Total CARE scoring

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Author:
edunbar
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241173
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Total CARE scoring
Updated:
2013-10-17 05:12:15
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care
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  1. How is bathing defined?
    How the client takes a full body bath/shower, sponge bath and transfers in/out of tub/shower.
  2. What is the self-performance category for bathing trying to capture?
    Self-performance for bathing is different than the other ADLs and it is trying to capture how the client has received a bath over the past 7 days.
  3. How is self-performance coded for bathing?
    • Independent
    • Supervision
    • Physical help limited to transfer only
    • Physical help in part of bathing activity
    • Total Dependence
  4. How is support provided coded for Bathing?
    Same as for other ADLs:
  5. What are the tasks included in the CARE ADL category?
    • Memory Tip: Visualize what you do when you wake up in the morning.
    • B-Bed Mobility
    • T-Transfer
    • W- Walk in Room
    • L-Locomotion in Room
    • L-Locomotion outside Room
    • D-Dressing
    • E-Eating
    • T-Toilet Use
    • P-Personal Hygiene
    • B-Bathing
  6. What is the self-performance category for ADLs trying to capture?
    Self-performance is trying to capture how a client performed a task during the past 7 days/24 hours, after setup and with the use of assistive devices.
  7. How is self-performance coded for ADL categories?
    • Independent - None OR (any type of assistance only 1 or 2 times) or Activity did not occur in last 7 days because either client was not able, there was no provider available, the client declined. 
    • Supervision - 3 or more times: Verbal, no physical contact
    • Limited - 3 or more times, physical assistance. 
    • Extensive - 3 or more times full CG help on subtask or full CG help of task but not all time or physical assistance with weight bearing with task 3 or more times. 
    • Total Dependence - Task occurred and client did not participate.
  8. How is support provided coded for ADLs?
    • 1. No set up or physical assist from caregiver
    • 2. Setup help only
    • 3. One person physical assist
    • 4. Two plus person physical assist
    • 5. Activity did not occur
  9. What is the support provided category for ADLs trying to capture?
    It is trying to capture the highest level of support provided to the client during the last 7 day/24 hour period.
  10. What is the status category trying to capture? 
    • Who is available (and willing) to help client with tasks. Does anyone share in the benefit of the task being performed by the paid provider. 
    • *Remember: Services we provide help fill in the gap.
  11. How is status coded for ADLs?
    • Met: Informal resources will meet all of this need.
    • Partially Met: Informal resources will meet part of this need.
    • Unmet: There are no other available resources to meet the client's need. 
    • Client Declines
    • Shared Benefit
  12. If partially met, you have to calculate how much of task is partially met by informal supports. What are the options to choose from?
    • Less than 1/4
    • 1/4 to 1/2
    • Over 1/2 to 3/4
    • Over 3/4 but not all the time
  13. What is assistance available trying to capture?
    The amount of time that informal supports are able to help with a task. 
  14. How is informal support defined?
    Non-ADSA paid (except adult day health and skilled care).
  15. How is assistance available calculated?
    Number of times task occurred divided by number of times informal (non-ADSA) assistance is available to assist client with task.

    • e.g.
    • 21 meals during past 7 days
    • Informal help everyday for breakfast (7 times)

    7/21 = .33, so category equals 1/4 to 1/2

    So units could be times per day/week or hours per day, etc.
  16. What is a shared benefit?
    Client and paid caregiver both share in the benefit of an IADL task being performed or two or more client's in a multi-client household benefit from the same IADL task(s) being performed.
  17. What are some questions you can ask about shared benefit?
    When provider does task, is part of task being done for their own benefit 

    OR

    In a multi-client household, when the task is performed, is it being done for more than one person?
  18. How is bed mobility defined?
    How the client moves to and from a lying position, turns from side to side, and positions body while in bed, recline or other type of furniture.
  19. How is transfer defined?
    How the client moves between surfaces-i.e., to/from bed, chair, wheelchair, standing position. Excluded from this definition is movement to/from bath, toilet and car which is covered under the definitions of toilet use, bathing and transportation.
  20. How is walk in room defined?
    Hallway and rest of immediate living environment. How client walks between locations in his/her room and immediate living environment. Immediate living environment is defined as areas adjacent to the client's room.
  21. How is locomotion in room defined?
    How client moves between locations in his/her room and immediate living environment; if in a wheelchair code for how self sufficient once in the wheelchair.
  22. How is locomotion outside of room defined?
    How client moves outside of immediate environment to include outdoors, going to and from patio or porch, to mailbox to see the next door neighbor.
  23. How is dressing defined?
    How the client puts on, fastens, and takes off all items of clothing, including donning/removing a prosthesis.
  24. How is toilet use defined?
    • How the client uses the:
    • toilet room,
    • commode,
    • bedpan, or
    • urinal,
    • transfers on/off toilet,
    • cleanses,
    • changes pads,
    • manages ostomy or catheter and
    • adjusts clothing
  25. How is eating defined?
    How the client eats and drinks, regardless of skills or gets nourishment (e.g. tube feeding or getting nutrients intraveneously)
  26. How is personal hygiene defined?
    • How client maintains personal hygiene, including
    • combing hair,
    • brushing teeth,
    • shaving,
    • applying make-up,
    • washing/drying face,
    • hands (including nail care)
    • and perineum (menses care).
  27. What are the tasks included in the CARE IADL category?
    • Memory Tip: Days of the week 
    • M-Meal Preparation
    • T-Transportation
    • W- Wood Supply
    • H-Housekeeping
    • F- Finances
    • S- Shopping
  28. What is the self-performance category for IADLs trying to capture?
    How the client performed the task in the last 30 days. (After setup?)
  29. How is self-performance coded for IADL categories?
    • Independent:No help, setup, supervision
    • Set up only: Set up/arrangements
    • Limited Assistance: Sometimes did on own, other times needed help.
    • Extensive Assistance: Client is involved but required cueing/supervision or partial assist at all times.
    • Total Dependence: Activity performed by others
    • Activity Did not Occur
  30. What is the difficulty category for IADLs trying to capture?
    How difficult it would be for the client to do the activity on their own.
  31. How is difficulty coded for IADL categories?
    • No difficulty
    • Some difficulty (e.g., needs some help, is very slow or fatigues easily)
    • Great difficulty (little or no involvement in activity possible)
  32. What is the status category trying to capture?
    Who is available and willing to help client do task? CARE does not want to supplant supports that are already in place. 
  33. How is status coded for IADLs?
    • Met: Informal resources will meet all of this need.
    • Partially Met: Informal resources will meet part of this need.
    • Unmet: There are no other available resources to meet the client's need. 
    • Client Declines
    • Shared Benefit
  34. If partially met, you have to calculate how much of task is partially met by informal supports. What are the options to choose from?
    • Less than 1/4
    • 1/4 to 1/2
    • Over 1/2 to 3/4
    • Over 3/4 but not all the time
  35. What is assistance available trying to capture?
    The amount of time that informal supports are able to help with a task. 
  36. How is informal support defined?
    Non-ADSA paid (except adult day health and skilled care).
  37. How is assistance available calculated?
    Number of times task occurred divided by number of times informal (non-ADSA) assistance is available to assist client with task.

    • e.g.
    • 21 meals during past 7 days
    • Informal help everyday for breakfast (7 times)

    7/21 = .33, so category equals 1/4 to 1/2

    So units could be times per day/week or hours per day, etc.
  38. What is a shared benefit?
    Client and paid caregiver both share in the benefit of an IADL task being performed or two or more client's in a multi-client household benefit from the same IADL task(s) being performed.
  39. What are some questions you can ask about shared benefit?
    When provider does task, is part of task being done for their own benefit 

    OR

    In a multi-client household, when the task is performed, is it being done for more than one person?
  40. How is meal preparation defined?
    How meals are prepared.
  41. What are subtasks of meal preparation?
    • Meal planning + meal preparation
    • Preparing ingredients for cooking
    • Reheating meals
    • Operating Kitchen appliances
    • Throwing out spoiled food
    • Cleaning up after meal + meal preparation.
  42. What is considered set up for meal preparation?
    • Cueing or reminding to prepare meals/snacks,
    • Taking items from shelves,
    • Opening cans/bottles & packaged foods
    • Assembling ingredients for cooking
  43. How is medication management defined?
    The level of assistance the client will need to manage his/her medications.
  44. What is the self-administration category for medication management trying to capture?
    • The highest level of support that client may needed.
    • Does not include set-up.
  45. How is Medication self-administration coded?
    • Independent
    • Assistance required
    • Must be administered
    • Self-Direction
  46. How is Independent defined?
    Client remembers to take own medications as prescribed and will manage own administration independently.
  47. How is Assistance Required defined?
    • Reminding or coaching client
    • Handing the medication container to client
    • Using an enabler to assist client in getting med to mouth
    • Placing medication in client's hand
    • DOES NOT INCLUDE: Assistance with intravenous medications or injectable medications. The client must have an awareness that they are taking medication.
  48. How is Must be administered defined?
    Medication must be placed in the client's mouth and applied or instilled to the skin or mucous membrane OR client is not aware that he/she is taking medication.
  49. How is self-direction defined?
    Client with functional disability that prevents them from performing a health-care function that he or she would normally do who chooses and is able to self-direct medication assistance or administration
  50. Who can administer medications to clients?
    • Client can self-administer
    • Family IPs (whoever client calls family)
    • Informal supports (e.g. family, friends)
    • Paid providers (non-family) under nurse delegation.
    • Individual Providers who are "self-directed" by client
    • RNs, LPNs
  51. Who can fill a Medi-set?
    • MD
    • RN
    • LPN
    • Pharmacist
    • Family
    • Informal Caregivers
    • Self-Directed
  52. How do you know if an over-the-counter (OTC) topical medication can be done by IP/Agency provider?
    • If it is a topical cream used for prevention it can be done by an IP/Agency Provider.
    • If it is a topical cream that is a treatment, it is considered medication administration. (E.g. anti-fungal creams for a yeast infection, hydrocortisone for a psoriasis outbreak)
  53. If client directs medications, what should be included in the comments screen?
    • A description of the care
    • Name of prescribing healthcare provider
  54. How is status and assistance available scored for medication management?
    Same as for other ADLs

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