RFP 240000001827 - Attachment D - Adult Services Manual.pdf

ASM 121 1 of 6

FUNCTIONAL ASSESSMENT DEFINITIONS

AND RANKS

ASB 2018-008

8-1-2018

ADULT SERVICES MANUAL STATE OF MICHIGAN

DEPARTMENT OF HEALTH & HUMAN SERVICES

ACTIVITIES OF

DAILY LIVING

Use the following information as guidance when completing a comprehensive assessment.

Eating - helping with the use of utensils, cup/glass, getting food/drink to mouth, cutting up/manipulating food on plate, swallowing foods and liquids, cleaning face and hands after a meal.

1. No assistance required.

2. Verbal assistance or prompting required. Client must be prompted or reminded to eat.

3. Minimal hands-on assistance or assistive technology needed.

Help with cutting up food or pushing food within reach; help with applying assistive devices. The constant presence of another person is not required.

4. Moderate hands-on assistance required. Client has some ability to feed self but is unable to hold utensils, cup, or glass.

5. Totally dependent on others in all areas of eating.

Toileting - helping on/off the toilet, commode or bedpan; emptying commode, bed pan or urinal, managing clothing, wiping and cleaning body after toileting, cleaning ostomy and/or catheter tubes/receptacles, applying diapers and disposable pads. May also include catheter, ostomy or bowel programs.

1. No assistance required.

2. Verbal direction, prompting or reminding is required.

3. Minimal hands-on assistance or assistive technology needed with some activities. The constant presence of another person while toileting is not necessary.

4. The client does not carry out most activities without human assistance.

5. Totally dependent on others in all areas of toileting.

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Bathing - helping with cleaning the body or parts of the body using a tub, shower or sponge bath; including getting a basin of water, managing faucets, soaping, rinsing and drying. helping shampoo hair.

1. No assistance required.

2. Bathes self with direction or intermittent monitoring. May need reminding to maintain personal hygiene.

3. Minimal hands-on assistance or assistive technology required to carry out task. Generally, bathes self but needs some assistance with cleaning hard to reach areas; getting in/out of tub/shower. Client can sponge bath, but another person must bring water, soap, towel. Client relies on a bath or transfer bench when bathing. The constant presence of another is not required.

4. Requires direct hand- on assistance with most aspects of bathing. Could be at risk if unassisted.

5. Totally dependent on others in all areas of grooming.

Grooming - Maintaining personal hygiene and a neat appearance;

including the combing/brushing of hair; brushing/cleaning teeth, shaving, fingernail and toenail care.

1. No assistance required.

2. Bathes self with direction or intermittent monitoring. May need reminding to maintain personal hygiene.

3. Minimal hands-on assistance required. Grooms self but needs some assistance with activities of personal hygiene.

4. Requires direct hands-on assistance with most aspects of grooming. Could be at risk if unassisted.

5. Totally dependent on others in all areas of grooming.

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Dressing - Putting on and taking off garments; fastening and unfastening garments/undergarments, assisting with special devices such as back or leg braces, elastic stockings/garments and artificial limbs or splints.

1. No assistance required.

2. Client can dress self but requires reminding or direction in clothing selection.

3. Minimal hands-on assistance or assistive technology required.

Client unable to dress self completely (for example, tying shoes, zipping, buttoning) without the help of another person or assistive device.

4. Requires direct hands on assistance with most aspects of dressing. Without assistance would be inappropriately or inadequately dressed.

5. Totally dependent on others in all areas of dressing.

Transferring - Moving from one sitting or lying position to another.

Assistance from the bed or wheelchair to the sofa, coming to a standing position and/or repositioning to prevent skin breakdown.

1. No assistance required.

2. Client can transfer but requires encouragement or direction.

3. Minimal hands-on assistance needed from another person for routine boosts or positioning. Client unable to routinely transfer without the help of another or assistive technology such as a lift chair.

4. Requires direct hands-on assistance with most aspects of transferring. Could be at risk if unassisted.

5. Totally dependent on others for all transfers. Must be lifted or mechanically transferred.

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Mobility - Walking or moving around inside the living area, changing locations in a room, assistance with stairs or maneuvering around pets, or obstacles including uneven floors.

1. No assistance required even though the client may experience some difficulty or discomfort. Completion of the task poses no risk to safety.

2. Client can move independently with only reminding or encouragement. For example, needs reminding to lock a brace, unlock a wheelchair or to use a cane.

3. Minimal hands-on assistance required for specific maneuvers with a wheelchair, negotiating stairs or moving on certain surfaces. Without the use of a walker or pronged cane, client would need physical assistance.

4. Requires hands-on assistance from another person with most aspects of mobility. Could be at risk if unassisted.

5. Totally dependent on other for all mobility. Must be carried, lifted or pushed in a wheelchair or gurney always.

INSTRUMENTAL

ACTIVITIES OF

DAILY LIVING

Taking Medication - Taking prescribed and/or over the counter medications.

1. No assistance required.

2. Client can take all medications but needs reminding or direction.

3. Client can take all medication if someone assists in measuring dosages or prepares administration schedule.

4. Client can take some medication if another person assists in preparation but needs someone to assist in administering other medications.

5. Totally dependent on another. Does not take medication unless someone assists in administering.

Meal Preparation - Planning menus. Washing, peeling, slicing, opening packages/cans, mixing ingredients, lifting pots/pans, ASM 121 5 of 6

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reheating food, cooking, safely operating stove, setting the table, serving the meal. Washing/drying dishes and putting them away.

1. No assistance required.

2. Verbal direction, prompting or reminding is required for menu planning, meal preparation or clean up.

3. Minimal hands-on assistance required for some meals. Client can reheat food prepared by another and/or prepare simple meals/snacks.

4. Requires another person to prepare most meals and do clean-up.

5. Totally dependent on another for meal preparation.

Shopping - Compiling a list, managing cart or basket, identifying items needed, transferring items to home and putting them away, phoning in and picking up prescriptions. Limited to brief, occasional trips in the local area to shop for food, medical necessities and household items required specifically for the health and maintenance of client.

1. No assistance required.

2. Verbal direction, prompting or reminding is required for shopping.

3. Minimal hands-on assistance required for some task (grocery shopping) but client can compile a list and go to nearby store for small items.

4. Requires hands-on assistance from another person with most aspects of shopping but client can accompany and select needed items.

5. Totally dependent on another for shopping.

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Laundry - Gaining access to machines, sorting, manipulating soap containers, reaching into the machine for wet/dry clothing, operating the machine controls, hanging laundry to dry, folding and putting away.

1. No assistance required.

2. Performs all tasks but needs reminding or direction to do laundry on a regular basis or to do it properly.

3. Minimal hand-on assistance required with some task but can do most laundry without assistance.

4. Requires hands-on assistance from another person with most aspects of laundry. Can perform some laundry tasks such as folding small clothing items or putting clothes away.

5. Totally dependent on another for laundry.

Light Housecleaning - Sweeping, vacuuming and washing floors;

washing kitchen counters and sinks; cleaning the bathroom;

changing bed linens; taking out garbage; dusting; cleaning stove top; cleaning refrigerator.

1. No assistance required.

2. Performs all tasks but needs reminding or direction from another.

3. Requires minimal assistance from another for some tasks due to limited endurance or limitations in bending, stooping or reaching.

4. Requires assistance for most tasks although client can perform a few simple tasks alone such as dusting and wiping counters.

5. Totally dependent on another for housecleaning.