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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.


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 judgment​, 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 client’s 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.


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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