long-term care - Legislative Reference Bureau

CONCEPT OF A SINGLE ENTRY POINT
Of course, an assessment would be incomplete if limited to only ADLs and IADL
performance measures. The following are also generally included in an assessment: 47
1. Cognitive capacity;
2. Social interaction;
3. Family support;
4. Resources in the physical environment;
5. Mental health functioning.
Sample Assessment Tool: . Attached as Appendix B is a sample assessment tool used
by the Wisconsin Department of Health and Social Services entitled the "Model Long Term
Care Assessment Tool," dated May 1995. In addition, the Arizona Department of Economic
Security uses a tool entitled the "Arizona Minimum Assessment." This latter form covers the
following broad topics:
I. IDENTIFYING INFORMATION:
(1) Personal identification data
(2) Marital status
(3) Educational level
(4) Ethnicity
(5) Primary language spoken
(6) Referral source
(7) Personal/legal status
(8) Current living arrangement (including subsidized housing)
(9) Household composition
(10) Financial eligibility
(11) Current use of housekeeper, home health aide, visiting nurse
(12) Source and amount of income
II. INSTRUMENTAL ACTIVITIES OF DAILY LIVING -- STATUS, SOURCE OF HELP,
USE OF ASSISTIVE DEVICES, AND CLIENT NEEDS, WITH SPACE FOR
ADDITIONAL COMMENTS, FOR:
(1) Medication use
(2) Meal preparation
(3) Shopping
(4) Financial management
(5) Telephone use
(6) Transportation
(7) Housework
(8) Laundry
III. PERSONAL ACTIVITIES OF DAILY LIVING -- STATUS, SOURCE OF HELP, USE OF
ASSISTIVE DEVICES, AND CLIENT NEEDS, WITH SPACE FOR ADDITIONAL
COMMENTS, FOR:
(1) Bathing and grooming
(2) Dressing
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