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Assessment of ADL’s from Brenda’s SC Training:

What does ADL mean? Activities of Daily Living

We assess six areas of “ADLs”

“Frail” – Deficiency in three of six areas

“At-Risk” – Deficiency in one to two of six areas

Areas Assessed:

– Bathing
– Dressing
– Eating
– Grooming
– Home Management
– Transferring

HUD’s rational is that through identification of people with deficiencies in these areas we are able to help identify “risks” and meet those needs to help people remain living longer in the community.

HUD’s definition of “ADLs” is different than traditional ADL’s.

– ADL traditionally looks at areas of self-care tasks: Personal hygiene/grooming, Dressing, Self feeding, Transfers, Bowel & Bladder Management, Ambulation (with or without the use of an assistive device)
– IADL (Instrumental Activities of Daily Living) looks at items that are not fundamental functioning, but allow people to live independently in the community: Housework, Medication Management, Money Management, Shopping, Use of Telephone, Transportation
– HUD combines ADL’s and IADL’s in their general category of “ADL”, also fails to look at significant areas (i.e. incontinence management) and combines other areas traditionally separated (i.e. Home Management is a catch-all)

HUD considers any problem despite adaptation as a deficiency.

When do we assess ADL Status?

– On opening of a client’s case
– Within 30 days of noted change in physical or mental capabilities (do not wait until need is address to update ADL)
– Review during annual review/update of SP
Assessment:

First – how do we assess?

1) Direct questions
2) Observation (physical and environmental) – ideal to complete in apartment
3) Interview of family/caregivers

Bathing:
Does the person require assistance with any of the bathing process?
– Getting in and out of the tub?
– Washing their body? Their hair?
– Do they currently use any adaptive equipment? i.e. shower bench/chair, grab bars, handheld shower
– Do they have anyone that assists them with bathing?
– Do they avoid taking a bath because they don’t feel safe in the bathtub? i.e. bathe at sink, sponge bath, bedside bathing

Dressing:
Does the person require any assistance with dressing? i.e. applying clothes, zipping, buttoning, putting on shoes or stockings, selecting clothing items
– Can they obtain their own clothes or does someone have to buy clothes for them?
– Do they have any problem with dressing appropriately, wearing the same outfit day after day, wearing soiled/dirty clothes?
– Do they have any adaptive equipment to help them dress? i.e. zipper pulls, button fasteners
– Do they require assistance in obtaining incontinence products? Managing them?
– Do they require verbal cues to get dressed?

Eating:
Is the person able to prepare their own meals? Can they cook safely? Can they serve their own food?
– Do they require adaptive equipment? Dentures to chew, specialized utensils i.e. rocking knives, built-up handles, scoop dishes or cups, sippy cups
– Do they have any dietary restrictions? Low/no salt, diabetic diet, supplements to maintain weights, modified consistency, unable to eat orally
– Do they need someone to help them eat? Do they have difficulties chewing their food? Swallowing?

Grooming:
Does the person require assistance with personal care (nail care, toe nail care, foot care, make-up application, shaving [men and women], oral hygiene?
– Do they drool, require assistance with application of make-up, combing hear, etc.
– Do they require verbal cues for grooming? Reminds to shower?
– Are they able to maintain their hygiene? Dental, Hair, Nail

Home Management:
Does the person require any assistance with housekeeping, laundry, transportation, finances, understanding entitlement programs (i.e. Medicare benefits)
– Do they have difficulties with hearing and require modifications to their environment?
– Can they complete their housekeeping? i.e. laundry, shopping, vacuuming, scrubbing toilets, doing dishes
– Operating Home Equipment
– Are they able to sort through and management paperwork, or do they require assistance?
– Do they need assistance with obtaining transportation?
– Do they require assistance with understanding entitlement programs? Continued education, require assistance to understand

Transferring:
Can the person safely transfer from one spot to another (i.e. chair to bed, bed to chair, sitting to standing, standing to sitting, one elevation to another)?
– Does the person have an amputation that requires care? Has a prosthetic device?
– Does the person have any adaptive equipment in the home to assist with transfers? i.e. raised toilet seat, grab bars, elevating chair
– Does the individual have difficulties with falls? Does their gait place them at risk for falls? i.e. unsteady balance, shuffling, dragging limbs, swaying, limp
– Does the person have difficulties getting in and out of cars, chairs?
– Does the person require escort from the home for safety reasons?