed on the LTCFS, the distinction between "can direct the task" and "cannot direct the task" applies only if the person needs help at the higher frequency of "at least once a day 3-7 days per week." If the person needs help less often than 3-7 days per week, the screener does not need to make a determination about the person's ability to direct the task of taking or withholding his/her medications.

If, due to a person's cognitive impairment, the person needs a cue to take his/her medication (within an hour of when the dose is to be taken), the person cannot direct the task of managing his/her medication.

In addition, not every person with a cognitive impairment will be unable to direct the task of managing his or her medication. Some individuals with a cognitive limitation can independently take his/her medication as directed, without misuse or error, once the medication is set up. For such a person, the selection of "1: Needs some help 1-2 days per week or less often," would be applicable.

2b: Needs help at least once a day 3-7 days per week—CANNOT direct the task

Check this for a person who:

  • Due to a cognitive impairment, needs someone to assist him/her with his/her prescribed and regularly taken medication.
  • Is not self-directing and does not have the cognitive ability to select the proper medication and dosage and also lacks the judgment to understand the medications' purpose, side effects, report problems, and needs someone to physically assist with the medication.
  • Needs a call or cue from another person, to take his/her medication or to check if the person has or has not taken his/her medication, if that call or cue is timely enough for the person to take the missed dose. To be timely, the call or cue would typically need to be within an hour of when the dose is to be taken.
  • Due to a cognitive impairment, needs assistance to check his/her blood glucose level or to adjust his/her insulin dose given the current blood glucose level.

Do NOT check this for a person who:

  • Needs help taking his/her prescribed and regularly taken medication due to a physical limitation, but is able to direct helpers in selecting and taking the medication appropriately.
  • Has a cognitive impairment but takes medication as directed, without misuse or error, once the medication is set up.
  • Is blind or visually impaired, if he/she is able to self-manage and administer his/her medications with reasonable accommodations (e.g., use of Braille on a pill bottle to indicate what the medication is.)
  • Needs a call or cue from another person, to take his/her medication or to check if the person has or has not taken his/her medication, if that call or cue is NOT timely enough for the person to take the missed dose.
  • Is given medication by IV only. This is captured on the IV Medications row (see Module 7.12).
  • Does not have a cognitive impairment and the person cannot name each of his/her medications, but can tell you what health issues he/she takes medication for. Examples include, but are not limited to, when a person cannot name his/her hypertension medication (e.g., chorthalidone) but can tell you, "That little yellow pill is my water pill. I have high blood pressure." Or, the person can tell you, "I take a pill once a week for my osteoporosis." when they are prescribed alendronate.

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5.15 Money Management

Definition: The physical and cognitive ability to handle money, pay bills, and complete financial transactions needed for basic necessities (food, shelter, and clothing). These financial transactions include any of the following types of money transactions: cash, credit card, debit card, personal check, money order, automatic withdrawal, automatic deposit, or the exchange of currency.

REMINDER: A person is independent with the task of Money Management if he/she does not have a physical disability or cognitive impairment preventing him/her from learning the task. Do not indicate a need for assistance when the limitation is due to a language barrier, illiteracy, or a gender, age, or cultural norm.

REMINDER: A person without a cognitive impairment is independent with the tasks of Money Management if he/she manages his/her money consistent with his/her lifestyle, values, and goals, while those financial choices may not necessarily be in agreement with professionals' values or goals.

REMINDER: Selecting 1: (Can only complete small transactions) is indicated when the person can independently handle minor money transactions and smaller amounts of currency. Selecting 2: (Needs help from another person with all transactions) is indicated when the person requires assistance from another person anytime he or she handles money or with all of his or her financial matters.

MONEY MANAGEMENT RATING SYSTEM

  • 0: Independent
  • 1: Can only complete small transactions
  • 2: Needs help from another person with all transactions

Check this for a person who:

  • Has a physical, cognitive, or memory loss impairment limiting his/her ability to complete the task of Money Management independently.
  • Lacks or has limited fine motor dexterity.
  • Has a cognitive impairment (brain injury, intellectual/developmental disability, severe and persistent mental illness, or Alzheimer's disease/dementia) limiting the person's ability to manage his/her money.
  • Needs assistance with the money transaction to pay for purchases with cash, credit card, debit card gift card, personal check, money order, or by store charge account.
  • Needs assistance recognizing money denominations.
  • Needs assistance to write a personal check or balance a checkbook, due to a physical or cognitive impairment.

Do NOT check this for a person who:

  • Does not have a physical, cognitive, or memory loss impairment limiting his/her ability to complete the task of Money Management independently.
  • Has inadequate income to meet his/her basic needs.
  • Needs assistance related to a lack of experience with managing money due to his/her gender, age, or a cultural norm.
  • Is blind or vision impaired, without assessing how he/she manages his/her money with reasonable accommodations (e.g., use of a debit card instead of writing a check).
  • Hasn't had experience managing money and his/her ability to complete this task has yet to be tested. Examples of a person with the cognitive ability to manage his/her money, but not the experience of doing so could include, but is not limited to, a person with a severe and persistent mental illness, an intellectual/developmental disability, young adult, recent immigrant, or even a recent widow/widower, whose partner handled all of the couple's finances.
  • Has a representative payee or money manager due to a history of poor money management related to personal choices or issues with alcoholism, a drug addiction, or a gambling addiction.
  • Has a representative payee, durable power of attorney, power of attorney, authorized representative, activated power of attorney for health care decisions, designated power of attorney for health care decisions, conservatorship, or a guardian of the person and/or estate without reviewing the person's ability to handle at least some money transactions.
  • Does not speak, read, or write English.
  • Is illiterate.
  • Needs transportation to the bank. (This need is captured in Module 5.18 Transportation.)
  • Has a diagnosis of a cognitive impairment (e.g., brain injury, intellectual/developmental disability, severe and persistent mental illness, or Alzheimer's disease/dementia) without reviewing the person's ability to manage his/her money.
  • Needs assistance budgeting his/her income. How a person plans or doesn't plan to spend his/her money is not a Money Management task included in the LTCFS.
  • Uses a charge account at a store (e.g., grocery store) without reviewing the person's ability to manage his/her money. The charge account may be set up as a convenience for the person paying the account's tab.

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5.16 Laundry and/or Chores

Definition: The physical and cognitive ability to complete one's personal laundry, routine housekeeping, and basic home maintenance tasks, including the tasks of snow shoveling and lawn mowing.

Assistance with some Laundry and/or Chores tasks is not typically provided on a daily basis. On the rating system, a 1 would be selected for the frequency of assistance needed with the following Laundry and/or Chores tasks:

  • Laundry (unless the person is incontinent and in need of more frequent laundry assistance)
  • Snow shoveling
  • Lawn mowing
  • Vacuuming (unless the person has a documented medical reason and need for more frequent vacuuming)
  • Floor washing (unless the person has incontinence or other documented medical reason and is in need of more frequent floor washing)

REMINDER: Screeners need to acknowledge that the person's lifestyle choices, values, and goals related to the person's level of laundry and/or household cleanliness may not necessarily be in agreement with the professionals'.

REMINDER: The frequency of needed assistance with the tasks of Laundry and/or Chores is to be based on need, not the availability of staff to assist the person.

LAUNDRY AND/OR CHORES RATING SYSTEM

  • 0: Independent
  • 1: Needs help from another person weekly or less often
  • 2: Needs help more than once a week

Check this for a person who:

  • Has a physical, cognitive, or memory loss impairment limiting his/her ability to complete his/her laundry and/or household chores.
  • Is able to independently complete the tasks involved in completing his/her laundry and/or household chores but doing so causes a significant, negative health outcome. During the tasks involved in completing the person's laundry and/or household chores, a significant, negative health outcome has occurred when a person experiences any of the following symptoms: shortness of breath, dizziness, chest pain, exhaustion, falls, incontinence, or debilitating pain, to the point where the individual is unsafe and another person should be present to help with some or all of the components of a task.
  • Hoards personal items or food and this behavior creates a potential health or safety issue.
  • Needs assistance cleaning up after a meal.
  • Needs assistance cleaning the inside of his/her refrigerator.
  • Needs assistance to re-order medications.

Do NOT check this for a person who:

  • Does not have a physical, cognitive, or memory loss impairment limiting the person's ability to complete his/her laundry and/or household chores.
  • Is able to independently complete the tasks involved in completing his/her laundry and/or household chores but it takes additional time to do so WITHOUT causing a significant, negative health outcome.
  • Needs assistance with window washing, gardening, weatherization, grooming the yard (including weeding, pruning hedges, raking leaves, and aerating or fertilizing the grass).
  • Needs housecleaning assistance more than weekly due to having a pet(s) in his/her home and has related allergies.
  • Needs assistance with home repairs that are beyond basic cleaning but enhance the dwelling's appearance (e.g., painting).
  • Resides in a residential facility or institution and the provision of Laundry and/or Chore services is provided as part of the facility package, without reviewing the person's need for assistance with these tasks.
  • Needs assistance completing other household members' laundry (e.g., spouse's or children's laundry) or the cleaning of living spaces not used by the individual (e.g., teenager's bedroom or bathroom).
  • Needs assistance with heavy-duty cleaning done infrequently, such as carpet, drapery, and window cleaning or wall washing.
  • Needs assistance related to a lack of experience completing his/her laundry and/or household chores due his/her age, gender, or cultural norm and does not complete these tasks.

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5.17 Telephone

Definition: The physical and cognitive ability of a person to use his/her personal telephone to make and receive a routine telephone call with or without assistive devices. What constitutes a routine telephone call is very person-specific. They are the familiar and frequent telephone calls a person makes and receives.

The ability to use the telephone does not include the assistance a person may need to make or receive a non-routine telephone call. The need for assistance with non-routine telephone calls is captured in the Cognition for Daily Decision Making task in the Communication and Cognition Section of the LTCFS.

Examples of non-routine telephone calls can include, but are not limited to, a person's need for assistance making an appointment with the income maintenance unit for an annual financial review, making an appointment with a health care specialist every three months, responding to his/her doctor's office, or sporadic calls to change an appointment time.

TELEPHONE RATING SYSTEM

  • 1a: Independent. Has cognitive and physical abilities to make calls and answer calls.
  • 1b: Lacks cognitive or physical abilities to use phone independently.
    -and-
  • 2a: Currently has working telephone or access to one.
  • 2b: Has no phone and no access to phone.

1a: Independent. Has cognitive and physical abilities to make calls and answer calls.

Check this for a person who:

  • Needs assistance with a telephone other than his/her personal telephone, but can independently use his/her personal telephone.
  • Independently uses a telephone with preprogrammed numbers or list of frequently called numbers.
  • Independently uses a telephone with an assistive device or with assistance from a telecommunications relay service.
  • Does not have a landline, but does use a cell phone.
  • Does not speak or understand spoken English.
  • Does not use a telephone due to the person's age, gender, or cultural norm.
  • Needs assistance with non-routine telephone calls.

1b: Lacks cognitive or physical abilities to use phone independently.

Check this for a person who:

  • Would be independent with this task if he/she used an assistive device, but he/she doesn't currently have it. A person's untried potential for using an assistive device should not be considered when assessing the person's current need for assistance.
  • Will answer a ringing telephone but is not able to place a call.
  • Is hard of hearing, deaf, or has a speech impairment, and does not have a teletypewriter (TTY) or other adaptive device to use with his/her telephone.
  • Is unable to make himself or herself understood due to significant communication impairment (e.g., aphasia).

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5.18 Transportation

Definition: At the time of the screening, the person is physically and cognitively capable of driving a regular or adapted vehicle.

TRANSPORTATION RATING SYSTEM

  • 1a: Person drives regular vehicle
  • 1b: Person drives adapted vehicle
  • 1c: Person drives regular vehicle, but there are serious safety concerns
  • 1d Person drives adapted vehicle, but there are serious safety concerns
  • 2: Person cannot drive due to physical, psychiatric, or cognitive impairment
  • 3: Person does not drive due to other reasons

A regular vehicle is a standard model vehicle the person operates without needing specialized adaptations to drive.

A regular vehicle may be equipped with modifications that allow the person to enter/exit the vehicle or allow his/her mobility device to be transported with him/her. While these modifications may be needed in order for the person to RIDE in the vehicle, they are not necessary for the person to operate the vehicle.

Examples of vehicular modifications include, but are not limited to, a car top carrier for a wheelchair, trunk lift for carrying a wheelchair or scooter, grab bar, automatic door opener, van lift used to enter/exit the van when sitting in a wheelchair or scooter, etc.

For the purposes of the LTCFS, a vehicle with these and similar modifications is not an adapted vehicle.

Select 1a: Person drives regular vehicle if he/she is able to drive a vehicle with or without modifications described above.

An adapted vehicle is one the person operates that has after-market specialized equipment making the vehicle accessible for the person to DRIVE; without the specialized adaptations, the person would not be able to drive the vehicle.

These adaptations help the driver control the vehicle's speed and direction and may include, but are not limited to, hand controls, adaptive pedal extensions, switch pad controls, extended gearshift handle, etc.

Select 1b: Person drives adapted vehicle if he/she is only able to drive a vehicle that has specialized and adaptive driving equipment described above.

Serious Safety Concerns
Serious safety concerns may be evident when a person with a physical, psychiatric, or cognitive impairment drives a motor vehicle. The screener will rely on professional judgment when reviewing how limitations may affect the person's ability to safely drive a vehicle.

Some examples of a person driving with serious safety concerns can include but are not limited to a person who drives:

  • With a diagnosis of dementia
  • With impaired vision
  • With paresis without using specialized equipment
  • Under the influence of alcohol or a controlled substance

REMINDER: Do not select 1b: Person drives adapted vehicle, when the person could drive an adapted vehicle but does not currently have the needed specialized equipment in his/her vehicle.

Select 1c: Person drives a regular vehicle, but there are serious safety concerns if the person has a diagnosis, condition, or driving history described above and he/she drives a regular vehicle.

Select 1d: Person drives adapted vehicle, but there are serious safety concerns if the person has a diagnosis, condition, or driving history described above and he/she drives an adapted vehicle.

Serious safety concerns should not be selected for a person who has made a reasonable accommodation(s) that limits driving to:

  • Only during daylight hours
  • Non-rush hours (typically weekdays, 9:00 a.m. to 3:00 p.m.)
  • Neighborhood driving
  • Only short distances from his/her residence
  • Comply with the Division of Motor Vehicles (DMV) restrictions on his/her license
  • Comply with the limits associated with his/her occupational license

Select 2: Person cannot drive due to physical, psychiatric or cognitive impairment if at the time of the screening, the person does not drive or is not capable of driving due to a physical condition (e.g., blindness or hemiparesis), psychiatric condition (e.g., schizophrenia), or cognitive impairment (e.g., dementia).

Select 3: Person does not drive due to other reasons if at the time of the screening, the person does not have a physical, psychiatric, or cognitive impairment limiting his/her ability to drive, but the only reason he/she does not drive is because the person:

  • Never learned to drive
  • Lacks a valid driver license due to a reason other than a physical, psychiatric, or cognitive impairment
  • Does not own a vehicle or have access to one
  • Cannot afford to maintain a vehicle
  • Cannot afford vehicle insurance coverage
  • Only utilizes mass transit or taxi service
  • By choice, is only driven by family members or friends
  • Adheres to an age, gender, or cultural norm

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Last Revised: January 9, 2017