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Activities of Daily Living

Eating: Includes the use of suitable utensils, bringing food to mouth, chewing and swallowing once presented on table or tray, drinking from cup or glass.

7

Independent

Does not need help or any modifications.

6

Modified Independent

Needs assistive device, increased time, safety issues or modify consistency of food.

5

Supervision/Set-up

Needs cuing or set-up: Help required to open containers, pour liquids, cut food.

4

Minimal Assist

Needs incidental assistance such as placement of food, or scoop food (performs >75% of task).

3

Moderate Assist

Needs physical assist to eat 50-74% of task.

2

Maximal Assist

Needs Maximum physical assist (performs 25-49% of task).

1

Total Assist

Total assist; dependent or assist w/ tube feedings (performs <25% of task).

0

Activity Does Not Occur

Enter only for admission assessment. Pt. does not receive any nutrition during assessment. (rare)

 

Grooming: Includes oral care, hair grooming, washing and drying hands and face, shaving and applying make-up.

7

Independent

Does not need help or any modifications.

6

Modified Independent

Needs assistive device, increased time, or safety issues.

5

Supervision/Set-up

Needs cuing, coaxing or assistance organizing grooming supplies.

4

Minimal Assist

Needs incidental assistance such as placement of washcloth or help with specific task (performs >75% of task).

3

Moderate Assist

Needs physical assist to groom 50-74% of task.

2

Maximal Assist

Needs Maximum physical assist (performs 25-49% of task).

1

Total Assist

Total assist; helper provides most of the assistance (performs <25% of task).

0

Activity Does Not Occur

Enter only for admission assessment. Pt. does not perform any grooming activities. (rare)

 

Bathing: Includes bathing the body from the neck down excluding the back (washing, rinsing, drying in tub, shower or sponge bath).

7

Independent

Does not need help or any modifications.

6

Modified Independent

Needs assistive device, increased time, or safety issues.

5

Supervision/Set-up

Needs cuing, coaxing or assistance to set out bathing equipment.

4

Minimal Assist

Needs incidental assistance such as placement of washcloth (performs >75% of task).

3

Moderate Assist

Needs physical assist bathe one or two areas 50- 74% of task.

2

Maximal Assist

Needs Maximum physical assist (performs 25-49% of task).

1

Total Assist

Helper performs most/all of the activity <25%

0

Activity Does Not Occur

Enter only for admission assessment. Pt. does not bathe self or is not bathed by helper.

 

Dressing: Scored separately for upper and lower body. Includes dressing and undressing as well as obtaining clothing from storage location. Assessment should occur with persons own clothing.

7

Independent

Does not need help or any modifications.

6

Modified Independent

Needs assistive device, increased time, or safety issues.

5

Supervision/Set-up

Needs cuing, coaxing or assistance to set out bathing equipment.

4

Minimal Assist

Needs incidental assistance such as placement of washcloth (performs >75% of task).

3

Moderate Assist

Needs physical assist bathe one or two areas 50- 74% of task.

2

Maximal Assist

Needs Maximum physical assist (performs 25-49% of task).

1

Total Assist

Helper performs most/all of the activity <25%

0

Activity Does Not Occur

Enter only for admission assessment. Pt. does not dress self or is not dressed by helper.

 

Bowel and Bladder Management: Part I=level of assistance

7

Independent

Does not need help or any modifications.

6

Modified Independent

Needs assistive device, equipment, pads, or medicine.

5

Supervision/Set-up

Needs cuing, coaxing or assistance to set up equipment.

4

Minimal Assist

Needs incidental assistance such as placement of equipment (performs >75% of task).

3

Moderate Assist

Needs physical assist for more than one task or manage equip. 50-74% of task.

2

Maximal Assist

Needs Maximum physical assist (performs 25-49% of task).

1

Total Assist

Helper performs most/all of the activity and manages equipment <25%

 

Bowel and Bladder Management: Part II, Frequency of bowel or bladder accidents over the past 7 days.

7

No accidents

Does not need help or any modifications.

6

No accidents in past 7 days

Needs assistive device, equipment, pads, or medicine.

5

1 accident

Including bedpan or urinal spills

4

2 accidents

Including bedpan or urinal spills

3

3 accidents

Including bedpan or urinal spills

2

4 accidents

Including bedpan or urinal spills

1

5 or more accidents

Including bedpan or urinal spills

 

Toileting: Includes perineal hygiene and clothing management before and after use of toilet or bedpan.

7

Independent

Does not need help or any modifications.

6

Modified Independent

Needs assistive device and or more time to complete.

5

Supervision/Set-up

Needs cuing, coaxing or assistance to set up equipment.

4

Minimal Assist

Needs incidental assistance such as balance while cleaning or adjusting clothing.

3

Moderate Assist

Needs physical assist for more than one task or manage equip. 50-74% of task.

2

Maximal Assist

Needs Maximum physical assist (performs 25-49% of task).

1

Total Assist

Helper performs most/all of the activity and manages equipment <25%

0

Activity Does Not Occur

Enter only for admission assessment.

 

Transfers: Bed, Chair, W/C in both directions. Toilet and Tub are scored separately.

7

Independent

Does not need help or any modifications.

6

Modified Independent

Needs assistive device such as grab bar, sliding board or extra time.

5

Supervision/Set-up

Needs cuing, coaxing or assistance to set up equipment.

4

Minimal Assist

Needs incidental assistance such as placement of equipment (performs >75% of task).

3

Moderate Assist

Needs physical assist for more than one task or manage equip. 50-74% of task.

2

Maximal Assist

Needs Maximum physical assist (performs 25-49% of task).

1

Total Assist

Helper performs most/all of the activity and manages equipment <25%

0

Activity Does Not Occur

Enter only for admission assessment. Pt. does not transfer unable to get out of bed. (rare)

 

Locomotion: Walk or Wheelchair, to be scored on level surfaces.

7

Independent Walks >150ft

Does not need help or any modifications.

6

Modified Independent Walks >150ft

Needs assistive device, equipment, pads, or medicine.

5

Supervision/Set-up Walks >150ft

Needs cuing, coaxing or assistance to set up equipment.

4

Minimal Assist Walks >150ft

Needs incidental assistance such as contact guard or steadying (performs >75% of task).

3

Moderate Assist Walks >150ft

Needs physical assist for 50-74% of task.

2

Maximal Assist Walks 50-149ft

1 person Maximum physical assist (performs 25- 49% of task).

1

Total Assist Walks <50ft.

Walks less than 50ft and/or 2 person assist <25%

0

Activity Does Not Occur

Enter only for admission assessment.

 

Stairs: Scores to ascend and descend 1 flight of stairs.

7

Independent 12-14 stairs

Does not need help or any modifications.

6

Modified Independent 12-14 stairs

Needs assistive device, equipment, pads, or medicine.

5

Supervision/Set-up 12-14 stairs

Needs cuing, coaxing or assistance to set up equipment.

4

Minimal Assist 12-14 stairs

Needs incidental assistance such as contact guard or steadying (performs >75% of task).

3

Moderate Assist 12-14 stairs

Needs physical assist for 50-74% of task.

2

Maximal Assist 4-6 Stairs

1 person Maximum physical assist (performs 25- 49% of task).

1

Total Assist
Less than 4 stairs

Less than 4 stairs and/or 2 person assist <25%

0

Activity Does Not Occur

Enter only for admission assessment.

 

Comprehension: Understands auditory or visual communication or both. Basic=pain, hunger etc. Complex=current events, finances etc.

7

Independent

Understand complex/abstract infor..

6

Modified Independent

Understands most situations readily or with mild difficulty. Does not need prompting can self-correct.

5

Stand by: Prompting

Understands directions and conversations about basic needs 90% or more.

4

Minimal Prompting

Understands directions and conversations about basic needs 75-89%

3

Moderate Prompting

Understands directions and conversations about basic needs 50-74% of the time.

2

Maximal Prompting

Understands directions and conversations about basic needs 25-49% of the time.

1

Total Assist

Understands basics less than 25% of the time. May understand simple common expressions.

 

Expression: Includes clear vocal and/or non-vocal expression of language.

7

Independent

Expresses complex/abstract ideas.

6

Modified Independent

Expresses complex ideas in most situations readily or with mild difficulty. Does not need prompting can self-correct.

5

Stand by: Prompting

Expresses basic daily needs and ideas 90% or more.

4

Minimal Prompting

Expresses basic daily needs and ideas 75-89%

3

Moderate Prompting

Expresses basic daily needs and ideas 50-74% of the time.

2

Maximal Prompting

Expresses basic daily needs and ideas 25-49% of the time. Uses only single words or gestures.

1

Total Assist

Expresses basic daily needs and ideas less than 25% of the time.

 

Social Interaction: Cooperates, gets along with staff, family & other patients.

7

Independent

Appropriate social interactions.

6

Modified Independent

Appropriate interactions most of the time. May require time and/or medication.

5

Stand by: Prompting

Need supervision under stressful situations. Interacts appropriately 90% or more.

4

Minimal Prompting

Interacts appropriately 75-89%

3

Moderate Prompting

Interacts appropriately 50-74% of the time.

2

Maximal Prompting

Interacts appropriately 25-49% of the time.

1

Total Assist

Interacts appropriately less than 25% of the time.

 

Problem solving: Participates in decisions regarding personal, financial and social.

7

Independent

Able to recognize, initiate & carries out steps to solve complex problems.

6

Modified Independent

Recognizes and resolves most problems. May need more time.

5

Stand by: Prompting

Requires assistance to solve less routine problems 10% of the time.

4

Minimal Prompting

Solves routine problems 75-89%

3

Moderate Prompting

Solves routine problems 50-74% of the time.

2

Maximal Prompting

Solves routine problems 25-49% of the time.

1

Total Assist

Solves routine problems less than 25% of the time. May require 1:1 assistance

 

Memory: Recognizes familiar faces, recalling routine & complex.

7

Independent

Able to recall, remember routines and complex requests.

6

Modified Independent

May use cues or aids to help recall.

5

Stand by: Prompting

Needs only cueing in stressful or new situations.

4

Minimal Prompting

Recalls people and routine 75-89%

3

Moderate Prompting

Recalls people and routine 50-74% of the time.

2

Maximal Prompting

Recalls people and routine 25-49% of the time.

1

Total Assist

Recalls people and routine less than 25% of the time. May require 1:1 assistance

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