Or. Admin. R. 411-015-0006 - Activities of Daily Living (ADL)
(1) Evaluation of the individual's need for
assistance in activities of daily living is based on:
(a) The individual's ability to complete
activities, components, and tasks 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 preventive needs.
(2) Bathing and personal hygiene. This
activity of daily living is comprised of two components, which are bathing and
personal hygiene. To be considered assist, the individual must require
assistance in bathing or full assistance in hygiene. To be considered full
assist, the individual must require full assistance in bathing.
(a) Bathing means the tasks of getting in and
out of a bathtub or shower, washing hair, and washing the body, while using
assistive devices, if needed. This includes, but is not limited to, sponge
baths, bed baths, bathing in a tub, or showering, as chosen by an individual.
For individuals who are confined to a bed, bathing is assessed without
considering the need to get in or out of the bathtub or shower.
(A) 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.
(B) 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.
(b) Personal hygiene means the tasks of
shaving, caring for the mouth, or assistance with tasks of menstruation care.
This includes, but is not limited to, shaving the face, legs, or other desired
areas, brushing teeth, maintaining dentures, caring for gums, and using
feminine hygiene products to address menstrual needs.
(A) 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.
(B) Full Assist: Even with assistive devices,
the individual is unable to complete 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.
(3) Cognition refers to how the individual is
able to use information, make decisions, and ensure their daily needs are met.
There are four components to cognition: self-preservation, decision-making,
ability to make one's self-understood, and unsafe behaviors. 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. For each assist level, individuals must have a documented
history of actions or behaviors demonstrating they need assistance with
ensuring their health and safety.
(a) An
individual's ability to manage any component of cognition, as defined in this
rule, is assessed by how the individual is able to function without the
assistance of another person.
(b)
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
need would likely reoccur in the absence of existing supports.
(c) An individual under age 65, with
cognition needs driven by a mental illness, emotional disorder, or substance
abuse disorder does not meet the criteria for service eligibility per OAR
411-015-0015.
(d) To assess an
individual as meeting the assist criteria for cognition, an individual must
require:
(A) Substantial assistance in one of
the four components of cognition; or
(B) Minimal assistance in at least two of the
four components of cognition.
(e) To meet the criteria for full assist in
cognition an individual must require:
(A)
Full assistance in at least one of the four components of cognition;
or
(B) Substantial Assistance in at
least two of the four components.
(f) The four components of cognition are:
(A) SELF-PRESERVATION. Self-Preservation
means an individual's actions or behaviors reflecting the individual's
understanding of their health and safety needs and how to meet those needs.
Self-preservation refers to an individual's cognitive ability to recognize and
take action in a changing environment or a potentially harmful situation.
(i) Self-Preservation includes, but is not
limited to an individual:
(I) Being oriented
to their community and surroundings such that they can find their way to their
home or care setting.
(II)
Understanding how to safely use appliances.
(III) Understanding how to take their
medications.
(IV) Understanding how
to protect themselves from abuse, neglect, or exploitation.
(V) Understanding how to meet their basic
health and safety needs.
(ii) 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 their actions.
(iii) Self-preservation includes the
following assistance types (see OAR 411-015-0005) unless otherwise indicated in
the assist level:
(I) Cueing.
(II) Hands-on.
(III) Monitoring.
(IV) Reassurance.
(V) Redirection.
(VI) Support.
(iv) Minimal Assist: The individual needs
assistance at least one day each month to ensure they are able to meet their
basic health and safety needs because they are unable to act on the need for
self-preservation or they are unable to understand the need for
self-preservation. The need may be event specific.
(v) Substantial Assist: The individual
requires assistance because they are unable to act on the need for
self-preservation nor understand the need for self-preservation at least
daily.
(vi) Full Assist: The
individual requires assistance to ensure that they meet their basic health and
safety needs throughout each day. The individual is not able to be left alone
without risk of harm to themselves or others or the individual would experience
significant negative health outcomes. This does not include assistance types of
support or monitoring.
(B) DECISION-MAKING. Decision-making means an
individual's ability to make everyday decisions about ADLs, IADLs, and the
tasks that comprise those activities. An individual needs assistance if that
individual demonstrates they are unable to make decisions, needs help
understanding how to accomplish the tasks necessary to complete a decision, or
does not understand the risks or consequences of their decisions.
(i) Decision-making includes the following
assistance types, unless otherwise indicated in the assist definitions:
(I) Cueing.
(II) Hands-on.
(III) Monitoring.
(IV) Redirection.
(V) Support.
(ii) Minimal Assist: The individual requires
assistance at least one day each month with decision-making. The need may be
event specific.
(iii) Substantial
Assist: The individual requires assistance in decision-making and completion of
ADL and IADL tasks at least daily.
(iv) Full Assist: The individual requires
assistance throughout each day to make decisions, understand the tasks
necessary to complete ADLs and IADLs critical to one's health and safety. The
individual may not be left alone without risk of harm to themselves or others
or the individual would experience significant negative health outcomes. This
does not include assistance types of support or monitoring.
(C) ABILITY TO MAKE
SELF-UNDERSTOOD. Ability to make self-understood means an 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 use of assistive technology. An
individual with a cognitive impairment in this component demonstrates an
inability to express themselves clearly to the point their needs cannot be met
independently.
(i) Ability to make
self-understood does not include the need for assistance due to language
barriers or physical limitations to communicate.
(ii) Ability to make self-understood includes
the following assistance types, unless otherwise indicated in the assist
definitions:
(I) Cueing.
(II) Monitoring.
(III) Reassurance.
(IV) Redirection.
(V) Support.
(iii) Minimal Assist: The individual requires
assistance at least one day each month in finding the right words or in
finishing their thoughts to ensure their health and safety needs. The need may
be event specific.
(iv) Substantial
Assist: The individual requires assistance to communicate their health and
safety needs at least daily.
(v)
Full Assist: The individual requires assistance throughout each day to
communicate and is rarely or never understood and cannot be left alone without
risk of harm to themselves or others or the individual would experience
significant negative health outcomes. Full assist includes hands on assistance
in addition to the assist definition included in paragraph (C). This does not
include assistance types of support or monitoring.
(D) CHALLENGING BEHAVIORS. Challenging
Behaviors means an individual exhibits behaviors that negatively impact their
own, or others', health or safety. An individual who requires assistance with
challenging behaviors does not understand the impact or outcome of their
decisions or actions.
(i) Challenging
behaviors include, but are not limited to, those behaviors that are verbally or
physically aggressive and socially inappropriate or disruptive.
(ii) Challenging behaviors does not include
the individual exhibiting behaviors when the individual understands the
potential risks and consequences of their actions.
(iii) Challenging behaviors includes the
following assistance types, unless otherwise indicated in the assist
definitions:
(I) Cueing.
(II) Hands-on.
(III) Monitoring.
(IV) Redirection.
(iv) Minimal Assist: The individual requires
assistance at least one day each month dealing with a behavior that may
negatively impact their own or others' health or safety. The individual
sometimes displays challenging behaviors, but can be distracted and is able to
self-regulate behaviors with reassurance or cueing. Minimal assist includes
reassurance assistance.
(v)
Substantial Assist: The individual requires assistance in managing or
mitigating their behaviors at least daily. 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 their
behaviors.
(vi) Full Assist: The
individual displays challenging behaviors that require additional support to
prevent significant harm to themselves or others. The individual needs constant
assistance to the level that the individual may not be left alone without risk
of harm to themselves or others or the individual would experience significant
negative health outcomes. This does not include assistance types of
monitoring.
(4) Dressing and Grooming: This activity of
daily living is comprised of two components: dressing and grooming. To be
considered Assist, the individual must require assistance in dressing or full
assistance in grooming. To be considered Full Assist the individual must
require full assistance in dressing:
(a)
Dressing is comprised of three tasks; putting on clothing, taking off clothing,
and putting on or taking off shoes and socks. This includes, but is not limited
to, the consideration of an individual's ability to use clothing with buttons,
zippers, and snaps, and reflects the individual's choice and reasonable
preferences.
(A) Assist: Even with assistive
devices, the individual 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 hands-on assistance, cueing, or stand-by presence during
the activity.
(B) Full Assist: Even
with assistive devices, the individual 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.
(b) Grooming means the tasks of nail and hair
care based on the individual's reasonable personal preferences. This includes,
but is not limited to, tasks of clipping and filing both toe nails and finger
nails, and brushing, combing, braiding, or otherwise maintaining one's hair or
scalp.
(A) Assist: Even with assistive
devices, the individual is unable to accomplish tasks of grooming, without the
assistance of another person at least one time each week totaling four days per
month. This means hands-on assistance, cueing, or stand-by presence during the
activity.
(B) 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
needs hands-on assistance of another person through all tasks of the activity,
every time the activity is attempted.
(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.
(a)
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.
(b) 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.
(6) 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. Dialysis care needs are not assessed as part of elimination.
(a) Bladder means the tasks of catheter care
and ostomy care. The tasks of catheter or ostomy care are specific to the
individual.
(A) Assist: Even with assistive
devices, the individual requires hands-on assistance with a task of bladder at
least one day each week totaling four days per month during the assessment
timeframe.
(B) Full Assist: The
individual requires hands-on assistance of another person to complete all tasks
of bladder care every time the task is attempted even with assistive
devices.
(b) Bowel means
the tasks of digital stimulation, suppository insertion, ostomy care, and
enemas.
(A) Assist: Even with assistive
devices, the individual requires hands-on assistance with a task of bowel care
at least one day each week totaling four days per month during the assessment
timeframe.
(B) Full Assist: The
individual requires hands-on assistance of another person to complete all tasks
of bowel care every time the task is attempted, even with assistive
devices.
(c) Toileting
means the assessed tasks of cleansing after elimination, changing soiled
incontinence supplies or soiled clothing, adjusting clothing to enable
elimination, or cueing to prevent incontinence.
(A) 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.
(B) 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.
(7) Mobility is comprised of two
components, which are ambulation and transfer. The activity of mobility is
organized into three assistance levels. To be considered Minimal Assist, the
individual must require minimal assistance in ambulation. To be considered
Substantial Assist, the individual must require substantial assistance with
ambulation or an assist with transfer. To be considered Full Assist, the
individual must require full assistance with ambulation or transfer.
(a) Mobility does not include getting in and
out of a motor vehicle, or getting in or out of a bathtub or shower.
(b) For the purposes of this rule, inside the
home or care setting, means inside the entrance to the individual's home or
apartment unit or inside the care setting (as defined in OAR 411-015-0005).
Courtyards, balconies, stairs or hallways exterior to the doorway of the home
or apartment unit are not considered inside.
(c) A history of falls with an inability to
rise without the assistance of another person, or with negative physical health
consequences, may be considered in assessing ambulation or transfer if they
occur within the assessment time frame. Falls prior to the assessment time
frame, or the need for prevention of falls alone, even if recommended by
medical personnel, is not sufficient to qualify for assistance in ambulation or
transfer.
(d) Ambulation means the
tasks of moving around 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.
(A) 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 their home or care setting less than one day each
week.
(B) Substantial Assist: Even
with assistive devices the individual requires hands-on assistance from another
person to ambulate inside their home or care setting at least one day each week
totaling four days per month.
(C)
Full Assist: Even with assistive devices, the individual requires hands-on
assistance from another person to ambulate every time the activity is
attempted. Individuals who are confined to bed are a full assist in
ambulation.
(e) Transfer
means the tasks of moving to or from a chair, bed, toileting area, or
wheelchair using assistive devices, if needed. This includes assessing one's
ability to transfer from areas used on a daily or regular basis, such as sofas,
chairs, recliners, beds, and other areas inside the home or care setting based
on their reasonable personal preferences. When individuals are confined to
their bed or a wheelchair, repositioning is also considered as a transfer task.
This assistance must be required because of the individual's physical
limitations, not their physical location or personal preference.
(A) 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.
(B) Full Assist: The
individual requires hands-on assistance from another person every time the
activity is attempted, even with assistive devices.
Notes
Statutory/Other Authority: ORS 410.070
Statutes/Other Implemented: ORS 410.070
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