Exit this survey Short Version - Key Words Used in Functional Assessment Question Title 1. Occasional help to perform task. Patient provides most of effort. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 2. Patient performs all effort while staff cues and coaxes completion. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 3. Requires more than occasional help with the caregiver providing hand over hand assistance for every portion of the performed activity. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 4. An assessment for this task was recorded earlier, I need to assist the patient quickly to perform this activity and do not have time to let them show me how much they can do for themselves at this moment. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 5. This patient requires occasional contact for balance; the activity requires three areas for assessment and the patient only performs one of those items independently without significant help of the caregiver. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 6. The patient uses a wheelchair and is ready to transfer back to bed. They manage to lock their brakes, remove leg rests and arm rest independently. I place the transfer board under the patient by shifting their weight and holding them so they do not fall. For each scoot over the board I assist the patient to reduce friction because they cannot scoot unless I lift them. They cannot stand pivot yet. Once they are in the bed they can pull their legs up onto the bed. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 7. It requires two persons to safely ambulate the patient for any amount of distance. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 8. The patient ambulates up and down 10 steps and requires the help of two persons. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 9. It is not safe to take the patient on the stairs anytime within the first three days of their IRF stay. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 10. The patient ambulates up and down 12 steps with the help of one person. The patient requires contact guard and an occasional placement of the foot on the step if a scissoring is noticed when placing their foot on the next step. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 11. After the utensils are placed in the patients hand (toothbrush, hair brush, washcloth), the patient requires the caregiver to help hand over hand (to keep utensils in the hand) and then assists in the necessary movements to complete each of the tasks for grooming. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 12. The patient approaches the sink independently at wheelchair level; as expected supplies were within reach on the sink and S/he performed the task independently and timely. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 13. The patient requires physical assistance for washing, rinsing and drying the body for more than two areas of the body, in fact, the caregiver must hold the washcloth or towel most of the time since grasp is weak. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 14. The patient is bathing and with just cues has performed all of the washing, rinsing and drying of all body parts. A few times, the patient required the caregiver to place the washcloth or towel back in their hand after dropping it out of their safe reach. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimal Independence; No more than touching; patient expends >75% or more of effort 3 = Moderate Independence: More help than touching; patient expends between 50 - 74% of effort 2 = Maximal Independence: Physically assist patient; patient expends between 25 - 49% of effort 1 = Total Independence; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 15. With the placement of a tenodesis wrist splint, the patient can dress their upper body independently, including buttoning and fastening the clothing. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 16. The patient uses a reacher and long handled shoe horn to dress the lower body. They are safe and perform the activity in a reasonable amount of time. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 17. The facility leaves a bedside commode next to every patients bed for convenience at night. The patient controls bowels completely and intentionally without any noted accidents for more than 3 days, but since the bedside commode is present they use it at night even though they could go to the bathroom but staff like the convenience. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 18. The patient requires continual prompting to communicate basic needs and does not seem to understand or responds inappropriately when asked questions about basic needs for comprehension. 7 = Complete Independence—The patient understands complex or abstract directions and conversation, and understands either spoken or written language (not necessarily English). 6 = Modified Independence—In most situations, the patient understands readily or with only mild difficulty complex or abstract directions and conversation. The patient does not require prompting, though (s)he may require a hearing or visual aid, other assistive device, or extra time to understand the information. 5 = Standby Prompting—The patient understands directions and conversation about basic daily needs more than 90% of the time. The patient requires prompting (slowed speech rate, use of repetition, stressing particular words or phrases, pauses, visual or gestural cues) less than 10% of the time. 4 = Minimal Prompting—The patient understands directions and conversation about basic daily needs 75 to 90% of the time. 3 = Moderate Prompting—The patient understands directions and conversation about basic daily needs 50 to 74% of the time. 2 = Maximal Prompting—The patient understands directions and conversation about basic daily needs 25 to 49% of the time. Understands only simple, commonly used spoken expressions (e.g., hello, how are you) or gestures (e.g., waving good-bye, thank you). Requires prompting more than half the time. 1 = Total Assistance—The patient understands directions and conversation about basic daily needs less than 25% of the time, or does not understand simple, commonly used spoken expressions (e.g., hello, how are you) or gestures (e.g., waving good-bye, thank you), or does not respond appropriately or consistently despite prompting Question Title 19. The patient needs help to understand directions and conversation about basic needs only occasionally. Very little prompting is necessary for comprehension. 7 = Complete Independence—The patient understands complex or abstract directions and conversation, and understands either spoken or written language (not necessarily English). 6 = Modified Independence—In most situations, the patient understands readily or with only mild difficulty complex or abstract directions and conversation. The patient does not require prompting, though (s)he may require a hearing or visual aid, other assistive device, or extra time to understand the information. 5 = Standby Prompting—The patient understands directions and conversation about basic daily needs more than 90% of the time. The patient requires prompting (slowed speech rate, use of repetition, stressing particular words or phrases, pauses, visual or gestural cues) less than 10% of the time. 4 = Minimal Prompting—The patient understands directions and conversation about basic daily needs 75 to 90% of the time. 3 = Moderate Prompting—The patient understands directions and conversation about basic daily needs 50 to 74% of the time. 2 = Maximal Prompting—The patient understands directions and conversation about basic daily needs 25 to 49% of the time. Understands only simple, commonly used spoken expressions (e.g., hello, how are you) or gestures (e.g., waving good-bye, thank you). Requires prompting more than half the time. 1 = Total Assistance—The patient understands directions and conversation about basic daily needs less than 25% of the time, or does not understand simple, commonly used spoken expressions (e.g., hello, how are you) or gestures (e.g., waving good-bye, thank you), or does not respond appropriately or consistently despite prompting Question Title 20. The patient needs help to express basic needs of hunger, thirst or discomfort only rarely. 7 = Complete Independence. The patient expresses complex or abstract ideas clearly and fluently (not necessarily in English). 6 = Modified Independence. In most situations, the patient expresses complex or abstract ideas relatively clearly or with only mild difficulty. The patient does not need any prompting, but (s)he may require an augmentative communication device or system. 5 = Standby Prompting. The patient expresses basic daily needs and ideas more than 90% of the time. Requires prompting (e.g., frequent repetition) less than 10% of the time to be understood. 4 = Minimal Prompting. The patient expresses basic daily needs and ideas 75 to 90% of the time. 3 = Moderate Prompting. The patient expresses basic daily needs and ideas 50 to 74% of the time. 2 = Maximal Prompting. The patient expresses basic daily needs and ideas 25 to 49% of the time. The patient uses only single words or gestures, and (s)he needs prompting more than half the time. 1 = Total Assistance. The patient expresses basic daily needs and ideas less than 25% of the time, or does not express basic needs appropriately or consistently despite prompting. Done