210 R.I. Code R. 210-RICR-50-10-2.15
Independent | LTSS beneficiary is independent in completing the task safely. |
Set-Up | LTSS beneficiary requires brief supervision, cueing, reminder and/or set- up assistance to perform the task. |
Minimum | LTSS beneficiary is actively involved in the activity, requires some hands- on assistance for completion, thoroughness or safety. Needs verbal or physical assistance with twenty-five (25%) of the task. |
Moderate | LTSS beneficiary requires extensive hands-on assistance but is able to assist in the process. Needs verbal or physical assistance with fifty percent (50%) of the task. |
Extensive | LTSS beneficiary requires verbal or physical assistance with seventy-five percent (75%) of the task. |
Total Assistance | LTSS beneficiary cannot participate or assist in the activity and requires one hundred percent (100%) assistance with the task. |
Not Applicable | This task does not apply to this LTSS beneficiary. |
ADL/IADL | Functional Characteristics |
Bowel | Behavioral Issues, Limited ROM, Spasticity/Muscle Tone |
Dressing | Behavioral Issues, Limited ROM, Spasticity/Muscle Tone |
Eating | Behavioral Issues, Fine Motor Deficit, Spasticity/Muscle Tone |
Grooming | Cognitive, Limited ROM, Spasticity/Muscle Tone |
Mobility | Balance Problems, Decreased Endurance, Pain, Spasticity/Muscle Tone |
Shower | Balance Problems, Behavioral Issues, Limited ROM, Spasticity/Muscle Tone |
Skin Care | Open Wound |
Sponge Bath | Behavioral Issues, Limited ROM, Spasticity/Muscle Tone |
Transfers | Balance Problem, Limited ROM, Spasticity/Muscle Tone |
Tub Bath | Balance Problem, Behavioral Issues, Limited ROM, Spasticity/Muscle Tone |
Urinary/Menses | Behavioral Issues, Limited ROM, Spasticity/Muscle Tone |
Communications | No Functional Characteristics |
Housework | LTSS beneficiary Lives Alone |
Meal Preparation | No Functional Characteristics |
Shopping | No Functional Characteristics |
Activity | Unit Time | Functional Time |
Sponge Bath | 30 | 45 |
Shower | 20 | 40 |
Tub Bath | 40 | 45 |
Dressing | 15 | 20 |
Eating | 20 | 40 |
Mobility | 10 | 10 |
Urinary/Menses | 10 | 15 |
Transfers | 5 | 10 |
Grooming | 8 | 8 |
Skin Care | 10 | 10 |
Bowel | 30 | 50 |
Meal Preparation | 25 | 25 |
House Work | 12.5 | 25 |
Communications | 15 | 15 |
Shopping | 60 | 60 |
Medications | 2 | 5 |
Level of Assistance | Sponge Bath | Shower | Tub Bath | Dressing | Eating | Mobility | Urinary Menses | Transfers | Grooming | Skin Care | Bowel |
Total Assist | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
Maximum Assist | .75 | .75 | .75 | .75 | .75 | 1 | .75 | 1 | .75 | 1 | .75 |
Moderate Assist | .5 | .5 | .5 | .5 | .5 | .75 | .5 | .75 | .5 | .75 | .5 |
Minimum Assistance | .25 | .25 | .25 | .25 | .25 | .75 | .25 | .75 | .25 | .25 | .25 |
Set-Up Assistance | .15 | .15 | .15 | .15 | .15 | .20 | .15 | .20 | .15 | .20 | .15 |
Independent | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Level of Assistance | Meal Preparation | Housework | Communications | Shopping |
Total Assist | 1 | 1 | 1 | 1 |
Maximum Assist | 1 | 1 | 1 | 1 |
Moderate Assist | .75 | .75 | .75 | 1 |
Minimum Assistance | .5 | .5 | .5 | 1 |
Set-Up Assistance | .25 | .25 | .25 | 1 |
Independent | 0 | 0 | 0 | 0 |
210 R.I. Code R. 210-RICR-50-10-2.15