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
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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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
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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.
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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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)
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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.
Definition of Cognition cont.
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.
Definition of Cognition cont.
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What does this mean?
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.
Definition of Cognition cont.
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.
Definition of Cognition cont.
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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.
What does this mean?
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.
What does this mean?
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.
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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.
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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
Assistance Levels of Ability to Make
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
Assistance Levels of Ability to Make
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.
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.
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
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
Ambulation continued….
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.
This means the individual:
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
Ambulation continued….
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.
This means the individual:
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.
Ambulation continued….
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.
This means the individual:
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.
This means the individual:
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
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.
Transfercontinued….
98
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
Toiletingcontinued….
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
Toiletingcontinued….
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.
Toiletingcontinued….
116
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.
This means the individual requires:
1. Hands-on assistance through all tasks of bathing; and
2. Assistance is needed every time the activity is attempted.119
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.
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.
This means the individual requires:
1. Hands-on assistance for part of the task; or
2. Cueing during the activity; or
3. Stand-by presence during activity.
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.
This means the individual requires:
1. Hands-on assistance for dressing tasks; and
2. Assistance is needed every time the tasks are attempted.
Dressingcontinued….
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
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.
Dressingcontinued….
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
2. Cueing during the activity; or
3. Stand-by presence during activity.
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
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
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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