Table 3.
Activities (1 or 0 points) | Independence (1 point) No supervision, direction, or personal assistance |
Dependence (0 points) With supervision, direction, personal assistance, or total care |
---|---|---|
Bathing points: _________ | Bathes self completely or needs help in bathing only a single part of the body, such as the back, genital area, or disabled extremity | Needs help with bathing more than one part of the body, getting in or out of the bathtub or shower; requires total bathing |
Dressing points: _________ | Gets clothes from closets and drawers and puts on clothes and outer garments complete with fasteners; may need help tying shoes | Needs help with dressing self or needs to be dressed completely |
Toileting points: _________ | Goes to toilet, gets on and off, arranges clothes, cleans genital area without help | Needs help transferring to the toilet and cleaning self, or uses bedpan or commode |
Transferring points: _________ | Moves in and out of bed or chair unassisted; mechanical transfer aids are acceptable | Needs help in moving from bed to chair or requires a complete transfer |
Faecal and urinary continence points: _________ | Exercises complete self-control over urination and defecation | Is partly or totally incontinent of bowel or bladder |
Feeding points: _________ | Gets food from plate into mouth without help; preparation of food may be done by another person | Needs partial or total help with feeding or requires parenteral feeding |
Total points: ________ | ||
Scoring: 6=High (patient independent) 0=Low (patient very dependent) |