Functional Assessment Scale

Directions: Check the most appropriate box to indicate the amount of assistance required for the specific daily living skill: None, Minimal, Moderate, Extensive, and Total.

	None (1)	Minimal (2)	Moderate (3)	Extensive (4)	Total (5)
1. PREPARING MEALS: Identify the consumer’s ability to prepare own food. Consider safety issues such as whether burners are left on.
2. EATING MEALS: Identify the level of assistance needed to perform the activity of feeding and eating with special equipment if regularly used or special tray setup.
3. TOILETING: Identify the consumer’s ability to get to and from the toilet (including commode, bedpan, and urinal), to cleanse after eliminating, and to adjust clothing.
4. AMBULATION: Identify the consumer’s physical ability to get around, both inside and outside, using mechanical aids if needed.
5. TRANSFERRING: Identify the consumer’s ability to transfer when in bed or wheelchair.
6. PERSONAL HYGIENE: Identify the consumer’s ability to shave, care for mouth, and comb hair.
7. DRESSING: Identify the consumer’s ability to dress and undress, including selection of clean clothing or appropriate seasonal clothing.
8. BATHING: Identify the consumer’s ability to bathe and wash hair.
9. ACCESS TO TRANSPORTATION Identify the consumer’s ability to get to and from stores, medical facilities, and other community activities, considering the ability both to access and use transportation.
10. FINANCES: Identify the consumer’s ability to handle paying bills, managing checking/savings accounts, and overseeing other items which are part of a household budget.
11. SHOPPING: Identify the consumer’s ability to shop for food and personal items.
12. LAUNDRY: Identify the consumer’s ability to do own laundry either at home or at laundromat.
13. HOUSEWORK: Identify the consumer’s ability to clean surfaces and furnishings in his/her living quarters, including dishes, floors, and bathroom fixtures, and disposing of household garbage.
14. NIGHT NEEDS: Identify the consumer’s need for assistance during the night.
15. EMERGENCY RESPONSE: Identify the consumer’s ability to recognize the need for and to seek emergency help.
16. MEDICATION: Identify the consumer’s ability/willingness to administer his/her own medication.
17. SUPERVISION: Identify the consumer’s ability to manage his/her life, including needs and activities.

(FAS) Developed by the Idaho Department of Health and Welfare

Functional Assessment Scale -- Instructions

(Assessment of Functional Abilities and Supports)

Measurements of functional abilities and supports are commonly used across the country as a basis for differentiating among levels of care giving. Functional abilities and supports are the degrees of independence with which a consumer performs Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs).

Points to Remember when Assessing Functional Abilities and Supports

There are three important points to remember when assessing functional abilities and supports:

a) Functional abilities and supports are measures of the consumer’s impairment level and need for personal assistance. In many cases, impairment level and need for personal assistance are described by the help received, but this could lead to an inaccurate assessment. For example, a disabled consumer needs help to perform an activity in a safe manner, but he/she lives alone, has no formal supports, and “receives no help.” Coding the consumer’s performance as “independent” because no help is received is very misleading in terms of the actual impairment level. In order to avoid this type of distortion, interpret the ADLs in terms of what is usually needed to safely perform the entire activity.

b) Second, an assessment of functional abilities and supports are based on what the consumer is able to do, not what he/she prefers to do. In other words, assess the consumer’s ability to do particular activities, even if he/she doesn’t usually do the activity. Lack of capacity should be distinguished from lack of motivation, opportunity, or choice. This is particularly relevant for the IADLs mentioned above. For example, when asking someone if he/she can prepare light meals, the response may be “no”, he/she does not prepare meals, even though the consumer may be able to do so. The consumer should be coded as not needing help. If a consumer refuses to perform an activity, thus putting himself/herself at risk, it is important to probe for the reason why the consumer refuses, in order to code the activity correctly. The emphasis in this section is on assessing whether ability is impaired. Physical health, mental health, cognitive, or functional disability problems may manifest themselves as the inability to perform ADL and IADL activities. If a consumer is mentally and physically free of impairment, there is not a safety risk to the consumer, and the consumer chooses not to complete an activity due to personal preference or choice, indicate that the consumer does not need help.

c) The emphasis of the measurement of each of the functional activities should be how the consumer usually performed the activity over the past two weeks. For example, if a consumer usually bathes with no help or reminding/cuing, but on the date of the interview requires some assistance with bathing, code the consumer as not requiring help unless the consumer’s ability to function on the date of the assessment accurately reflects ongoing need.

There are several components to each functional activity, and the coded response is based on the consumer’s ability to perform all the components. For example, when assessing the consumer’s ability to bathe, it is necessary to consider all of the bathing activities such as getting in and out of the tub, preparing the bath, washing, and towel drying.

Base the selection of the amount of assistance required (None, Minimal, Moderate, Extensive, and Total) on the consumer’s ability to perform each activity on the day of the review. Base the selection according to how the consumer would perform each item if the consumer lived on his/her own. If the consumer has a temporary problem on the day of the review which interferes with how the activity is usually performed, base the selection on the consumer’s most typical performance. If the consumer often has wide variations in performance of the activity, base the selection on the most dependent performance. When completing this functional assessment, utilize all available information. Your contacts and interviews with the consumer are important, and feedback from the family and documentation can also be helpful.

Examples of how to rate the categories on the FAS follow.

Descriptions/Examples of Functional Needs

(Note: There is an example for each category on the measure. The scale is

N=None, MI=Minimum, MO=Moderate, E=Extensive, and T=Total)

1. Preparing Meals

-- Capable of preparing nutritious meals. (N)

-- Capable of eating main meal at meal site or restaurant or receiving home-delivered meals and can fix other meals as required. (MI)

-- Needs assistance to prepare main meal and can fix most other simple meals required. (MO)

-- Needs assistance to prepare all meals. (E)

-- Cannot prepare any meals. (T)

2. Eating Meals

-- Can feed self, chew, and swallow solid foods without difficulty or can feed self by gastrostomy tube or catheter. (N)

-- Can feed self, chew, and swallow foods but needs reminding/cuing to maintain adequate intake, or may need food cut up. (MI)

-- Can feed self only if food is brought to them. (MO)

-- Can feed self but needs standby assistance or cuing. May have occasional gagging, choking, or swallowing difficulty, or require assistance with feeding appliances. (E)

-- Must be fed by another person by mouth, or gastrostomy tube. (T)

3. Toileting

-- Can toilet self without physical assistance or supervision. May need grab bars / raised toilet seat or can manage own closed drainage system if has a catheter or sheath or uses protective aids. (N)

-- Needs standby assistance or cuing for safety or task completion. May need some physical assistance with parts of the task such as clothing adjustment, washing hands, etc. (MI)

-- Needs physical assistance with parts of the task such as wiping, cleansing, clothing adjustment. May need a protective garment. (MO)

-- Cannot get to the toilet unassisted. May or may not be aware of need. (E)

-- Physically unable to be toileted. Requires continual observation and total cleansing. Needs someone else to manage care of closed drainage system if they have catheter or sheath. (T)

4. Ambulation

-- Can get around inside and outside without assistance. (N)

-- Can get around inside without assistance but needs assistance outside. (MI)

-- Needs occasional assistance inside and usually needs assistance outside. (MO)

-- Can only get around with regular assistance both inside and outside. (E)

-- Cannot move around even with regular assistance. (T)

5. Transferring

-- Can transfer independently and can manage own position changes. (N)

-- Transfers and changes position most of the time but needs assistance on occasion. (MI)

-- Can assist with own transfers and position changes but needs assistance most of the time. (MO)

-- Can assist with own transfers and position changes but needs assistance all of the time. (E)

-- Transfers / position changes must be done by one person all of the time. (T)

6. Personal Hygiene

-- Can manage personal hygiene without reminders, assistance, or supervision. (N)

-- Can manage personal hygiene but must be reminded/cued at least some of the time. (MI)

-- Performs personal hygiene but requires physical assistance to complete. (MO)

-- Caregiver performs most personal hygiene but consumer assists. (E)

-- Dependent on others to provide all personal hygiene. (T)

7. Dressing

-- Can dress / undress and select clothing without assistance or supervision. (N)

-- Can dress / undress and select clothing but may need to be reminded / supervised. (MI)

-- Can dress / undress and select clothing with assistance. (MO)

-- Caregiver dresses / undresses and selects clothing but consumer assists. (E)

-- Dependent upon others to do all dressing / undressing. (T)

8. Bathing

-- Can bathe without reminders and without assistance or supervision. (N)

-- Can bathe without physical assistance but may need reminding or standby assistance. (MI)

-- Requires assistance or cuing with parts of bathing, (i.e., washing back, feet, rinsing hair, etc.). Includes people who cannot get into / out of tub and may require some other assistance. (MO)

-- Caregiver bathes the consumer with consumer’s assistance. (E)

-- Dependent on others to provide complete bath, including shampoo. (T)

9. Access to Transportation

-- Can drive safely or is capable of using alternate transportation without assistance. (N)

-- Can use available transportation but needs instruction or physical assistance to get to or from transportation vehicle. (MI)

-- Can use available transportation if physical assistance or cuing is provided to both get into and out of vehicle, but assistance is not needed during trip. (MO)

-- Is dependent upon being accompanied to access the community. (E)

-- Medical condition is such that an ambulance is required. (T)

10. Finances

-- Handles financial business matters. (N)

-- Needs occasional assistance with financial business matters. (MI)

-- Needs help with some financial business. (MO)

-- Needs extensive helping managing financial business matters. (E)

-- Unable to handle financial business matters. (T)

11. Shopping

-- Can shop without assistance. (N)

-- Shops without physical assistance but may need to be reminded / supervised. (MI)

-- Can shop with physical assistance or cuing from caregiver. (MO)

-- Caregiver shops but consumer assists. (E)

-- Totally dependent upon others for shopping. (T)

12. Laundry

-- Is capable of doing laundry. (N)

-- Does laundry without assistance but may need to be reminded / supervised. (MI)

-- Can do laundry but needs physical assistance or reminding/cuing from caregiver. (MO)

-- Caregiver does the laundry but consumer assists. (E)

-- Totally dependent upon others to do laundry within/outside the home. (T)

13. Housework

-- Performs housecleaning with no assistance. (N)

-- Physically capable of performing all housecleaning but needs to be reminded / supervised. (MI)

-- Performs light housecleaning without supervision or cuing and caregiver handles physically difficult housecleaning. (MO)

-- Performs light housecleaning with supervision or cuing and caregiver handles physically difficult housecleaning. (E)

-- Totally dependent upon others for all housecleaning. (T)

14. Night Needs

-- Needs no assistance from another person during the night. (N)

-- Occasionally requires assistance from caregiver at night. (MI)

-- Requires care at night, but caregiver can get at least five hours of sleep during an eight-hour period. (MO)

-- Requires care at night, and caregiver cannot get at least five hours of sleep during an eight-hour period. (E)

-- Requires licensed staff to be up and awake all night. (T)

15. Emergency Response

-- Needs no assistance to get outside of present dwelling or get emergency help. Is able to use the phone in emergency situations. (N)

-- Needs supervision and / or verbal cuing to get outside of present dwelling or get emergency help. (MI)

-- Caregiver must assist to get outside of present dwelling, but consumer can assist. (MO)

-- Requires some physical assistance to get outside of present dwelling. (E)

-- Requires total physical assistance to get outside of present dwelling. (T)

16. Medication

-- Can self-administer medication without assistance. (N)

-- Requires minimal physical assistance (i.e. open containers only); understands medication routine. (MI)

-- Requires occasional supervision / cuing to follow medication routine. (MO)

-- Requires supervision / cuing; must be reminded to take medications; does not know medication routine; may not remember if took medications. (E)

-- Requires professional to administer medication. (T)

17. Supervision

-- No supervision required beyond that included in the previous answers. (N)

-- Requires occasional voice cues and prompts. (MI)

-- Requires frequent voice cues and prompts. (MO)

-- Requires both physical and voice prompts most of the time. (E)

-- Consumer requires a behavior management program. Supervision must be available all the time, and behavior is controlled by the program with only occasional outbursts. (T)