Intent:
To examine the areas of function that are most commonly associated with independent living.
Definitions:
Meal Preparation — How meals are prepared (e.g., planning meals, assembling ingredients, cooking, setting out food and utensils.) This item should be assessed in terms of the person’s ability to put meals together, regardless of the quality or nutritional value of the meal. For example, if the person is able to make cold cereal for breakfast, or put together a cold sandwich and drink coffee at lunch, or make toast for dinner without assistance, the person would be scored as independent in meal preparation capacity.
Ordinary Housework — How ordinary work around the house is performed (e.g., doing dishes, dusting, making bed, tidying up, laundry.)
Managing Finances — How bills are paid, checkbook is balanced, household expenses are budgeted, credit card account is monitored.
Managing Medications — How medications are managed (e.g., remembering to take medicines, opening bottles, taking correct drug dosages, giving injections, applying ointments.)
Phone use — How telephone calls are made or received (with assistive devices such as large numbers on telephone, amplification as needed.)
Stairs — How a full flight of stairs is managed (i.e., 12-14 stairs). [Note – if the person is able to go up and down only a half flight (2-6 stairs), do not score as independent.]
Shopping — How shopping is performed for food and household items (e.g., selecting items, paying money) – EXCLUDE TRANSPORTATION.
Transportation — How person travels by public transportation (navigating system, paying fare) or drives self (including getting out of the house, into and out of vehicles).
Process:
Question the person about his or her performance of normal activities around the home or in the community in the last 3 days. You may also talk to family members if they are available. Use your own observations as you are gathering information for other interRAI HC items.
IADL SELF-PERFORMANCE — Measures what the person actually did within each IADL category in the last 3 days. Do not base your coding on what the person might be capable of doing (see IADL CAPACITY item).
CAPACITY — Code based on the person’s presumed ability to carry out the activity. This requires speculation by the assessor.
Coding:
Note - Code each item for both Performance and Capacity
0 = Independent — No help, set up, or supervision
1 = Setup help only
2 = Supervision — Oversight/cuing
3 = Limited Assistance — Help on some occasions
4 = Extensive assistance — Help throughout task, but performs 50% or more of tasks on own
5 = Maximal assistance — Help throughout task, but performs less than 50% of task on own
6 = Total dependence — Full performance of activity during entire period by others
8 = Activity did not occur — During entire period [Do not use this code in scoring capacity].
Because of lack of skills or experience in performing some activities, some individuals may not perform an activity, but would be capable of doing so with the proper training or opportunity. Therefore, it is important to distinguish between physical capability and non-performance for reasons not related to health problems affecting capacity. For example, some males may never have learned to cook, and some females may never have handled financial matters. For some activities, the person may perform the activity independently at times, but receive/require assistance at other times. First, determine whether the person actually performed the activity. If not, evaluate whether the person is capable of performing the task.
Examples
Mrs. Q does not do her shopping. Her daughter visits every Sunday, gets the list from her mother, and does the shopping. Mrs. Q, while appreciating her daughter, feels she would have no difficulty doing the shopping on own.
Code: Shopping Self-Performance = 6; Shopping Capacity = 0.
The following are two possible conversations between the assessor and a person, both dealing with meals.
Assessor: Do you prepare your own meals? [For example, do you plan your meals, gather ingredients together, cook, and lay out your food utensils?]
Person: No, I can’t do it.
Assessor: Who gets your breakfast?
Person: I get myself some cold cereal.
Assessor: How about lunch?
Person: I get meals-on-wheels 5 days a week.
Assessor: What about the weekends?
Person: They leave me enough to heat up in the microwave. Or, my neighbors or family send lunch over.
Assessor: Who fixes dinner?
Person: I just fix a snack. Or, my homemaker fixes dinner and leaves it to be heated up.
Assessor: Could you manage to get yourself something to eat without this help?
Person: All I could do is get some cold food. I am really too unsteady to cook at a stove.
Code: Meals Self Performance = 5 (Maximum Assistance); Meals Capacity = 4 (Extensive Assistance)
Assessor: Do you prepare your own meals?
Person: No, my wife takes care of that.
Assessor: Do you ever get your own breakfast?
Person: No, she gets me cold cereal and fruit, with coffee every morning.
Assessor: Do you ever get your own lunch?
Person: Sometimes if my wife is out.
Assessor: Did you do it in the last 3 days?
Person: No.
Assessor: So, are you saying that she prepares the main meal and heavy cooking?
Person: Yes.
Assessor: Could you do the cooking if you had to?
Person: Yes, not as well as my wife as she is a real pro, but I could manage.
Code Meals Self Performance = 6 (Total dependence), Meals Capacity = 0 (Independent)
IADL Example |
Performance Code |
Capacity Code |
Mrs. Y has not made any meals for herself over the last 3 days. Her daughter is visiting and she is doing all the cooking. Mrs. Y tells you she can do all her own meal preparation. |
For the last 3 days Mrs. Y’s daughter has been making the meals.
Code = 6, Total dependence
|
Client states she usually fixes her own meals.
Code = 0, Independent |
Mr. D’s niece helps him with finances such as paying bills and keeping track of the accounts. Mr. D and his niece work on this together. Mr. D. gets the bills out and the checkbook and bank accounts. The niece writes out the checks, puts stamps on envelopes and mails them. She also does any needed banking. Mr. D likes this arrangement and feels that he would be unable to do any more of the activity himself.
Over the last 3 days Mr. D has not done any financial activities.
|
In last 3 days, Mr. D has not done any financial management.
Code = 8, Activity did not occur |
Mr. D’s niece helps him with finances. She does more than 50% of the sub-tasks.
Code = 5, Maximal Assistance |
Ms. A has a visit from a skilled nurse every week. The nurse puts 7 days worth of correct medications into Mrs. A’s pill caddy. The nurse calls in the refills and the pharmacy delivers them. Ms. A does remember to take her medications each day on her own. The nurse refilled her pill caddy 3 days ago. Ms. A has problems with remembering to take her medications correctly if the pre-filled caddy is not available.
|
All Ms. A does is remember to take pills in the caddy, and swallows them at the correct times. The nurse is doing > 50% of sub-tasks of medication management.
Code = 5, Maximal Assistance |
There is no difference between Ms. A’s performance and capacity.
Code = 5, Maximal Assistance |