spl rule training - dhs.state.or.us and assessment...3. meet the service priority level (spl)...

SPL Rule Training

Chapter 411, Division 015

February 2018

Presented by: Ben Sherman and Lisa Bouchell1

Agenda - Table of

Contents

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1) Purpose

i. Agencies

2) Eligibility for NF or Home & CBC Services

3) Current Limitations

4) Assessment

i. Buckley Bill Notice – 70B form

ii. Assessment Process

iii. Evaluation of ADL/IADL Needs

iv. Assessing IADL Needs

v. Natural Supports

5) Assessment Time Frame

Agenda - Table of

Contents

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6) Assessment Questions & Documentation

i. Questions

ii. Documentation

iii. CA/PS Comments

1) Tasks vs Phases

2) Assistance Types

3) Cognition and Behaviors

i. Definition of Cognition

ii. Assessment Time Frame in Cognition &

Behaviors

iii. MED Team: Mental & Emotional Disorders Team

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Agenda - Table of Contents

1) Self-Preservation

2) Decision Making

3) Ability to Make Self Understood

4) Challenging Behaviors

5) Activities of Daily Living (ADL)

6) Mobility

i. Considerations

ii. Consideration of Falls

7) Ambulation

i. Bedbound with Ambulation

Agenda - Table of

Contents

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16) Transfer

17) Eating

18) Elimination

i. Bladder Care

ii. Bowel Care

iii. Toileting

19) Bathing and Personal Hygiene

i. Bathing

ii. Personal Hygiene

20) Dressing and Grooming

i. Dressing

ii. Grooming

21) Assessing IADL Needs

22) Web Sites & Contact Info

PurposeOAR 411-015-0000

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Agencies

Aging and People with Disabilities (APD) serve:

Aging (65 and over)

Physically Disabled (under 65)

Oregon Health Authority (OHA) Health Services Division (HSD) serve:

Individuals with Mental Health (MH) diagnosis such as schizophrenia

Intellectual/Development Disabilities (I/DD) programs serve:

Individuals determined eligible by Oregon Intellectual/Developmental Disabilities Services (ODDS)

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The purpose of establishing priorities is to assist the Department in addressing these goals:

1. To enable persons eligible for & receiving services to remain in the least restrictive & least costly setting

2. To serve those who are the most functionally impaired & have little or no alternative service supports

3. To assure access to APD services

4. To assure services & settings are safe & adequate

5. To manage limited resources to enable the greatest # of persons to receive services based on a priority system.

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Eligibility for Nursing Facility

or

Medicaid Home and Community-Based

Services

OAR 411-015-0100

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Basic Eligibility Requirements:

1. Be age 18 years or older

2. Eligible for Medicaid under either the Oregon Supplemental Income

Program Medical (OSIPM) or Modified Adjusted Gross Income (MAGI)

MAGI recipients must also meet the following criteria:

Transfer of assets per OAR 461-140-0210 through 461-140-

0300; and

A notice for transfer of assets is required per OAR 461-175-

0310 if the individual is not eligible for this reason.

The equity value of the home per OAR 461-145-0220

A notice for being over resources is required per OAR 461-

175-0200 if the individual not eligible for this reason.

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3. Meet the Service Priority Level (SPL) currently served by the

Department per OAR 411-015-0010 and OAR 411-015-0015

SPL 1-13 for Home and Community Based Services

SPL 1-18 for Oregon Project Independent (OPI)

4. Extended Waiver Eligibility (EWE)

OAR 411-015-0000 through 411-015-0100

SPL 14-17 for all LTC cases and NF cases

5. Additional requirements apply for Spousal Pay. We also provide

authorization for individuals 17 and younger in nursing facility settings

only.

Basic Eligibility Requirements:continued

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1. FA in Mobility, Eating, Elimination, and

Cognition

2. FA in Mobility, Eating, and Cognition

3. FA in Mobility, or Cognition, or Eating

4. FA with Elimination

5. SA with Mobility, A with Elimination, and A

with Eating

6. SA with Mobility and A with Eating

7. SA with Mobility and A with Eating

8. MA with Mobility and A with Eating and

Elimination

9. A with Eating and Elimination

10.SA with Mobility

11.MA with Mobility and A with Elimination

12.MA with Mobility and A with Eating

13.A with Elimination

SPL Levels

14.A with Eating

15.MA with Mobility

16.FA in Bathing or Dressing

17.A in Bathing or Dressing

18.Independent in above levels, however

has complex medical or medication

needs.

99.Does not meet any of the above (99 is

not an SPL)

FA= Full Assistance, SA=Substantial Assistance,

MA=Minimal Assistance, A=Assistance

Current LimitationsOAR 411-015-0015

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Age 65 and older:

Current Limitations

All populations may be served in home or community based services.

MH and DD driven needs may not be served in a nursing facility unless

identified in the PASSRR process per OAR 411-070-0043

Age 18-64 and Nursing Facility Stay:

MH and DD driven needs are not eligible unless identified through the PASRR

process per OAR 411-070-0043.

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Current LimitationsContinued………..

Age 18-64 with Home and Community Based Care:

Individuals with diagnosed mental, emotional, or substance abuse related disorder are

not eligible unless:

The individual meets SPL criteria based upon a medical (non-psychiatric) or physical

disability; and

The individual provides supporting documentation (approved by the Department)

demonstrating that his or her need for services is based on the medical, non-psychiatric

diagnosis, or physical disability.

Individuals determined eligible for Developmental Disability Services may not be served

by Aging and People w/Disabilities.

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Cost of Services for OSIPM

Individuals may have to pay for in-home services if their income is above the SSI standard

plus $500

Individuals may have to pay for community based or nursing facility services if they are

not a SSI recipient.

Other rules apply. See OAR 461-160-0610 and OAR 461-160-0620.

Assessment

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70B Buckley Bill Notice for

Reassessments

Buckley Bill Notice

OAR 411-015-0008

(1)(g)

(A) Individuals must be sent a notice of the need for re-assessment a minimum of 14

days in advance.

(B) Consumer requested re-assessments based on a change in the consumer's condition

or service needs are exempt from the 14-day advance notice requirement.

(1)(h) An individual may request the presence of natural supports at any assessment.

Automatic system generated notices are sent mid-month, the month before the CAPS service

benefit category end date.

Case Managers will mail a manual notice to consumers when conducting an early

reassessment prior to the automatic notice date (4th business day prior to the end of the

month) if the consumer did not request the assessment because of a change in condition

or service need.

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Buckley Bill Notice continued……

General notice information:

Individual must receive an automatic or manually generated 70B notice at least 14 days prior to the assessment date

Administrative Hearings – without a 70B Buckley Bill Notice, the Department may not be upheld in a hearing

70B notice is not required if the consumer requested a reassessment based on a change in the consumer’s condition or service needs.

Transmittals:

PT-10-039 - Update on the Buckley Bill Notice Requirements and the View Direct Reports for assessments due, past due and coming due

PT-06-024 – Assessments

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The Assessment Process

Identifies an individual's ability to perform activities of daily living and

instrumental activities of daily living;

Determines an individual's ability to address health and safety

concerns; and

Includes an individual's preferences to meet service needs.

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AssessmentOAR 411-015-0008

1(e) CAPS assessments must be conducted:

At least annually; or

When requested by an individual; or

When there is a change in the individual’s care needs

1(f) Initial assessment must be conducted face to face in an individual’s home or care setting

1(g) All reassessments must be conducted face to face in an individual’s home or care setting, unless there is a compelling reason to meet elsewhere and the individual requests an alternative location.

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Evaluation of ADL/IADL OAR 411-015-0006(2) & OAR 411-015-0007(2)

Must be based on:

The individual’s ABILITIES rather than the services provided

and

How the individual functioned during the assessment time frame

and

Evidence of the ACTUAL or PREDICTED need for assistance of another

person.

Do NOT consider based on possible or preventative needs

NOTE: If an individual does not engage in an ADL/IADL or the task of an

ADL/IADL, the individual is assessed as “Independent” unless he/she is

considered confined to a bed.23

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Natural Supports

Paid services are not intended to replace any natural support.

Natural supports are:

Willing to provide assistance without pay.

Able to provide the needed assistance; have the knowledge, skills and

ability.

Please Consider:We can’t force someone to be a natural support.

Determine what the unmet needs are of the individual.

Why does the natural support need to get paid now?

Is the natural support willing to voluntarily provide ongoing IADL care such as shopping, meal prep, and housekeeping (especially if they live together and/or are related)?

Don’t voluntarily ask a natural support if they would like to get paid!

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Assessment Time FrameOAR 411-015-0008(1)(d)

Must include all three:

Evaluation of how the individual functioned up to 30 days prior to the assessment date;

and

Evaluation is with consideration of how the individual is likely to function up to 30 days

following the assessment date;

and

In order to be eligible, an individual must demonstrate the need for assistance of

another person within the 30 day look back and forward periods and expect the need

will be on-going beyond the assessment time frame.

Note: The assessment time frame may be expanded for Cognition and Behaviors if

specific criteria is met as described in OAR 411-015-0006 (rule criteria is covered in the

Cognition section).

AssessmentOAR 411-015-0008

Using the assessment time frame limitations, assess the:

ABILITY to perform ADL and IADL tasks

ABILITY to address health and safety concerns

PREFERENCES with consideration of meeting his/her health

and safety needs

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Assessment Questions and Documentation

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Ask Open-Ended Questions

Avoid questions that lead to “yes” or “no” responses

Ask open-ended questions

Who? Why?

What? When?

Where? How?

Use Terminology the Consumer Can Understand

Don’t Ask – How’s your mobility?

Try – Can you show me how you walk from the kitchen to the living room?

Don’t Ask – Can you transfer out of bed?

Try – Why do you wait for your HCW to arrive before you get out of bed?

Don’t Ask – What is your cognition like?

Try – What are those sticky notes on your calendar used for?28

Examples of open-ended questions

1. What do you need in the way of help right now?

2. Let’s talk about things you are able to and the things you cannot do.

3. You say that you’re not able to (cook/bathe/etc….). How have you been

managing your (meals/bathing/etc….)?

4. I’m not certain I understand…… Can you give me an example?

5. Help me understand…..

6. What do you mean by____________?

7. Would you tell me more about……?

8. Would you explain that to me in more detail?

9. When you say_____________, what do you mean?

10. How are you doing today?

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Ask for Details

Quantify the need for assistance (Assessment period?)

Once a day

Twice a day

A year ago

Round the clock

Ask questions using words such as, where, when and why

Examples

Where did this happen?

When did this happen?

Why did this happen?

Don’t make any assumptions of ability or lack of ability

Keep it positive…. Bring it back to strengths, preferences, goals and abilities

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Once a week

Once a month

Everyday

Every other day

Documentation

Why is there a need?

It may not be necessary to describe this in each ADL/IADL, however the

“why” needs to be clear in the assessment, synopsis, diagnosis tab, etc.

How frequent is the need?

Be specific. Words or phrases, such as, ‘occasionally’, ‘at times’, ‘only

on bad days’, are not specific enough.

How is the assistance being received?

Try to describe what the provider is doing instead of just stating the

assist type (hands on assistance, stand-by assistance, cueing, etc.).

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Comments should be about what the individual needs, not what the provider is doing

for the person.

CA/PS Comments

Clarify information about the specific need being assessed. Explain

or justify the need level chosen.

May apply to more than one screen, i.e. Medications section or

Cognition section.

Are used to clarify how the assessor came to his/her decision on a

specific ADL/IADL.

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CA/PS Synopsis Captures additional information about the assessment and consumer.

Quick summary of service needs or plan.

Other issues that may affect the client’s living situation, such as tobacco use,

alcohol use, other household members or pets.

Information to support Exceptional Rate requests.

Fully utilize all areas in the CA/PS assessment, including the Client Details

component, such as the Diagnosis, Strengths/Preferences, Risks, Goals,

Equipment, Personal Elements & Scales/Tools.

Used for documenting the following:

General statement of age, health, physical & mental status.

Recent events that might affect the individual’s functioning.

Important interests, motivators, family or other significant supports.

Significant changes in any of the above.

A summary of major issues, individual preferences or needs (may reference other

sections if more information is there).33

Activities, Components and Tasks

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Activities are comprised of components

Components are comprised of tasks

Tasks are the steps required to complete an activity or component

Activities

Activities are Activities of Daily Living

Activities of Daily Living are the actions that individuals do on a daily basis. Without assistance when needed, the outcome may result in an individual requiring an institutional level of care (nursing facility) to ensure or maintain his/her health and safety.

For Example: Each of these are the Activities listed in the OAR:

1. Mobility

2. Eating

3. Elimination

4. Cognition

5. Bathing and Personal Hygiene

6. Dressing and Grooming

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Components

Components make up Activities of Daily Living

Components are ‘sub-sections’ of broader Activities such as Cognition,

Mobility or Elimination.

The combination of assistance levels for each component is used to

determine the need level for each Activity.

For Example: The Activity of Elimination is currently comprised of three

components:

1. Bladder Care

2. Bowel Care

3. Toileting

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Tasks

Tasks are the steps required to complete an activity or

component

Tasks means part of an activity of daily living

For Example: These are the tasks listed in the OAR definition of

Toileting:

1. Cleanse after elimination,

2. Change soiled incontinence supplies or soiled clothing,

3. Adjust clothing to enable elimination,

4. Cue to prevent incontinence

The allowable tasks are defined in rule for each activity or

component

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Understanding a Full Assist

Per OAR definitions:

A full assist means the consumer requires the assistance every time an

activity is attempted, and without that assistance the activity would not

be completed.

Assessing for Full Assist:

When assessing an individual consider each task listed in the definition of

the activity.

If the individual is able to complete any of the activities some of the time,

the consumer should be assessed as an assist, not a full assist.

If the individual requires assistance to complete each task every time the

task is attempted, the individual meets the criteria for a full assist.

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Example:

An individual requires another person to cue him/her constantly in

order to prevent incontinence;

and requires assistance with cleansing after elimination every time;

but he/she is able to manage his/her own incontinence supplies

and adjust his/her clothing

This individual would not meet the criteria for a full assist.

Understanding a Full Assist

Assistance TypesUsed to Assess ADLs

(OAR-Chapter 411, Division 15)

Created by: Rob Jennings, case manager

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8 Assistance

Types

MonitoringReassurance

Hands-OnSet-Up

Assistance Types

Redirection

Stand-By Cueing

Support

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Assistance Types Definitions

Cueing means giving verbal or visual clues during the activity to help the

individual complete activities without hands-on assistance. Note: Cueing is not reminding. The individual must require verbal prompting

throughout the activity/component/task in order for it to be completed.

Hands-on means a person physically performs all or parts of an activity because

the individual is unable to do so. Note: Hands-on assistance is beyond guiding an individual by taking his/her arm or

placing a hand at the small of the back. Without the hands-on assistance of another

person the activity/component/task will not be completed.

Monitoring means a person must observe the individual to determine if

intervention is needed. Note: In order to meet the definition of monitoring, the provider must be able to

immediately respond to an individual’s need to complete an

activity/task/component, if necessary.

Reassurance means to offer encouragement and support.

Note: Be sure to document how the reassurance is needed to protect the

individuals health and safety.

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Assistance Types Definitionscontinued………

Redirection means to divert the individual to a more appropriate

activity. Note: Determine if the individual understands the consequences of his/her

actions & consider how the need for redirection impacts the individual’s

health and safety.

Set-up means getting personal effects, supplies, or equipment ready so

that an individual can perform an activity. Note: This assist type is allowed only in the activity of Eating when setting

up an individual’s feeding tube or nutritional IV.

Stand-by means a person must be at the side of an individual, ready to

step in and take over the task because the individual is unable to

complete the task independently.

Support means to enhance the environment to enable the individual to

be as independent as possible. (like a shower/bath bench for bathing)

Cognition

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Cognition refers to the individual’s

mental functional ability to ensure

their health, safety and basic needs are met.

Self Preservation

Decision Making

Ability to Make Self

Understood

Challenging Behaviors

Cognition

Cognition

Cognition refers to how the brain functions:

Cognition includes:

1. Self-Preservation

2. Decision Making

3. Ability to Make Self Understood

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Challenging Behaviors include:

1. Verbally aggressive 411-015-0005

(41)

2. Physically aggressive 411-015-0005

(33)

3. Socially Inappropriate or Disruptive

411-015-0005 (36)

Cognitioncontinued……….

Considerations:

1. Cognition refers to how the brain functions and generally speaking, multiple components will be impacted when there is a cognitive impairment

2. Cognition is about the inability of the person to use information appropriately

3. Behavioral symptoms are likely the result of deficits in cognition

4. Assessed need in Cognition is NOT about poor choices

5. The assessment of Cognition begins when contact occurs with the individual. Information will be picked up throughout the conversation, through observation of the surroundings, listening to the individual and other participants and using other senses.

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Definition of CognitionOAR 411-015-0006 (3)

Cognition refers to how the individual is able to use

information, make decisions, and ensure that his/her daily

needs are met. Note: This means that when assessing an individual’s cognitive

abilities & limitations, it is important to consider how his/her

health and safety is impacted, how the need is met, and if the

individual understands the potential risks or consequences of

his/her actions.

Cognition is comprised of four components;

Self-Preservation

Decision Making

Ability to Make Self Understood

Challenging Behaviors

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Definition of Cognition cont.

OAR 411-015-0006 (3)

For purposes of this rule, Assist levels are defined within each of the

four components. Individuals assessed as minimal assist may receive

Cognition hours as defined in OAR 411-030.

Note: Hours (411-030) are generally assigned based on the need level of each

component rather than the overarching activity. This is why allowing for the

authorization of hours to individuals who only require a minimal level of

assistance is defined in rule.

An individual's ability to cognitively manage his/her daily needs, as

defined in rule, is assessed by how the individual is able to function

without the assistance of another person or the supports of a structured

living setting.

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411-015-0006 (3) (b)

An individual is assessed based upon his/her functioning while

taking prescribed medications. Assess the consumer’s understanding

of the risks & consequences of consciously refusing to take his/her

medication rather than assessing the impact of his/her decisions

related to taking the medication.


OAR 411-015-0006 (3)

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What does this mean?

When assessing cognition, a helpful indicator may be the impact of not

properly managing his/her medication.

1. Is the individual aware of the medication and the reason for it?a) This is an indicator of an individual’s abilities in self-preservation as it will

reflect whether the individual understands his/her basic health and safety

needs and how to meet them.

b) A consumer may not be able to name every medication, but an individual

who is cognitively intact should have an idea of how many medications

he/she is taking and why.

c) An individual who is able to provide a reasonable answer to this question is

showing an ability to reason and understand the connection between a

choice and an outcome.


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2. Is the individual able to manage taking his/her day to day

medications?a) This is an indicator of an individual’s abilities in decision

making as it will reflect whether he/she has the cognitive

ability to sequence information and execute steps.


Note: Medication management is one example of many tasks or activities that may

help to explain an individuals cognitive state, abilities, or limitations. In addition,

individuals who are cognitively impaired will likely present with other examples to

help explain affirm his/her cognitive state, abilities or limitations.

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Clarification

We do not assess the individual’s decision making as a result of not taking

his/her prescribed medications. A consumer who is prescribed

antipsychotics should be assessed on that medication; his/her cognitive

ability to function cannot be accurately assessed if the individual is not

taking his/her medication.


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Definition of Cognition

Medication is not considered a support:

If the individual does not currently take medication, assess as he/she presents himself/herself during the assessment.

If the individual is currently using medication, assess as he/she presents himself/herself during the assessment.

If the person is now taking medication, but wasn’t prior to the assessment, do not expand the assessment time frame to assess the individual back to a time when he/she was taking medications.

Without supports means the individual lacks the assistance of another person, a care setting and staff, or an alternative service resource.

Lack of medication or medication management is not considered a “support” when evaluating cognition and/or behaviors.

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411-015-0006 (3) (c)

The assessment time frame in OAR 411-015-0008 shall be expanded when assessing cognition. A documented history demonstrating the need for assistance that occurred more than 30 days prior to the assessment date shall be considered if the need would likely re-occur without existing supports.


When considering an individual’s cognitive abilities, we are able to consider events that happened in the individual’s past - more than 30 days. This is important because an individual may have supports & structure built into his/her routine that disguise cognitive limitations. Documenting historical information regarding the individual’s care needs will ensure health & safety needs can be met.

For all other ADL’s and IADL’s the assessment only considers the individual’s needs that have occurred in the previous 30 days and those needs that are likely to occur during the next 30 days based on the individual’s actual needs.

Cognition – Assessment Time Frame

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411-015-0006 (3) (d)

An individual under age 65, with cognition needs driven by a mental illness, emotional disorder or substance abuse disorders, does not meet the criteria for service eligibility per OAR 411-015-0015.


Individuals under the age of 65 with needs driven by mental illness, emotional disorder or substance abuse disorders should be served by the Oregon Health Authority’s (OHA) Health Services Division (HSD) – formally known as Addictions and Mental Health (AMH)

Note: APD can serve individuals who have mental illness, emotional disorder or substance abuse disorders but it cannot be the sole factor driving eligibility.

Individuals with mental illness, emotional disorder or substance abuse disorders should be referred to the local Community Mental Health Provider (CMHP)

Note: Individuals with intellectual or developmental disabilities, under the age of 65, should be referred to the local Community Developmental Disability Provider (CDDP) or Brokerage of the Office of Developmental Disabilities (ODDS)

Definition of Cognition

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Full Assist

Full assistance in at least one of the four components of cognition;

Substantial Assistance in at least two of the four components to meet the criteria for full assistance in cognition

Assist

Substantial assistance in one of the four components of cognition; OR

Assistance in at least three of the four components of cognition; OR

Minimal assistance in at least two of the four components of cognition

Cognition as an Eligibility Driver

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1• Medical emergency at home

2

• Call 911

• Ask for help

3

• Explain the problem

• Give address and phone #

The inability to sequence information may occur in Cognition

A person with no cognitive deficits understands the sequence of

events to problem solve in an emergency.

For example:

MED:

Mental & Emotional Disorders Program

Under 65 years of age are not served by APD unless the individual:

OAR 411-015-0015(5)

Has a medical non-psychiatric diagnosis or physical disability; and

Has a need for services based on a medical, non-psychiatric diagnosis,

or physical disability;

and

Provides supporting documentation demonstrating that the need for

services is based on the medical, non-psychiatric diagnosis, or

physical disability.

The Department authorizes documentation sources through

approved and published policy transmittals.

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"Self-Preservation” means the individual’s actions or behaviors that

reflect an understanding of his/her health and safety needs & how to

meet those needs.

Self- preservation refers to the individual’s ability to recognize and take

action in a changing environment or a potentially harmful situation.

Self-preservation includes the assistance types of cueing, hands-on,

monitoring, reassurance, redirection or support unless otherwise indicated

in the assist level.

Self-preservation does not include the individual engaging in acts that

may be risky or life threatening when the individual understands the

potential consequences of his/her actions.

Definition of Self Preservation

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Self-Preservation includes tasks such as, but not limited to;

Being oriented to the community and surroundings such that the

individual can find his/her way home or to the care setting;

Understanding how to safely use appliances;

Understanding how to take prescribed medications;

Understanding how to protect himself/herself from abuse, neglect or

exploitation; or

Understanding how to meet basic health and safety needs.

For each assist level, individuals must have a documented history of

actions or behaviors demonstrating that they need assistance with

ensuring their health and safety.

Definition of Self Preservation

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Minimal Assist: The individual needs assistance to ensure he/she is able to

meet basic health and safety needs.

Example: Mr. Baker goes to the doctor once per month. When this occurs,

he becomes easily confused. His caregiver must ensure that he gets to the

car, arrives at the doctor’s office and comes home. In the past, without

assistance, Mr. Baker has gotten lost and had to be brought back home by

law enforcement.

Assistance Levels of Self Preservation

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Substantial Assist: The individual requires assistance because he/she is

unable to act on the need for self preservation nor understand the need

for self-preservation.

Example: Gladys tries to cook on the gas stove; turns the knob for the

burner but forgets to light the burner. In the past, she has been

hospitalized because of carbon monoxide poisoning and also burned

herself on the burner, forgetting it was just turned off. She tries to use

the stove daily so the caregiver must monitor her at meal time every day.

Additionally, if Gladys goes just a few homes away from the yard, she

cannot find her way home. In the past, she has tried to elope from her

home so the caregiver redirect Gladys whenever she tries to leave her

home which is at least daily.

Assistance Levels of Self Preservation

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Assistance Levels of Self Preservationcontinued…

Full Assist: The individual requires assistance to ensure that he/she

can meet basic health and safety needs throughout each day.

FA only includes Cueing, Hands On, Reassurance, and Redirection.

Example: Mr. Jones has advanced Dementia and is living in a memory

care facility. He requires supports all day, every day because of the

level of dementia. He no longer understands basic life sustaining

activities such as eating, drinking, bathing and elimination. The

caregiver must provide hands on assistance and cueing during

activities/tasks throughout the day. Due to the level of care required

to ensure his health and safety throughout the day, Mr. Jones cannot

be left alone for even short periods of time during the day.

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Definition of Decision Making

Decision-making means an individual’s ability to make everyday decisions

about ADLs, IADLs, and the tasks that comprise those activities. Decision-

making includes the assistance types of cueing, hands-on, monitoring,

redirection or support unless otherwise indicated in the assist level.

An individual needing assistance demonstrates:

Is unable to make decisions

Needs assistance in understanding how to accomplish the tasks

necessary to complete a decision, or

Does not understand the risks or consequences of his/her decisions.

Decision Making is different than Self-Preservation. In this component, an

individual may know that he/she needs to eat but is unable think through the

steps to get food.

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Assistance Levels of Decision Making

Minimal Assist: The individual requires assistance at least one day each

month with decision-making. The need may be event specific.

Example: Mr. Smith cannot follow through on making decisions. He has

CVD and sees his doctor monthly. He knows that he needs to go to the

doctor but he cannot remember the steps it takes to call the doctor and

schedule the appointment. His caregiver has to schedule the

appointment, keep the appointment reminder visible, cue him while

getting ready for the appointment and help him to get to there. Without

support, Mr. Smith misses his critical appointments.

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Assistance Levels of Decision Makingcontinued…

Substantial Assist: The individual requires assistance in decision-

making and completion of ADL and IADL tasks at least daily.

Example: Mrs. Jones cannot make decisions independently. She must

be cued through each decision. For example, Mrs. Jones knows that she

is hungry but cannot remember how to get to the kitchen, take out

food or prepare it. In the past, she was hospitalized because she did

not eat. Additionally, she forgets the steps necessary to manage her

medications. Her caregiver must cue, monitor and provide support

throughout common ADL and IADL tasks.

70

Assistance Levels of Decision Makingcontinued…

Full Assist: The individual requires assistance throughout each day in

decision making. The individual may not be left alone without risk of

harm to himself/herself or others.

FA only includes Cueing, Hands-on Assistance, Redirection

Example: Luther has advance dementia and cannot make decisions

independently. The caregiver must cue, support and provide hands-on

assistance throughout the entire day to complete all ADLs. He has a

tendency to discuss topic that are not part of the ongoing conversation.

Due to the level of care Luther requires, he cannot be left alone. Prior

to receiving services, Luther was found dazed and confused, wandering

aimlessly in the community.

71

Definition of Ability to Make Self

Understood

Ability to Make Self-Understood means the individual’s cognitive ability to

communicate or express needs, opinions, or urgent problems, whether in speech,

writing, sign language, body language, symbols, pictures, or a combination of these

including the use of assistive technology.

An individual with a cognitive impairment in this component demonstrates an inability

to express himself/herself clearly to the point his/her needs cannot be met

independently.

The assistance types include: cueing, monitoring, reassurance, redirection or support

unless otherwise indicated in the assist level.

Ability to Make Self-Understood does not include the need for assistance due to

language barriers or physical limitations to communicate.

72

Assistance Levels of Ability to Make

Self Understood

Minimal Assist: The individual requires assistance in finding the right

words or in finishing his/her thoughts to ensure health and safety needs

are met.

Example: Alice is diagnosed with Alzheimer's. She is unable to tell her

caregiver when she is hungry or when she needs her pain medications.

During a home visit, the CM observed Alice struggling to find the words to

explain to her caregiver that she was thirsty. The caregiver must try to

interpret what the consumer needs or cue the consumer with appropriate

words or expressions.

73


Self Understoodcontinued…

Substantial Assist: The individual requires assistance to communicate his/her

health and safety needs at least daily.

Example: Steven is unable to express his needs, including asking for food or

water. He can be left alone for short periods of time without endangering his

safety. The caregiver interprets sounds and facial expressions to determine if

Steven needs something. At a visit, the CM saw the caregiver provide

reassurance while Steven tried to express himself.

74


Self Understoodcontinued…

Full Assist: The individual requires assistance throughout each day to

communicate and is rarely or never understood and cannot be left alone.

Full assist includes hands on assistance.

Example: Mildred cannot be left alone because she cannot tell anyone she is in

pain or if her limbs are in an uncomfortable position. At a visit, the CM saw

Mildred become agitated and cry out wordlessly when the caregiver left the

room. The caregiver must help the consumer through hands-on assistance to

help the consumer communicate non-verbally.

75

Behaviors

76

Challenging Behaviors Definition

Challenging Behaviors means the individual exhibits behaviors that

negatively impact his/her own health or safety or the health and safety

of others.

An individual who requires assistance with challenging behaviors does

not understand the impact or outcome of his/her decisions or actions.

Challenging behaviors include, but are not limited to, those behaviors

that are verbally or physically aggressive and socially inappropriate or

disruptive. Assessments review the individual’s needs for the assistance

types of cueing, hands-on, monitoring or redirection unless otherwise

indicated in the assist level.

Challenging behaviors does not include behaviors when the individual

understands the risks and consequences of his/her actions.

77

Assistance Levels of Challenging Behaviors

Minimal Assist: The individual requires assistance dealing with a

behavior that may negatively impact his/her health or safety or the

health and safety of others.

The individual sometimes displays challenging behaviors, but can be

distracted and is able to self-regulate behaviors with reassurance or

cueing.

MA includes reassurance assistance.

Example: George has Huntington’s Disease. He becomes agitated and is

disruptive to others. He has a history of shoving other residents in MCC.

The caregiver must monitor his behavior while around others. He can

be redirected and is able to “get back in control“ with reassurance or

cueing. This usually occurs three days per week.

78

Assistance Levels of Challenging Behaviorscontinued…

Substantial Assist: The individual displays challenging behaviors and

assistance is needed because the individual is unable to self-regulate the

behaviors and does not understand the consequences of his/her behaviors.

Example: Beverly has significant challenging behaviors. She strikes out at

others at least daily. She has been hospitalized because she hurt herself

while in a behavioral outburst. Beverly is unable to self-regulate her

behaviors and does not understand the consequences of her actions. The

caregiver must provide reassurance, redirection, monitoring, cueing and

hands-on support, when needed.

79

Assistance Levels of Challenging Behaviorscontinued…

Full Assist: The individual displays challenging behaviors that require

additional support to prevent significant harm to himself/herself or to others.

Full Assistance does not include monitoring.

Example: Mr. Garcia has a significant TBI and is no longer able to manage his

behaviors. Every day he must have one to one support to prevent unprovoked

lashing out at other people. The caregiver provides redirection, reassurance

and hands-on support. Mr. Garcia can never be left alone because of the

significant danger to others.

80

Activities of Daily Living

(ADL)

Definition of Activities of Daily Living

(ADL)OAR 411-015-0006

(1) "Activities of Daily Living (ADL)" mean those personal functional

activities required by an individual for continued well-being which are

essential for health and safety. Activities include eating, dressing,

grooming, bathing, personal hygiene, mobility (ambulation and transfer),

elimination (toileting, bowel and bladder management), and cognition and

behaviors.

81

NOTE: If an individual does not engage in ADL/IADL or the task of

an ADL/IADL, the individual is assessed as “Independent” unless

he/she is considered confined to a bed or wheelchair.

82

(2) Evaluation of the individual's need for assistance in Activities of Daily

Living is based on:

(a) The individual's abilities rather than the services provided;

(b) How the individual functioned during the 30 days prior to the

assessment date, with consideration of how the person is likely to

function in the 30 days following the assessment date; and

(c) Evidence of the actual or predicted need for assistance of another

person within the assessment time frame and it must not be based on

possible or preventative needs.

(3) "Independent" means the individual does not meet the definition of

"Assist" or "Full Assist" for each Activity of Daily Living as defined in this

rule.

Definition of Activities of Daily Living

(ADL)OAR 411-015-0006

MobilityAmbulation and Transfers

83

MobilityOAR 411-015-0006(9)

Considerations:

1. Is the need for assistance inside the home or care setting or is it outside?

2. Assistance Types include Hands-on only

Does not include cueing, reminding, stand-by, set-up, monitoring, etc….

3. How is the person’s mobility using assistive devices, such as:

Walker

Wheelchair

Walls & furniture

Transfer board

4. Do not assess for prevention

Assess ability, not “what if” the person needs assistance to perform the task.

84

Mobility continued….

Considerations:

5. Do not include exercise, ROM or physical therapy

6. Does not include getting in & out of a motor vehicle

7. Does not include getting in & out of a bathtub/shower

8. Where is “inside” the Home or Care Setting?

Inside the entrance to the client’s home or apartment unit or inside the care

setting

Courtyards, balconies, stairs or hallways exterior to the doorway of the home

are not considered inside.

The threshold between the outside and the inside of the home or care setting

is “outside”

Inside another person’s home, such as a neighbor’s home, is not considered

inside the home or care setting

85

Mobility continued….

Consideration of Falls:

9. Falls are considered for individuals with or resulting in mobility difficulties only.

To meet the criteria of a “history of falls”, the fall(s) need to result in on-going mobility problem or the resulting fall has created a mobility problem.

Do not consider falls which resulted in a negative physical health consequence unless the fall has now caused problem with mobility. or

The fall resulted in a need for mobility assistance following the fall. Individuals with mobility difficulties, who managed to rise without assistance ,due to the person having no other options (such as unavailable assistance) is considered in mobility. This person may meet the assist or full assist need level criteria.

86

87

AmbulationOAR 411-015-0006(7)(a)

Ambulation means the activity of moving around both inside and outside the

home or care setting. This includes assessing the individual’s needs after

taking into consideration their level of independence while using

assistive devices such as walkers, canes, crutches, manual and electric

wheelchairs, and motorized scooters.

Ambulation does not include exercise or physical therapy.

88

Ambulation continued….

Minimal Assist:

Even with assistive devices, the individual requires hands-on assistance

from another person to ambulate outside the home or care setting at

least once each week, totaling four days per month. The individual

requires hands-on assistance from another person to ambulate inside the

home or care setting less than one day each week.

This means the individual:

Can get around inside the home or care setting with assistance less

than weekly

and

Requires hands-on assistance outside the home or care setting at least

once each week

89


Substantial Assist:

Even with assistive devices the individual requires hands-onassistance from another person to ambulate inside the home or care setting at least one day each week totaling four days per month.


Must need hands-on assistance inside the home or care

setting sometimes during the assessment time frame, but

not always. and

May need assistance outside the home or care setting, but

not required.

90


Full Assist:

Even with assistive devices, the individual requires hands-onassistance from another person to ambulate every time the activity is attempted. Individuals who are confined to bed are a full assist in ambulation.


Always needs hands-on assistance inside the home or care

setting for ALL TASKS of ambulation

and

Most likely needs assistance outside the home or care

setting, but outside is not required

Independent means the individual does not meet the definition of “assist" or “full

assist" when assessing ADLs as described in OAR 411-015-0006 or when

assessing IADLs as described in OAR 411-015-0007.


91

Ambulationcontinued….

Considerations:

1. Comments need to substantiate the need level

For example: If a person uses an electric wheelchair, explain in

comments why, when and how the individual needs assistance

2. Question whether a client can physically perform the task

3. Question what happens if a provider is not available to assist

4. Make determinations based on the ability to ambulate, not on hesitation due

to fear

5. The task of positioning a walker or other assistive device is not considered in

ambulation; this is considered set up and set-up is not a valid assistance type

for ambulation.

92

Bedbound with Ambulation

A truly bedbound person is Full Assist

A caregiver acts as an extension of the individual when the caregiver ambulates

for the purpose of taking care of the individuals needs.

For example: Walk to the dresser to get the individual’s clothes or get

the person a glass of water.

In-home service planning: Hours may be reduced if the individual does not need

the maximum assessed hours.

93

94

TransferOAR 411-015-0006(7)(b)

Transfer means the tasks of moving to or from a chair, bed, toileting area, or

wheelchair using assistive devices, if needed. This includes repositioning for

individuals confined to bed or wheelchair. This assistance must be required

because of the individual's physical limitations, not their physical location or

personal preference.

95

Transfer continued….

Assist:

Even with assistive devices, the individual requires hands-on assistance with a

task of transferring inside the home or care setting at least one day each

week totaling at least four days per month.


Requires hands-on assistance at least one time each week, totaling

four different days during the month. The assistance doesn’t need to

be all day, each of these four days.

Is able to transfer on their own at times

Clearly document in CA/PS Comments:

What are the steps in the tasks being completed in order to transfer

Explain why the consumer only requires help some of the time

96

Transfer continued….

Full Assist:

The individual requires hands-on assistance from another person every

time the activity is attempted, even with assistive devices.


Always requires hands-on assistance throughout all tasks of transferring.

Also consider assistance when repositioning individuals confined to bed or wheelchair.

Transfercontinued….

Special Considerations of Full Assist and Assist:

Full Assist: a person that always requires assistance throughout the actual task of transferring, but is able to:

Sit up; or

Sit up and move legs to side of bed; or

Bear weight; or

Bear weight and pivot

Assist: a person does not require assistance throughout the transfer, but requires and needs assistance:

To get legs in/out of bed; or

To steady them once in the standing position

For someone to hold on or steady an assistive device in order to transfer

97


assist" when assessing ADLs as described in OAR 411-015-0006 or when assessing

IADLs as described in OAR 411-015-0007.

Transfercontinued….

98

Eating

99

100

EatingOAR 411-015-0006(5)

Eating means the tasks of eating, feeding, nutritional IV set up, or feeding

tube set-up by another person and may include using assistive devices.

Eatingcontinued….

Considerations:

1. Should the need be assessed in Eating or Meal Prep?

a. Cutting up food is assessed in Meal Prep, NOT Eating.

2. Evaluate the person’s ability and limitations for self feeding.

3. Can the person be left alone due to the possibility of choking or aspiration?

4. What is the individual’s ability to eat with or without assistive devices?

5. Does the individual need assistance using special utensils?

6. Does the individual need assistance getting a special utensil applied?

7. Assistance types do not include monitoring, reassurance, stand-by or reminding.

a. Reminding is not the same as Cueing.

8. When choking, is the individual able to clear themselves or does another person

need to assist the individual when there is a choking event?

101

102

Assist: When eating, the individual requires another person to be within sight and immediately

available to actively provide hands-on assistance with feeding, special utensils, or

immediate hands-on assistance to address choking, or cueing during the act of eating

at least one time each week totaling four days per month during the assessment

timeframe. Be sure to document the reason the consumer needs assistance one day

per week (or in frequently throughout the week).

This means the individual: Requires hands-on assistance for feeding or

Requires hands-on assistance using special utensils or

Requires cueing during the act of eating to complete

the activity without hands-on assistance or

Requires another person to be within sight and immediately available to

actively provide immediate hands-on assistance to address choking

Eatingcontinued….

103

Full Assist:

When eating, the individual always requires one-on-one assistance through all

tasks of the activity for direct feeding, constant cueing to prevent choking or

aspiration every time the activity is attempted.

This means the individual always requires one-on-one assistance for all tasks

of:

Direct feeding or

Constant cueing or

To prevent choking or aspiration or

Nutritional IV or

Feeding tube

Eatingcontinued….

Independent means the individual does not meet the definition of “assist"

or “full assist" when assessing ADLs as described in OAR 411-015-0006

or when assessing IADLs as described in OAR 411-015-0007.

Eatingcontinued….

104

EliminationBladder Bowel Toileting

105

Elimination is comprised of three components, which are bladder, bowel,

and toileting.

To be considered assist, the individual must require assistance in at

least one of the three components inside the home or care setting.

To be considered full assist the individual must require full assistance

in any of the three components inside the home or care setting.

NOTE: Dialysis care needs are not assessed as part of elimination.

106

Definition of BladderOAR 411-015-0006(6)(a)

Bladder care means the tasks of catheter care and ostomy care.

Elimination: Bladder Care

Bladder care means the tasks of catheter care and ostomy

care.

Do NOT consider tasks of toileting schedule, monitoring

for infection, and changing incontinence supplies.

Assist

Requires HANDS-ON assistance to complete a task of bladder care

at least one day each week totaling four days per month.

Full Assist

ALWAYS requires HANDS-ON assistance to manage all tasks of

bladder care every time the activity is attempted.

107

108

Definition of BowelOAR 411-015-0006(6)(b)

Bowel means the tasks of digital stimulation, suppository insertion, ostomy care,

and enemas.

Elimination: Bowel Care

The activity of Bowel care is limited to suppository

insertion, digital stimulation, ostomy care and enemas

when the care is required to clear bowels.

Toileting schedule or changing incontinence supplies are

no longer considered a task of bowel care.

An individual who does not have a need for one of the

tasks is considered to be independent in the area of bowel

care.

109

Bowel - Assessment Considerations

Suppository insertion:

To be “Full Assist” with suppository insertion as the only bowel care task:

The need must be every time a bowel movement occurs during the assessment time frame

and

The person can only have a bowel movement with a suppository insertion (Even if this is the only bowel task needed)

and

Must be considered a “routine” suppository insertion administered by another person

Routine means the suppository insertion is required each time the individual

has a bowel movement

PRN or as needed means the suppository insertion is only required when the

individual needs one due to constipation, etc…. PRN is not “routine” and does

not meet Full Assist, but at times may meet the Assist criteria

110

111

Definition of Toileting

OAR 411-015-0006(6)(c)

Toileting means tasks requiring the hands-on assistance of another person to

cleanse after elimination, change soiled incontinence supplies or soiled clothing,

adjust clothing to enable elimination, or cue to prevent incontinence.

Elimination: Toileting

The activity of toileting assess a consumer’s need for HANDS-ONassistance to:

Cleanse after elimination,

Change soiled clothing or incontinence supplies, or

Adjust clothing.

The activity also assess a consumer’s need for CUEING to prevent incontinence.

Tasks no longer considered:

Assistance getting to/from or on/off the toileting area.

Cleaning and maintaining the toileting area.

112

Toiletingcontinued….

Consider why the consumer requires HANDS-ON or CUEING

assistance from another person to complete the activity

If the consumer requires assistance because of limited range or motion,

pain or fatigue attempt to explain the reason for the limitation.

How does the provider assist the consumer to complete the

activity?

Be specific about which tasks of the activity the consumer is able to do

and which tasks the consumer requires assistance to complete.

113


How frequently does the consumer require assistance?

The minimum frequency of need is at least one time each week totaling

four times each month.

This means that the individual must require assistance at least one time

during one day each week of the month.

An individual who needed assistance 4 days in one week, but no days the rest

of the month would not meet the threshold for assistance.

Does the consumer use assistive devices each time or are there times

they are able to clear their bowels independently?

114

115


Assist:

Even with assistive devices, the individual requires hands-on assistance from another

person with a task of toileting or cueing to prevent incontinence at least one day each

week totaling four days per month during the assessment timeframe.

Full Assist:

The individual is unable to accomplish all tasks of toileting without the assistance of another person. This means the individual needs assistance of another person through all tasks of the activity, every time the activity is attempted.

To be considered Full Assist the individual must require the hands-on assistance of

another person every time the consumer eliminates:

1. To cleanse after elimination.

2. To change soiled incontinence supplies or soiled clothing.

3. To adjust (take off or put on) clothing to enable elimination.

OR

4. Requires cueing assistance from another person during the entire act of elimination

to prevent incontinence.

Independent the individual does not meet the definition of “assist" or “full assist"

when assessing ADLs as described in OAR 411-015-0006 or when assessing IADLs as

described in OAR 411-015-0007.


116

Bathing & Personal Hygiene

117

Definition of BathingOAR 411-015-0006(2)(a)

Bathing means the tasks of washing the body, washing hair, using assistive

devices if needed, or getting in and out of the bathtub or shower.

118

Considerations:

Bathing is one component broken down into THREE tasks:

1. Getting in & out of the shower or bathtub

2. Completely washing the hair

3. Completely washing the body.

If the person can not fully accomplish all three of the tasks of Bathing without hands-on assistance each time, then the person is considered a Full Assist need level.

If the person can accomplish some of the tasks of Bathing, than the person may be an Assist need level.

NOTE: If the consumer needs assistance washing the back only, the consumer isIndependent in Bathing.

Bathingcontinued….

Assist:

Even with assistive devices, the individual requires assistance of another person for a task

of bathing at least one day each week totaling four days per month. This means hands-on

assistance, cueing, or stand-by presence during the activity.

This means the individual requires:

1. Hands-on assistance for part of the tasks of bathing; or

2. Cueing during the activity; or

3. Stand-by presence during activity.

Full Assist:

Even with assistive devices, the individual is unable to accomplish any task of bathing

without the assistance of another person. This means the individual needs hands-on

assistance of another person through all tasks of the activity, every time the activity is

attempted.


1. Hands-on assistance through all tasks of bathing; and

2. Assistance is needed every time the activity is attempted.119


assist" when assessing ADLs as described in OAR 411-015-0006 or when assessing IADLs

as described in OAR 411-015-0007.

Bathingcontinued….

120

Definition of Personal HygieneOAR 411-015-0006(2)(b)

Personal Hygiene means the tasks of shaving, caring for the mouth, or assistance with the tasks of menstruation care.

Assist:

Even with assistive devices, the individual requires assistance of another person for a task of personal hygiene at least one day each week totaling four days per month. This means hands-on assistance, cueing, or stand-by presence during the activity.

Full Assist:

Even with assistive devices, the individual is unable to accomplish at least two personal hygiene tasks, without the assistance of another person. This means the individual needs hands-on assistance of another person through all tasks, every time the activity is attempted.

Independent:

The individual does not meet the definition of “assist" or “full assist" when assessing ADLs as described in OAR 411-015-0006 or when assessing IADLs as described in OAR 411-015-0007.

121

Personal Hygienecontinued….

Considerations:

1. What are the specific tasks of Personal Hygiene?

Shaving (face, legs or underarms);

Caring for the mouth (denture or teeth care); or

Assistance with tasks of menstruation care.

2. What tasks can the individual perform themselves?

3. Does the individual shave? If so, is assistance needed to shave?

4. Does the individual need assistance with caring for their mouth? If so, what assistance is needed?

5. Does the individual need menstruation care? If so, what assistance is needed for the menstruation care?

NOTE: Set up for oral care, shaving, and menstruation care is not an appropriate assist

type for Personal Hygiene. If a consumer only requires set up for the activity of

Personal Hygiene, the consumer is considered Independent.

122

Dressing & Grooming

123

This activity of daily living is comprised of two components; dressing and grooming.

To be an Assist, the individual must require assistance in dressing or full assistance

in grooming.

To be a Full Assist, the individual must require full assistance in dressing.

124

Dressing means the tasks of putting on and taking off clothing or shoes and

socks.

Dressing is comprised of two tasks:

1. The individual’s ability to complete the task of putting on clothing, including shoes and socks.

2. Consider the individual’s ability to complete the task of taking off clothing, including shoes and socks.

Note: Ted Hose are considered a treatment that is captured in dressing, as

this is a function of dressing.

Definition of DressingOAR 411-015-0006(4)(a)

Considerations:

1. Evaluate the reason the person cannot dress and/or undress themselves.

2. Can the person make forward progress and fully complete each task?

3. Would the person be able to accomplish dressing with cueing or standby?

125

Assist:

Even with assistive devices, the consumer is unable to accomplish some tasks of dressing

without the assistance of another person at least one time each week totaling four days per

month.


1. Hands-on assistance for part of the task; or



Full Assist:

Even with assistive devices, the consumer is unable to accomplish any tasks of dressing

without the assistance of another person. This means the individual needs hands-on

assistance through all tasks of the activity, every time the activity is attempted.


1. Hands-on assistance for dressing tasks; and

2. Assistance is needed every time the tasks are attempted.

Dressingcontinued….


Considerations for the following need levels:

1. Full Assist Hands-on assistance for tasks of dressing and undressing, both tops and bottoms

each time the activity occurs.

2. Assist Hands-on assistance needed at least one day each week for dressing and

undressing, or

Hands-on assistance to put clothing on, including fastening clasps, hooks, buttons

etc. or

Hands-on assistance to take clothing off.

Be sure to only consider the need for assistance with fasteners if it is the

individuals preference to wear that type of clothing.

3. Independent Able to dress themselves, button, including snaps & fasteners without assistance;

or

Able to dress themselves but it takes a bit longer to do on their own.

126

127


assist" when assessing ADLs as described in OAR 411-015-0006 or when assessing IADLs

as described in OAR 411-015-0007.


128

Definition of GroomingOAR 411-015-0006(4)(b)

Grooming means nail care and hair care.

Considerations:

1. Evaluate the consumer’s ability to complete the tasks of nail and hair care.

2. What can the person complete without assistance?

3. Would the person be able to accomplish grooming tasks with cueing or standby?

4. Evaluate the reason the person cannot accomplish grooming tasks without assistance.

NOTE: If the consumer chooses to have hair care and/or nail care tasks completed by an

outside source such as a doctor, hair salon, etc., assess the need for assistance but don’t

assign hours for the need in an In-Home plan.

129

Assist:

Even with assistive devices, the individual is unable to accomplish tasks of grooming without the

assistance of another person. This means the individual requires:

1. Hands-on assistance for part of the task; or



Full Assist:

Even with assistive devices, the individual is unable to perform any tasks of grooming without

the assistance of another person. This means the individual requires:

1. Hands-on assistance for grooming tasks; and

2. Assistance is needed every time the tasks are attempted.

Independent:

Does not need assistance with nail care and hair care.

Groomingcontinued….

Groomingcontinued….

Considerations for the following need levels:

1. Full Assist

Always needs hands-on assistance for both hair and nail care.

2. Assist

Always needs hands-on assistance for nail care, but not hair care OR

Always needs hands-on assistance for hair care, but not nail care OR

Needs assistance sometimes with nail care and hair care OR

Needs assistance with hair care only OR

Needs assistance with nail care only.

130

INSTRUMENTAL ACTIVITIES of

DAILY LIVING (IADL)

131

Definition of Instrumental

Activities of Daily Living (ADL)OAR 411-015-0007

1) Instrumental Activities of Daily Living (IADL) consists of housekeeping, laundry,

shopping, transportation, medication management and meal preparation.

2) Evaluation of the consumer’s need for assistance in Instrumental Activities of Daily

Living is based on:

(a) The individual's abilities rather than the services provided; and

(b) How the individual functioned during the 30 days prior to the assessment date,

with consideration of how the person is likely to function in the 30 days following

the assessment date; and

(c) Evidence of the actual or predicted need for assistance of another person within

the assessment time frame and cannot be based on potential or preventative needs.

132

133

3) Independent means the individual does not meet the definition of "Assist" or

"Full Assist" for IADLs as defined in this rule.

NOTE: If an individual does not engage in an IADL activity or the task of an IADL,

the individual is assessed as Independent unless he/she is confined to a

bed or wheelchair.

Definition of Instrumental Activities of

Daily Living (ADL)OAR 411-015-0007

Assessing IADL Needs

Housekeeping and Laundry

Consider the needs specific to the individual. What are they able to do

themselves?

Meal Prep

Do not evaluate the ability to use the microwave or toaster.

Evaluate ability to prepare meals even if they live in a facility.

Evaluate ability to plan, put ingredients together, use appliances and pots and

pans, cooking, cutting food, and bring food to the table.

134

Assessing IADL Needscontinued…..

Medication Management

Evaluate all aspects of med management and oxygen equipment related tasks

Independent if they do not have the above needs.

Shopping

Determine and evaluate the individual’s ability to perform the tasks related to

shopping.

Transportation

Tasks are specific to arranging rides, getting in/out of vehicle, and physical or

cognitive assistance during the ride.

Driving an individual in and of itself is not defined under transportation.

135

Web Sites

411-015-0000 through 411-015-0100

Long-Term Care Service Priorities for Individuals Served

http://www.dhs.state.or.us/policy/spd/rules/411_015.pdf

APD Case Management Tools

http://www.dhs.state.or.us/spd/tools/cm/index.htm

APD Staff Tools

http://www.dhs.state.or.us/spd/tools/index.htm

136

137

APD Medicaid Long Term Care Services &

Policy Unit

Contact Information

Jane-ellen Weidanz: (503) 602-8399

APD Medicaid LTC Manager

Darla Zeisset: (503) 945-7035

Darwin Frankenhoff: (503) 947-5162

Christine Maciel: (503) 881-9064

Mat Rapoza: (503) 945-6985

Ben Sherman: (503) 947-5189

Bob Weir: (503) 945-6414

Lisa Bouchell: (503) 269-4711

PACE Coordinator

Kelsey Weigel: (503) 779-6849

Chris Angel: (503) 945-7034

Kathryn Nunley: (503) 947-2309

Scott Spencer (503) 945-5990

Exceptions Coordinator

spl rule training - dhs.state.or.us and assessment...3. meet the service priority level (spl)...

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