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Activities of Daily Living (ADLs) & Service Priority Levels
Assistance with Activities of Daily Living (ADL)
Activities of daily living (ADLs) are those personal functional activities
required by all of us for continued well-being and include things like eating/nutrition,
personal hygiene and mobility.
For many individuals with disabilities, assistance from other human beings
to perform activities of daily living is a daily need. Whether the person
experiences a physical or cognitive disability requiring some level of assistance
from others, choice and control are fundamental to achieving successful outcomes.
Preserving one’s sense of dignity and self-esteem when receiving services
is something that must be learned, and requires patience, flexibility, and
a commitment from both service provider and consumer. Building meaningful
and mutually beneficial partnerships takes patience and hard work on everyone’s
part.
For the thousands of Oregonians who require ADL services, selecting competent
providers and establishing effective working relationships is essential for
living independently.
Oregon determines Medicaid eligibility for long term care services based on
an individual's limitation of activities of daily living. See ADL
Definitions and Service Priority Levels, below.
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ADL Definitions
Mobility Clients with limitations in mobility have problems walking
inside, outside or in unfamiliar surroundings. They may also have difficulties
in safely transferring from a lying or sitting position.
Eating Clients with limitations in this category cannot feed
themselves, cannot be left alone due to the possibility of choking or they
need constant encouragement to eat.
Elimination Individuals with limitation in elimination cannot
manage bowel or bladder incontinence, cannot get to the toilet or cannot
cleanse after elimination and adjust clothing;
Cognition Individuals with impairments in cognition have difficulties
in adapting to changes, may be unaware of their own needs, may pose a danger
to self or others, may place unreasonable demands on others, exhibit poor
judgement, inability to remember current information, may not be orientated
to time, place or surrounding or may wander off presenting serious safety
issues.
Bathing/personal hygiene Clients with limitations in this area
cannot bathe, shave or brush their teeth safely without assistance. They
may need someone to remind them how to perform this task, stand by for help
or actually perform the task in its entirety; and
Dressing and grooming Clients with impairments in this category
need help to get dressed or need help performing common grooming tasks such
as brushing their hair.
A clients limitations are defined as full, substantial or assistance.
Individuals needing:
Full assistance - must have someone else to do the specific activity
for him or her. As an example, for dressing someone who needs full assistance
cannot dress himself or herself at all. They cannot button or zipper clothing
and they cannot lift their legs or arms to put them where they need to go.
Substantial assistance must have some to help them on and off through
out the day. This category is only for mobility impairments. As an example,
a person in this category needs help outside the home, or in unfamiliar settings.
Assistance - must have someone help in the task. Someone with impairments
in cognition would need someone to remind them to eat or to take care of
other tasks. They may also need to be reassured and help in coping with change.
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Service Priority levels
Priority levels include groups of impairments and levels of impairments. Individuals
with the most impairments are assessed at a higher priority level. As an
example, individuals at level 1 have a much higher level of need than does
a level 15 to 17. Service Priority Administrative Rule
411-015-0015, Current Limitations indicates the levels Oregon is currently
serving.
Level 1 Client needs full assistance in all major activities of daily
living. They need another person to provide hands-on care throughout the
entire day.
Level 2 Client requires full assistance in mobility, eating and cognition.
The major difference with clients in level 1 is these individuals do not
need help with elimination.
Level 3 Client needs full assistance in at least one of the following
activities of daily living; mobility, cognition or eating.
Level 4 Client needs full assistance in elimination.
Level 5 Client is only slightly less impaired then individuals assessed
at the higher levels. At this level the client needs substantial assistance
with mobility and eating and requires assistance with elimination.
Level 6 Client requires substantial assistance with mobility and eating.
Level 7 Client needs substantial assistance with mobility and assistance
with elimination.
Level 8 Client needs assistance with mobility and eating and elimination.
Level 9 Client needs assistance with eating and elimination.
Level 10 Client needs substantial assistance with mobility.
Level 11 Client needs assistance with elimination and minimal assistance
with ambulation.
Level 12 means the individual needs assistance with eating and minimal
assistance with ambulation.
Level 13 means the individual needs assistance with elimination.
Level 14 means the individual needs assistance with eating.
Level 15 means the individual needs minimal assistance with ambulation.
Level 16 means the individual needs full assistance with bathing or
dressing.
Level 17 means the individual needs assistance with bathing or dressing.
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