documenting dementia capable care

© Copyright Synergy Care, Inc. 2019. CONFIDENTIAL – Synergy Care, Inc. Proprietary Document

Documenting Dementia Capable Care

1. Therapists should identify the person’s best ability to function, based on their

assessment and identification of the patient’s Allen Cognitive Level (ACL) and select

treatment goals and methods that maximize those abilities.

2. The short term goal is to match the assistance given to the person’s current ability to

function. The long term goal is to observe an improvement in ability to function within a

given time period.

3. Treatment goals should be stated as functional goals. Functional goals state what the

patient will do and give a reason for the behavior. Goals match the person’s best ability

to function at the present time.

4. The assessment of ability to function is divided into three parts: what the person can do,

will do and may do.

5. Therapists should have a major role in discharge planning to make sure the remaining

abilities are used safely. The discharge summary must indicate the skilled adaptations

and training provided for maintaining functional levels or prevention of risks or decline

related to the chronic illness.

Discharge planning should include:

- education of the person’s caregiver about what is the person’s best ability

to function

- what type of cognitive and physical assistance is required, and

- what safety precautions are applicable to the person.

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Goal Examples

LTG:

PT/OT/ST

(DCCLTG) (Who) will (reason for referral/problem) with (BATF-cog and physical assistance) provided (who?) to (prevent,

minimize or maintain) within (timeframe)

STG:

PT-OT-ST-

(ACL1) Pt will respond to (sensory stimulation) with automatic actions of (desired action) to prevent or minimize (reason

for referral/problem), with sensory stimulation provided by a competent caregiver.

PT

(ACL2PT) Pt will transfer with (verbal, visual and/or tactile) cues and minimum physical assist, as provided by a

competent caregiver.

(ACLLow3PT) Pt will ambulate from resident room to dining room three times daily using a rolling walker with (verbal,

visual and/or tactile) cues and minimum physical assist, as provided by competent caregiver.

(ACLLow4PT) Pt will perform LE HEP with (verbal, visual and/or tactile) cues, and minimum physical assist, as provided by

a competent caregiver.

OT

(ACL2OT) Pt will feed self with (level of cognitive assist) cognitive assist, as provided by a competent caregiver.

(ACLLow3OT) Pt will perform oral hygiene with (level of cognitive assist) cognitive assist, as provided by a competent

caregiver.

(ACLLow4OT) Pt will complete a morning ADL care routine with (level of cognitive assist) cognitive assist, as provided by

a competent caregiver.

ST

(ACL1AwarenessSLP) The resident will respond to stimulation of environment sounds demonstrated through variations

in arousal or physical effect on (____ out of ____ occasions).

(ACL2ST) Pt will identify target vocabulary used in ADLs in response to closed ended questions with (verbal, visual and/or

tactile) cues, as provided by a competent caregiver.

(ACL2.2NamingSLP) The resident will identify target vocabulary used in ADLs in response to open-ended responses or

cloze techniques on (____ out of ____ occasions).

(ACL2.6/8RepetitionSLP) The resident will produce familiar phrases in unison with the facilitator on (____ out of ____

occasions).

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Goal Examples

(ACLLowSLP) Pt will state basic and/or social needs with (verbal, visual and/or tactile) cues, as provided by a competent

caregiver.

(ACL3.4Language) The resident will generate simple phrases using verb + ing constructions on (____ out of ____

occasions) while participating in ADLs or social events.

(ACL3.8Expression) The resident will state basic and/or social needs when prompted with relevant content words or

revised verbal attempts on (____ out of ____ occasions)..

(ACLLow4SLP) Pt will generate a daily activity list with (verbal, visual and/or tactile) cues, as provided by competent

caregiver.

(ACL4.2WhQuestions) The resident will respond to “wh” questions about anticipated or scheduled events using

visual/graphic cues on (____ out of ____ occasions).

(ACL4.8Memory) The resident will generate a daily activity list with minimal assistance over (number of days)

consecutive days.

(ACL4MemoryBook) Resident will utilize a memory book, which includes a daily activity schedule with (percentage)

accuracy with intermittent verbal cues to increase orientation and decrease perseveration.

(ACL4Attention) Resident to attend/concentrate on a structured tasks for 30-minute intervals with intermittent verbal

cues for redirection.

(ACL3ReceptiveLanguage) Resident to demonstrate functional usage of an ADL object appropriately for receptive

language ability with (percentage) accuracy, with extended time for processing and with environmental setup.

(ACL3Naming) Resident will name three objects used during functional tasks with (percentage) accuracy with extended

time for processing and with environmental setup.

(ACL3Attention) Resident to attend/concentrate on a structured task for 15 minute intervals with intermittent verbal,

visual and tactile cues for redirection and with environmental setup.

(ACL2Singing)Resident will sing a refrain for a song with continuous auditory cues to strength vocal cords, increase lung

capacity and reduce risk of aspiration.

(ACL2Attention) Resident to attend/concentrate on a structured tasks for five-minute intervals with constant verbal,

visual and tactile cues for redirection and with environmental set-up.

(ACL1SensoryStim) Resident will respond vocally to sensory stimulation three times per session with constant verbal

cues to increase management of secretions/excretions.

These examples are from the Dementia Capable Care: Dementia Therapy Applications book created by Kim Warchol- Dementia Care

Specialists/Crisis Prevention Institute.

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Goal Examples

**Some goals may apply to more than one discipline**

Grooming

(Grooming3.0) Pt will grasp grooming objects. Caregiver will provide familiar safe objects and will cue with associated

action.

(Grooming3.2) Pt will initiate familiar actions of brushing, combing. Caregiver will supervise and provide assistance to

avoid harmful effects, ensure effective results.

(Grooming3.4) Pt will maintain grooming actions and cooperative with caregiver assistance. Caregiver will provide tools

and objects and appropriate supervision to avoid harmful or undesirable effects.

(Grooming3.6) Pt will note effects and will imitate changes in location and duration of actions. Caregiver will supervise,

provide appropriate assistance to avoid harmful effects.

(Grooming3.8) Pt will recognize completion of grooming tasks. Caregiver will supervise and provide appropriate

assistance to avoid harmful effects. Caregiver will arrange for long-term or special dental care.

(Grooming4.0) Pt will complete familiar routine of grooming with assistance in set-up and to avoid harmful effects.

Caregiver will provide familiar tools in accessible locations; will supervise use of new and potentially dangerous tools and

materials. Will schedule dental check-ups.

(Grooming4.2) Pt will complete familiar routine of grooming tasks with assistance to avoid harmful effects. Caregiver will

assist with error correction and supervise use of harmful materials.

(Grooming4.4) Pt will complete familiar routine of grooming with assistance to avoid harmful effects. Caregiver will

assist with error correction and supervise use of harmful materials and new procedures and products.

(Grooming4.6) Pt will complete familiar grooming routines with some variations from his or her standard performance

with assistance to avoid harmful or undesirable effects. Caregiver will assist with error correction and supervise use of

new or potentially harmful products.

(Grooming4.8) Pt will correct perceived errors one at a time in grooming tasks and will follow explanations of harmful

secondary effects to be avoided in shaving, dental, nail and hair care. Caregiver will monitor use of new supplies and

provide explanations of potential hazards.

(Grooming5.0) Pt will complete routine grooming care independently with assistance to avoid harmful effects in new

tasks. Caregiver will explain secondary effect and provide assistance with spatial and surface properties.


tasks. Caregiver will explain and provide secondary effects and provide assistance with spatial properties.


tasks Caregiver will explain secondary effects and consequences of failing to consider social rules governing appearance.


tasks. Caregiver will explain potential harmful secondary effects of new procedures/products.

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Goal Examples

Dressing

(Dressing2.0) Pt will move arms, legs, trunk in response to cues to assist with dressing. Caregiver will dress pt, apply

adaptive equipment to avoid medical complications.

(Dressing2.2, .4, .6) Pt will push arms and legs through garments when cues to assist with dressing. Caregiver will dress

pt, apply adaptive equipment to avoid medical complications.

(Dressing2.8) Pt will use grab bars or other objects for stability while dressing. Caregiver will dress pt, apply adaptive

equipment to avoid medical complications.

(Dressing3.0) Pt will grasp garments when these are handed to him/her. Caregiver will select and assist with donning

clothes and adaptive equipment.

(Dressing3.2) Pt will grasp and begin correct actions of donning familiar garments. Caregiver will select and assist with

donning clothes and adaptive equipment.

(Dressing3.4, .6) Pt will complete dressing with caregiver assistance. Caregiver will provide appropriate assistance.

Caregiver will provide appropriate assistance, check results and correct errors. Caregiver will monitor for correct

adjustment of donned items.

(Dressing3.8) Pt will dress self and recognize completion with assistance in selection and donning. Caregiver will provide

assistance in selection and donning, will check results and correct errors. Will apply and adjust adaptive equipment.

(Dressing4.0) Pt will initiate and complete dressing at customary time of day with assistance in selection and donning.

Caregiver will provide assistance in selection and donning, will check results and correct errors. Will apply and adjust

adaptive equipment.

(Dressing4.2) Pt will select clothing based on matching cues and will don common garments independently. Caregiver

will provide assistance as necessary with new garments, fasteners, and will monitor and correct dressing errors.

Caregiver will apply and monitor complex adaptive equipment.

(Dressing4.4) Pt will initiate and complete dressing using familiar combinations of clothing with assistance with new and

difficult fasteners. Pt will apply simple splint or other devices with assistance. Caregiver will provide assistance as

necessary with new garments, fasteners, and will monitor and correct dressing errors. Caregiver will apply and monitor

complex adaptive equipment.

(Dressing4.6) Pt will dress self independently and will vary combinations one feature at a time. Will apply simple splints

or pre-adjusted slings. Caregiver will provide assistance as necessary with new garments, fasteners, and will monitor and

correct dressing errors. Caregiver will apply and monitor complex adaptive equipment.

(Dressing4.8) Pt will select garments considering all striking features with caregiver assistance to consider secondary

effects. Caregiver will provide assistance as necessary with new garments, fasteners, and will monitor and correct

dressing errors. Caregiver will apply and monitor complex adaptive equipment. Caregiver will monitor fit and function of

complex adaptive equipment to avoid medical complications.

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Goal Examples

(Dressing5.0) Pt will successfully vary range of motion and strength to don garments. Caregiver will explain secondary

effects of selections to avoid undesirable consequences.

(Dressing5.2) Pt will select garments considering surface properties. Caregiver will explain secondary effects of

selections to avoid undesirable consequences.

(Dressing5.4) Pt will solve new provides involving spatial properties in dressing. Caregiver will explain secondary effects

of selections to avoid undesirable consequences.

(Dressing5.6) Pt will consider coordination of clothing for pleasing effects with caregiver assistance to identify social

consequences. Caregiver will explain secondary effects of selections to avoid undesirable consequences.

(Dressing5.8) Pt will consider tangible secondary effects when selecting garments, and will adjust pace of dressing as

needed. Caregiver will explain secondary effects of selections to avoid undesirable consequences.

(Dressing6.0) Pt dresses self, including putting on and removing adaptive equipment, independently and in a timely

fashion.

Bathing

(Bathing2.4,.6) Pt will cooperate with bathing by moving body parts. Caregiver will maintain cleanliness of pt to avoid

undesirable medical complications.

(Bathing2.8) Pt will cooperate with bathing by using grab bars to stabilize.

(Bathing3.0) Pt will grasp familiar bathing tools when placed in hand. Caregiver will initiate and supervise bathing,

providing assistance.

(Bathing3.2) Pt will start and stop actions on command. Caregiver will initiate and supervise bathing, providing

assistance.

(Bathing3.4) Pt will sustain familiar actions to complete a bath or shower and shampoo with assistance to sequence

actions. Caregiver will initiate and supervise bath and shampoo; will sequence through actions.

(Bathing3.6) Pt will imitate modifications in manual actions to complete bathing more effectively. Caregiver will initiate,

supervise bathing. Will demonstrate modifications for more effective results.

(Bathing3.8) Pt will follow cues to complete bathing and shampooing routing and will state when he or she is done.

Caregiver will initiate, supervise bathing. Will demonstrate modifications for more effective results.

(Bathing4.0) Pt will complete bath or shower with set-up to avoid harmful effects. Caregiver will provide familiar, safe

set-up, and be available to solve problems, check results.

(Bathing4.2) Pt will initiate and complete bathing by securing own supplies from visible locations, with assistance to

avoid harmful effects. Caregiver will provide familiar, safe set-up, and be available to solve problems, check results.

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Goal Examples

(Bathing4.4) Pt will initiate and complete a familiar bathing routine in home environment with assistance to avoid

harmful effects. Caregiver will provide familiar supplies, will correct errors, and will supervise new or potentially harmful

procedures.

(Bathing4.6) Pt will initiate and complete routine bathing with variations in daily schedule, product storage with

assistance to avoid harmful or undesirable effects. Caregiver will provide familiar supplies, will correct errors and will

supervise new or potentially harmful procedures.

(Bathing4.8) Pt will complete routing bathing independently and will check quality. Pt will understand explanations of

secondary effects. Caregiver will explain secondary effects that may result in harm or undesirable social consequences.

Eating

(Eating1.8) Caregiver will provide for nutritional needs of pt by providing soft finger foods, liquids in cups and assistance

with other foods. Pt will feed self soft finger foods.

(Eating2.0, .2) Caregiver will meet nutritional needs of pt by precutting foods and assisting with self-feeding as needed.

Pt will feed self with spoon or with gingers with assistances from caregiver.

(Eating2.8) Caregiver will meet nutritional needs of pt by precutting foods and assisting with self-feeding as needed. Pt

will feed self with conventional utensils with assistance from caregiver to cut food, open containers.

(Eating3.0, .2) Caregiver will provide for nutritional needs with appropriate food portions, restricting access to

undesirable foods, assisting with cutting and containers. Pt will feed self with conventional utensils with assistance in

cutting foods, opening containers.

(Eating3.6) Caregiver will provide for pt’s nutritional needs and will demonstrate modifications of classic eating actions

to increase effectiveness. Pt will feed self, using conventional utensils, with assistance, to comply with special dietary

needs. Pt will imitate modifications of classic eating actions.

(Eating3.8) Caregiver will provide for pt’s nutritional needs and will train in highly desirable social manners as needed. Pt

will feed self, using conventional eating utensils, with assistance, to comply with special dietary needs. Pt will be trained

to follow highly valued social routines.

(Eating4.0) Pt will feed self with conventional utensils, with assistance, to comply with special dietary needs. Will learn

to follow highly desired social routines, one step at a time. Caregiver will provide for pt’s nutritional needs and will

demonstrate modifications of classic eating actions to increase effectiveness.

(Eating4.4) Pt will feed self with conventional utensils, and will comply with reminders of standard table manners and

dietary restrictions. Caregiver will remind pt of standard table manners and will monitor compliance with dietary

restrictions.

(Eating4.8) Pt will feed self independently and will learn use of new utensils or procedures. Caregiver will identify

applications of dietary restrictions in new foods.

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Goal Examples

(Eating5.0) Pt will feed self independently and will learn use of new utensils by varying actions. Pt will comply with

dietary restrictions with assistance from caregivers. Caregiver will identify applications of dietary restrictions in new

foods.

(Eating5.8) Pt will follow dietary restrictions with assistance from others. Caregiver will identify applications of dietary

restrictions in new foods.

Toileting

(Toileting2.0) Pt will sit on toilet and cooperate with assistance. Caregiver will control bowel and bladder accidents and

prevent medical complications of incontinence.

(Toileting2.2) Pt will stand/sit on command and cooperate with pivot transfers. Caregiver will control bowel and bladder

accidents and prevent medical complications of incontinence.

(Toileting2.4) Pt will follow caregiver to bathroom and cooperate with assistance to complete toileting.

(Toileting2.6) Pt will communicate need to use toilet and cooperate with caregiver assistance. Caregiver will ask pt about

need to use toilet at regular intervals and will provide assistance to complete activities.

(Toileting2.8) Pt will use grab bars when standing and sitting and will cooperate with caregiver assistance. Caregiver will

ask pt about need to use toilet at regular intervals and will provide assistance to complete activities.

(Toileting3.0) Pt will initiate and complete toileting with appropriate assistance from caregiver. Caregiver will provide

appropriate cues to sequence pt through toileting activities and will check results to ensure safe and hygienic outcomes.

(Toileting3.4) Pt will initiate and complete toileting in familiar environment with caregiver assistance to avoid ineffective

results. Caregiver will check results and correct errors to avoid undesirable medical, social consequences.

(toileting3.6) Pt will imitate modifications of actions for better results. Caregiver will demonstrate modified actions,

check results, correct errors as needed.

(Toileting4.0) Pt will initiate and complete usual toileting routine when all supplies are available with caregiver

assistance to solve problems and avoid undesirable effects. Caregiver will provide appropriate set-up and assistance

with solving problems to avoid undesirable effects.

(Toileting4.8) Pt will independently perform toileting routine with assistance from caregiver to follow social rules.

Caregiver will identify desirable behaviors for pt to maintain social and hygienic standards.

Taking Medication

(Medication2.0-3.2) Caregiver will dispense all required medications in correct amounts at appropriate time of day to

avoid medical complications. Pt will swallow medications when given by caregivers.

(Medication3.4-3.8) Caregiver will provide medications in correct amounts at appropriate times of day and will check for

compliance, adverse reactions, or side effects. Pt will take medications with assistance from caregiver to avoid harmful

effects.

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Goal Examples

(Medication4.0-4.2) Pt will take simple dosages as prescribed with assistance from caregiver to avoid harmful effects.

Caregiver will monitor compliance, watch for undesirable effects and renew prescriptions.

(Medication4.4-4.6) Pt will take routine medications with assistance from caregiver to avoid harmful effects. Caregiver

will monitor compliance and check for adverse reactions, side effects.

(Medication4.8) Pt will secure and administer own medication in proper amounts at appropriate time of day with

assistance to avoid harmful effects. Caregiver will monitor compliance until new procedures are learned and will check

for adverse effects.

(Medication5.0) Pt will secure and take medications as prescribed and will monitor and report adverse effects to

physician. Caregiver will assist compliance by reminding to take and renew prescriptions, and explain effects as

necessary.

(Medication5.4) Pt will secure and administer medications accurately and report effects to physician with assistance

from caregiver to clarify effects. Caregiver will assist in identifying functional improvements and will clarify effects of

medication to enhance compliance.

(Medication6.0) Pt independently complies with taking medication.

Using Adaptive Equipment

(AdaptiveEq1.8) Caregiver will apply and monitor use of all adaptive equipment to avoid undesirable medical

complications. Pt will cooperate by holding body parts against gravity.

(AdaptiveEq2.0-.8) Caregiver will apply and monitor use of all adaptive equipment to avoid undesirable medical

complications. Pt will cooperate with transfers, positioning, by grabbing bars or pushing/pulling when cued by caregiver.


complications. Pt will grasp and self-feed with built-up spoons; will use wheelchair.


complications. Pt will do associate actions with equipment that resembles familiar objects.

(AdaptiveEq3.4) Caregiver will apply and supervise use of all appropriate adaptive equipment to avoid undesirable

medication complications. Pt will perform familiar actions with aid of appropriate adaptive equipment with assistance to

avoid harmful effects.

(AdaptiveEq4.0) Pt will use adaptive equipment using familiar movement patterns to complete routine tasks with

assistance from caregiver to avoid harmful effects. Caregiver will supervise application and use of adaptive equipment,

and maintain equipment to avoid undesirable medication complications.

(AdaptiveEq4.6) Pt will use adaptive equipment by familiar movement patterns and will make simple spontaneous

adjustments for better effects with caregiver assistance to avoid harmful effects. Caregiver will supervise application and

use of adaptive equipment, and will maintain equipment to avoid undesirable medical consequences.

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Goal Examples

(AdaptiveEq4.8) Pt will learn use of new equipment that does not require continuous neuromuscular adjustments with

caregiver assistance to avoid harmful effects. Caregiver will supervise use of appropriate adaptive equipment until well-

learned and will identify secondary effects to be avoided for safety reasons. Caregiver will provide appropriate

maintenance.

(AdaptiveEq5.0) Pt will learn use of equipment requiring neuromuscular adjustments with caregiver assistance to avoid

harmful effects. Caregiver will supervise use of appropriate adaptive equipment until well-learned and will identify

secondary effects to be avoided for safety reasons. Caregiver will provide appropriate maintenance.

(AdaptiveEq5.2) Pt will learn use of equipment requiring neuromuscular adjustments and will solve problems requiring

attention to all tangible features with caregiver assistance to avoid harmful effects. Caregiver will supervise use of

appropriate adaptive equipment until well-learned and will identify secondary effects to be avoided for safety reasons.

Caregiver will provide appropriate maintenance.

(AdaptiveEq5.4) Pt will learn use of equipment requiring neuromuscular adjustments and will solve problems requiring

attention to all tangible features with caregiver assistance to avoid harmful effects. Caregiver will supervise use of

appropriate adaptive equipment until well-learned and will identify secondary effects to be avoided for safety reasons.

Caregiver will provide appropriate maintenance.

(AdaptiveEq5.6) Pt will compare methods to solve problems in equipment use. Caregiver will identify potential

secondary effects to avoid undesirable consequences.

(AdaptiveEq5.8) Pt will plan out actions with assistance to identify potential harmful effects. Caregiver will identify

potential secondary effects to avoid undesirable consequences.

(AdaptiveEq6.0) Pt will use adaptive equipment effectively and safely, providing for regular maintenance to ensure

optimal function.

Housekeeping

(HouseKeep3.4) Caregiver will do all housekeeping tasks. Will supervise use of common tools using repetitive actions to

avoid harmful effects. Pt will follow demonstrated changes in location or duration of action demonstrated by caregiver.

(HouseKeep3.6) Caregiver will do all housekeeping tasks. Will supervise use of common tools using repetitive actions to

avoid harmful effects. Pt will follow demonstrated changes in location or duration of action demonstrated by caregiver.

(HouseKeep3.8) Caregiver will supervise selected housekeeping tasks by providing tools, monitoring use, checking

results. Caregiver will sequence pt through actions. Pt will follow demonstrated and verbal cues to complete selected

housekeeping tasks.

(HouseKeep4.0) Pt will completed selected routine housekeeping tasks with supervision to follow correct sequences and

avoid harmful effects. Caregiver will supervise selected housekeeping tasks, monitoring use of potentially harmful tools,

and checking effects.

(HouseKeep4.2-4.6) Pt will complete selected routine housekeeping tasks with supervision to note visible cues and avoid

harmful effects. Caregiver will supervise selected housekeeping tasks, assisting pt to solve problems and avoid harmful

effects.

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Goal Examples

(HouseKeep4.8) Pt will complete housekeeping activities and will learn by rote new procedures with assistance to avoid

harmful effects and to check problem-solving methods. Caregiver will provide assistance with rote learning for new

procedures or products and will verify new learning. Will identify potential secondary effects to avoid for safety reasons.

(HouseKeep5.0) Pt will initiate and complete routine housekeeping with assistance to solve problems involving surface

or spatial properties. Caregiver will identify secondary effects, tangible and spatial properties to be considered to avoid

harmful effects.

(HouseKeep5.2) Pt will initiate and complete routine housekeeping activities with assistance to solve problems involving

spatial properties and will follow verbal explanations of secondary effects to avoid for safety reasons. Caregiver will

identify secondary effects and spatial properties to be considered to avoid harmful effects.

(HouseKeep5.4) Pt will initiate and complete routine housekeeping with assistance in noting all tangible properties to

solve problems. Caregiver will identify secondary effects to avoid undesirable effects.

(HouseKeep5.6) Pt will compare methods to vary and improve housekeeping with assistance to avoid undesirable

effects. Caregiver will identify secondary effects to avoid undesirable effects.

(HouseKeep5.8) Pt will plan out new methods of solutions to housekeeping problems when objects are present.

Caregiver will identify secondary effects to avoid undesirable effects.

(HouseKeep6.0) Pt will plan and complete a safe, effective housekeeping routine including planning for long-term needs.

Preparing/Obtaining Food

(PrepFood3.4) Caregiver will provide healthful diet for pt, taking into account dietary restrictions and food preferences.

Pt will sustain repetitive actions to assist with food preparation or clean-up as directed by caregiver.


Pt will modify repetitive actions to assist with food preparation or clean-up as directed by caregiver.


Pt will persist at doing repetitive actions and will recognize a completed task.

(PrepFood4.0) Pt will prepare a well-learned simple meal with assistance from caregiver to provide necessary

ingredients and to avoid harmful effects. Pt will order a familiar meal in familiar restaurant with assistance from

caregiver to adjust to unexpected changes. Caregiver will plan for nutritional needs of pt taking into account food

preferences and dietary restrictions. Caregiver will provide safe tools and ingredients in visual locations for preparation

of familiar cold meals. Caregiver will remind pt of dietary restrictions and solve all new problems.

(PrepFood4.2) Pt will prepare a well-learned simple meal; will recognize visible errors and ask for help. Caregiver will

plan for long-term food needs. Caregiver will provide safe tools and ingredients in visible locations for preparation of

familiar cold meals and supervise use of appliances and sharp tools. Caregiver will be available for problem solving.

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Goal Examples

(PrepFood4.4) Pt will prepare well-learned dishes with assistance from caregiver to avoid harmful effects and solve new

problems related to food preparation, storage and clean-up. Caregiver will plan or assist pt in planning for long-term

food needs and will supervise preparation and storage of food to avoid harmful effects. Caregiver will monitor clean-up

for hygienic results.

(PrepFood4.6) Pt will prepare well-learned dishes with assistance from caregiver to avoid harmful effects and solve new

problems. Pt will scan environmental for needed items and will vary actions from a standard. Caregiver will plan or assist

pt to plan for long-term food needs and will supervise preparation and storage or food to avoid harmful effects.

Caregiver will monitor clean-up for hygienic results.

(PrepFood4.8) Pt will learn new methods of food preparation by rote with caregiver assistance to avoid harmful effects

and to solve problems. Pt will note all visible effects in food preparation. Caregiver will assist a planning for long-term

food needs, will assist new learning by rote, and will monitor regular for safety and to check problem-solving methods.

(PrepFood5.0) Pt will solve problems in food preparations that involve variations in neuromuscular effects with caregiver

assistance to avoid harmful effects. Caregiver will assist in planning for long-term food needs, will validate discovered

solutions to problems, and will monitor regularly for safety and to check problem-solving methods.

(PrepFood5.2) Pt will solve problems in food preparation that involve all tangible properties with caregiver assistance to

avoid harmful effects. Caregiver will assist in planning for long-term food needs, will validate discovered solutions to

problems, and will monitor regularly for safety and to check problem-solving methods.

(PrepFood5.4) Pt will solve problems in food preparation that involve varying spatial properties with assistance from

caregiver to avoid harmful effects. Caregiver will assist in planning for long-term food needs, will validate discovered

solutions to problems, and will monitor regularly for safety and to check problem-solving methods.

(PrepFood5.6) With assistance, pt will compare methods to solve problems in food preparation to avoid harmful effects.

Caregiver will assist in planning for long-term food needs, will validate discovered solutions to problems, and will

monitor regularly for safety and to check problem-solving methods.

(PrepFood5.8) Pt will plan in the presence of material objects to accomplish food preparation with assistance from

caregivers to avoid harmful effects. Caregiver will assist with planning overall organization and will identify intangible

and secondary effects to be avoided for safety reasons.

(PrepFood6.0) Pt will obtain and safely prepare a healthful diet for self and dependents, taking into account dietary

restrictions.

Spending Money

(Money3.6) Caregiver will plan and manage pt’s finances and will sequence pt through simple monetary transactions to

avoid harmful effects. Pt will follow cues given by caregiver in allow money exchanges.

(Money3.8) Caregiver will plan and manage pt’s finances and will train pt to perform highly valued routine exchanges,

supervising to avoid harmful effects. Pts will recognize completion of a routine exchange for direct product or service.

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Goal Examples

(Money4.0) Pt will make small routine purchases independently or manage a daily allowance with assistance from

caregiver to avoid harmful effects. Caregiver will assist pt with budgeting of a monthly income, providing a daily

allowance for routine purchases. Caregiver will manage on-going, long-term, and unusual monetary transactions.

(Money4.4) Pt will manage routine expenditures in cash with assistance from caregiver to make a monthly budget, and

to monitor bank and credit card use to avoid harmful effects. Caregiver will assist with making monthly budget and will

monitor all use of bank and credit accounts.

(Money4.8) Pt will do routine money management by following a budget and procedures by rote, with assistance from

caregiver to avoid harmful effects. Caregiver will provide assistance with learning rote procedures and will assist with

problem solving and long-term planning.

(Money5.0-5.2) Pt will manage routine weekly and monthly income and expenses with assistance from caregiver to

solve new problems, avoid harmful effects, and plan for future financial security. Caregiver will demonstrate new

banking procedures, identify consequences to avoid undesirable effects, assist with solving new problems, and plan for

long-term financial security.

(Money5.8) Pt will manage routine income and expenses and will plan out a new budget when all needed items are

identified. Caregiver will assist in planning a new budget by identifying all salient considerations and will assist with long-

term financial planning.

(Money6.0) Pt will plan for and manage routine and long-term financial activities.

Shopping

(Shopping4.0) Pt will shop for familiar items in familiar shops and with assistance from caregiver for other purchases to

avoid harmful effects. Caregiver will assist pt with identifying shopping needs, will provide adequate cash for simple

purchases, and will accompany to new shopping locations.

(Shopping4.4) Pt will do routine shopping in familiar locations with assistance from caregiver to avoid undesirable

effects. Caregiver will assist with shopping requiring price or product comparison, use of unfamiliar stores or preaches of

unfamiliar items, or taking into account budgetary constraints.

(Shopping4.6) Pt will do routine shopping in familiar locations, and will scan environment for cues to locate desired

items. Will accept caregiver assistance to avoid undesirable effects. Caregiver will assist with shopping requiring price or

product comparison, use of unfamiliar stores or preaches of unfamiliar items, or taking into account budgetary

constraints.

(Shopping4.8) Pt will, by rote, shop for routine items and will learn new ways to shop more efficiently. Caregiver will

assist with rote learning of desired methods and will identify undesirable secondary effects to avoid.

(Shopping5.0-.4) Pt will do routine daily/weekly shopping with caregiver assistance to consider intangible properties and

secondary effects. Caregiver will identify secondary effects of purchases to avoid harmful effects and will assist with

unusual purchases.

11

Goal Examples

(Shopping6.0) Pt will manage all shopping needs, including setting priorities, considering consequences of purchases for

overall budget. Will compare foods and services and made adjustments to availability of commodities as necessary.

Doing Laundry

(Laundry3.4) Caregiver will manage all laundry needs of pt. Pt will follow directions to remove bedding or place dirty

items in hamper.

(Laundry3.6) Caregiver will manage all laundry needs of pt. Pt will follow demonstrated changes in repetitive actions to

hold clothing or remove bedding.

(Laundry3.8) Caregiver will sequence pt through actions of holding or hanging laundry and will manage all other laundry

needs. Pt will follow directions to complete folding or hanging of laundry.

(Laundry4.0) Pt will initiate a familiar routine of laundry with assistance from caregiver to follow correct sequences and

to avoid harmful effects. Caregiver will assist pt with following correct sequences to complete a routine laundry task or

will do laundry for pt.

(Laundry4.2) Pt will initiate and complete routine laundry activities with caregiver assistance to solve problems resulting

from changes in environment or failure to consider all relevant properties. Caregiver will provide visual matching cues to

assist pt to complete routine laundry tasks, and will solve problems and remove hazards.

(Laundry4.8) Pt will learn methods of doing laundry by rate with caregiver assistance to avoid harmful or undesirable

effects. Caregiver will provide assistance with role learning for new procedures and will identify intangible properties

and secondary effects to be consider to avoid harmful effects.

(Laundry5.0) Pt will vary range of motion and strength to solve new problems in laundry activities with assistance from

caregiver to avoid harmful effects. Caregiver will identify secondary effects to avoid undesirable consequences.

(Laundry5.2) Pt will solve problems involving tangible properties in laundry activities with assistance from caregiver to

avoid harmful effects. Caregiver will identify secondary effects to avoid undesirable consequences.

(Laundry5.4) Pt will solve problems involving spatial properties with assistance to avoid harmful effects. Caregiver will

identify secondary effects to avoid undesirable consequences.

(Laundry5.6) Pt will compare methods to solve problems in laundry with assistance to avoid harmful effects. Caregiver

will identify secondary effects to avoid undesirable consequences.

(Laundry5.8) Pt will plan solutions to problems when objects are present. Caregiver will identify secondary effects to

avoid undesirable consequences.

(Laundry6.0) Pt will plan and complete laundry activities for self and others in safe, effective, flexible manner.

Telephoning

(Phone3.4) Pt will use telephone with supervision to call familiar numbers. Caregiver will sequence pt through steps to

complete telephone calls.

12

Goal Examples

(Phone3.6) Pt will use telephone with supervision to call a new familiar number and will imitate desired modifications in

actions. Caregiver will supervise or make telephone calls for pt to ensure outcome, and will demonstrate modifications

in action.

(Phone3.8) Pt will use telephone with supervision to dial a few familiar numbers and will be trained to dial highly valued

numbers. Caregiver will supervise or make telephone calls or ensure outcome, and will train pt to make highly valued

calls.

(Phone4.0) Pt will initiate and complete calls to familiar numbers and will complete calls to new numbers with caregiver

assistance to avoid harmful effects. Caregiver will monitor telephoning to solve problems, make new calls, and avoid

harmful effects.

(Phone4.2) Pt will complete calls by matching written numbers and will request caregiver assistance for locating new

numbers or solving problems in telephoning. Caregiver will provide written numbers, will monitor telephoning to solve

problems and avoid harmful effects.

(Phone4.4) Pt will complete routine telephone calls with assistance from visual cues and will accept caregiver assistance

to avoid harmful effects. Caregiver will provide written numbers, will monitor telephoning to solve problems and avoid

harmful effects.

(Phone4.6) Pt will complete routine telephoning. Will scan visible environment for cues to make calls, and will accept

assistance to solve problems. Caregiver will provide written numbers, will monitor telephoning to solve problems and

avoid harmful effects.

(Phone4.8) Pt will learn use of new telephone technology or telephone etiquette by rote with assistance from caregiver

to avoid harmful effects. Caregiver will assist pt in rote learning of new telephone procedures and will identify harmful

secondary effects.

(Phone5.0-5.4) Pt will manage telephoning needs with caregiver assistance to anticipate and avoid harmful effects.

Caregiver will identify secondary effects of telephoning to avoid.

(Phone5.6) Pt compares and substitutes telephone procedures with assistance to consider secondary effects to avoid.

(Phone5.8) Pt will plan new telephone calls with assistance to identify secondary effects. Caregiver will assist with

planning by identifying secondary effects.

(Phone6.0) Pt will plan and execute telephoning by considering various options and their consequences.

Walking and Exercising

(Exercising1.8) Pt will cooperate with ROM exercise by holding body parts against gravity. Caregiver will assist ROM

exercises.

(Exercising2.0) Pt will maintain seated position. Caregiver will assist with seated transfers.

(Exercising2.2) Pt will stand and make pivot transfer with assistance. Caregiver will provide cues, assistance in standing,

transfers)

13

Goal Examples

(Exercising2.4) Pt will ambulate in restricted areas without falling. Caregiver will provide safe environment.

(Exercising2.6) Pt will walk to known destinations within restricted areas. Caregiver will cue to climb stairs, provide safe

walking areas.

(Exercising2.8) Pt will stabilize self when changing body position. Caregiver will provide cues and assistance in climbing

stairs, sitting down, and transferring.

(Exercising3.0) Pt will ambulate in restriction areas. Caregiver will provide cues and assistance in climbing stairs, sitting

down, and transferring. Caregiver will escort to new locations.

(Exercising3.2) Pt will ambulate in restricted areas. Caregiver will provide cues and assistance in climbing stairs, sitting

down, and transferring.

(Exercising3.4) Pt will ambulate and transfer from sitting to standing positions with caregiver assistance. Pt will ambulate

in communicate with caregiver escort. Caregiver will escort pt to new locations.

(Exercising3.6) Pt will modify pace of ambulation in familiar environment. Caregiver will escort to new locations.

Caregiver will supervise graded exercise to ensure proper performance of repetitive actions.

(Exercising3.8) Pt will ambulate and transfer safely within a familiar setting with assistance to avoid getting lost or

fatigued from overexertion. Caregiver will escort to new locations in community.

(Exercising4.0) Pt will ambulate and perform transfers independently within a familiar environment to reach a desired

location. Caregiver will provide assistance in new or hazardous environments.

(Exercising4.2) Pt will ambulate and perform transfers independently using one to two visual cues to navigate to reach a

desire destination. Pt will ask for assistance if lost. Caregiver will provide assistance to avoid falls, hazards, getting lost.

(Exercising4.4) Pt will ambulate to familiar locations with assistance to identify safest routes. Pt will learn new route or

exercise program after several days or weeks of practice. Caregiver will provide assistance to avoid hazards or getting

lost.

(Exercising4.6) Pt will vary routes to familiar locations with caregiver assistance to identify hazards. Caregiver will

provide assistance to avoid hazards or getting lost.

(Exercising4.8) Pt will ambulate to desired new locations with assistance and will scan environment for safety hazards.

Caregiver will provide assistance to ensure safety in walking in community

(Exercising5.0) Pt will walk to desired new locations with assistance to identify safety hazards. Caregiver will provide

warnings regarding safety hazards.

(Exercising5.4) Pt will ambulate to new locations of desirable activities and will follow an exercises program with

assistance to avoid injury. Caregiver will provide warnings regarding safety hazards.

14

Goal Examples

(Exercising5.6) Pt will compare methods of exercise and follow suggested protocols to avoid harmful effects. Caregiver

will provide information as needed to avoid harmful effects.

(Exercising6.0) Pt participates in program of conditioning aware of risks, benefits, and consequences of deviations from

prescribed activity.

These examples are from the Occupational Therapy Treatment Goals for the Physically and Cognitively Disabled book written by Claudia Kay

Allen, Catherine A Earhart and Tina Blue.

Goal Examples Engaging Abilities and Following Safety Precautions When….

The Person Can Withdraw from and Respond to Stimuli

100% Cognitive Assistance: The person requires 24 hours nursing care to turn the body to prevent sores and hook up

artificial feeding. Total cognitive assistance (100%) is required to position, bathe and cloth the person who is bedridden.

A response to sensory stimulation may be obtained through any of the senses. You may individualize sensory stimulation

by using cues that are strong, distinctive and relevant to the person’s functional history.

100% Physical Assistance: One or more people are required to perform all physical activities.

1.0-Withdrawing From Stimuli

-Will withdraw from noxious stimuli to evaluate effects and protect self, with 100% cognitive assistance to initiate and

sustain activity.

-Will cooperate with passive range of motion exercises with 100% cognitive assistance.

-Will allow splints and positioners to be put in alignment to prevent contractures and pressure sores, with 100%

cognitive assistance.

1.2-Responding to Stimuli

-Will attend and respond to stimulation of a sense organ in a nonspecific manner to evaluate and protect self with 100%

cognitive assistance to initiate and sustain activity.

-Will move facial muscles to communicate a positive or negative appraisal of a stimulus, with 100% cognitive assistance

to initiate and sustain activity.

The Person Can Locate Stimuli and Move in Bed

96% Cognitive Assistance: The person requires 24 hour nursing care to feed a soft diet, place on bed pan, check for skin

redness, bathe and groom. Sensory stimulations suggested are common ideas that capture attention. Individual ideas

from the person’s past history may also be effective.

100% Physical Assistance: Requires total physical assistance of 1 or more persons with most activities. 75% physical

assistance with eating and oral hygiene (1.4-1.6) and moving in bed (1.6)

1.4-Locating Stimuli

-Will turn head to locate and keep track of moving stimulus to evaluate and protect self, with 96% cognitive assistance

to initiate and sustain activity.

-Will accept being fed and give oral hygiene to prevent weight loss and tooth decay, with 96% cognitive assistance to

initiate and complete activity.

-Will grunt, grimace or smile to communicate good preferences, with 96% cognitive assistance to initiate and sustain

activity.


1.6 Moving in Bed (92% Total Cognitive Assistance)

-Will supple 25% of effort to roll in bed, move from supine-to-sit, sit-to-supine to prevent pressure sores, cooperate

bowel evacuation and perineal care.

-Will cooperate with active assistive range of motion to hold arm over bed rail, and respond command to “hold still” to

assist with bathing and dressing, with 96% cognitive assistance to initiate/sustain actions, sequence steps to complete

activities.

-Will sit in gerichair/hoyer lift to protect skin integrity and prevent bone deterioration, with 96% cognitive assistance to

initiate and sequence positioning.

1.8 The Person Can Raise Body Parts

88% Cognitive Assistance: The person requires 24 hour nursing care to sustain feeding self, engage in exercises, bathe

and groom. 88% total cognitive assistance is required to place cup and soon in hand and establish a routine for voiding

and bathing. Sensory stimulation engages the arms in movements but trunk balance is not dependable and may require

support.

50% Physical Assistance to sit up/down, stand, pivot transfer. 100% physical assistance of a wheel chair for moving

around with support to sustain sitting position.

-Will supply 50% effort to move from supine to sit, sit to supine to prevent pressure sores.

-Will feed self finger food and drink from cup when placed in hand to prevent weight loss, with 88% cognitive assistance

to initiate and sustain actions.

-Will hold buttocks up a few seconds to cooperate with toileting, dressing and sensorimotor techniques.

-Will imitate upper extremity range of motion to prevent contractures and cooperate with self-care, with 88% cognitive

assistance to initiate/sustain actions to complete activities.

-Will change trunk position to protect skin integrity and assist with toileting, perineal care, bathing and dressing, with

88% % cognitive assistance to initiate/sequence actions to complete activities.

-Will strike out at balloon, ball, people or objects that cause discomfort to protect or amuse self.

-Will say “no” to communicate discomfort or dislike.

2.0 A Person Can Overcome Gravity

84% Cognitive Assistance: The person requires 24 hours nursing care to assist in moving from bed to chair to toilet. 84%

maximum cognitive assistance is required to act as a contract guard during transfers and to initiate and sustain all self-

care activities. Sensory stimulation is required to bear weight and balance while sitting and standing. Individual

preferences in bed position, favorite chair, and toileting location can be honored.

25% Physical Assistance is required to sit up/down, stand and pivot transfer. 50% physical assistance from wheelchair or

arm chair to sustain sitting position. For exercises, use a safety belt for sitting and standing exercises.


-Will supply 75% of effort to move from supine to sit, sit to supine on the count of 3 to promote skin integrity and pivot

transfer from bed to wheelchair/rolling shower chair, with 84% % cognitive assistance to initiate/sequence actions,

sequences steps to complete activities.

-Will control trunk stability with a contact guard or adaptive equipment to prevent falls.

-Will sit in a chair without a trunk support (if physically able) for 20 to 30 minutes to promote skin integrity and prevent

bone deterioration, with poor/fair endurance.

-Will answer “yes” or “no” to question to convert comfort/discomfort as well as food preferences, with 84$ % cognitive

assistance to initiate activity for response.

-Will use universal gestures (shrug shoulders, wave, point, clap hands) to communicate feelings to others with a

heightened response to loved ones, with 84% % cognitive assistance to initiate activity for response.

2.2 A Person Can Stand and Use Righting Reactions

82% Cognitive Assistance: The person requires 24 hours care to sit and stand safely or prevent standing if unable to bear

weight. 82% maximum cognitive assistance to initiate and sustain self-care activities is required. Touching and naming

parts of the body reduces burden of care. Individual preferences for the way things feel to the person can be honored.

15% Physical Assistance to sustain balance when changing position from sit to stand and maintain sitting position while

being dressed, bathed, groomed. A Lap tray or tab le may be used for support when seated in a chair with solid arms.

-Will identify location of tactile cues, evaluate comfort/discomfort to protect self during bathroom, grooming and

dressing, with 82% cognitive assistance to initiate/sustain actions, sequence steps to complete activities.

-Will spontaneously feed self finger food and drink from cup with 82% % cognitive assistance to initiate/sustain actions,

sequences steps to complete activity, to prevent weight loss and dehydration.

-Will cooperate with hand-over-hand tooth brushing to perform oral hygiene with 82% % cognitive assistance to

initiate/sustain actions, sequence steps to complete activity.

-Will extend arm to prevent falls while being bathed and dressed.

-Will spontaneously move from sit to stand to promote skin integrity and prevent bone deterioration.

2.4 The Person Can Walk

78% Cognitive Assistance: Requires 24 hour nursing care to prevent wandering off and getting lose and insure safe

toileting, bathing and grooming. 78% maximum cognitive assistance to initiate and sustain self-care activities and

prevent falls. Walks in indicated direction for activities of daily living. Indicates individual preferences for large, rhythmic

body movements.

10% Physical Assistance for fine motor actions on all objects used in activities of daily living.

-Will feed self with utensils, drink with set-up, enough to prevent weight loss or dehydration, with moderate assistance

to initiate/sustain actions, sequence steps to complete activity.

-Will stand at sink to perform oral hygiene with maximum assistance to initiate/sustain actions, sequence steps to

complete activity, and standby assistance for stability.


-Will walk on flat surfaces to go to bed, bathroom, dining room when pointed in the right direction, with

standby/contact guard (physical) assistance.

-Will wear incontinent pad in underwear and accept maximum assistance with pericare.

-Will engage in rhythmic movements to dance, march or rock in a chair for pleasant gross motor stimulation, with

maximum assistance to demonstrate/sustain movements for activity.

-Will not bang on doors, fall, or hurt self in efforts to resist confinement.

2.6 The Person Can Walk to an Identified Location

74% Cognitive Assistance: The person needs 24 hour nursing care to escort to activities of daily living, point out stairs

and curbs, assist with toileting, bathing, grooming and dressing (74% maximum cognitive assistance). Individual

differences in where the person wants to go may be honored.

10% Physical Assistance for fine motor actions on all objects used in activities of daily living. Physical barriers or alarms

to prevent getting lose and attempting to walk on anything other than flat surfaces.

-Will accept escort to bed, toilet, table of request to rest, void or eat, with 74% cognitive assistance to initiate activity

and ensure safety.

-Will disrobe for bath/bed but not in public with 74% cognitive assistance to position garments, initiate/sustain actions,

sequence steps to complete activity.

-Will cooperate with assistance to use bath chair with 74% cognitive assistance to sequence safe transfer.

-Will accept escort to toilet for 30 minutes after meals and every 203 hours to prevent soiling self, with 74% cognitive

assistance to cue, initiate and sequencing actions for completing pericare, dressing and hygiene.

-Will scoot over in bed or on a cough, cooperate with use of transfer board to facilitate transfer, with 74% cognitive

assistance to initiate/sustain actions, sequence steps to complete activity.

-Will step up, down, over curbs, steps and other barriers below knee to prevent falls and injury, with contact guard/10%

physical assistance.

-Will push a cart, wheelchair, or duster for exercises, with 74% cognitive assistance to initiate/sustain actions and ensure

safety.

-Will play catch with a rubber ball to protect self from moving objects, with 74% cognitive assistance to initiate and

sustain actions.

-Will sing familiar songs and learn new songs for pleasant communication, with 74% cognitive assistance to

initiate/sustain responses and actions, sequence steps to complete activity.

2.8 The Person Can Use Railings and Grab Bars for Support

70% Cognitive Assistance: The person needs 24 hour nursing care to assist with bathing, grooming, and dressing and

make sure objects used for support are stable. 70% maximum cognitive assistance is required to point out stairs, edge of

bathtub, to provide food, and to bathe. Individual preferences in what is used for support may be honored (grab bars,

rails, counters)


to prevent getting lose and attempting to walk on anything other than flat surfaces without an escort.


-Will sustain eating and drinking for adequate intake, with 70% cognitive assistance to initiate/sustain actions, sequence

steps to complete activity.

-Will grab onto objects for support to prevent falls, with 70% cognitive assistance to initiate/sustain actions, sequence

steps to complete safe transfers.

-Will release grip when given time to feel secure, with contact guard/10% physical assistance.

-Will hit, kick, or throw objects without harm, with 70% cognitive assistance to initiate/sustain actions, sequence steps

to complete activities.

-Will sing songs to inhibit striking out, with 70% cognitive assistance to initiate and sustain response.

-Will express comfort/discomfort with gestures or short phrases when a caregiver is present with 70% cognitive

assistance to initiate response.

-Will accept safe objects placed in hands to inhibit striking out while being cared for.

3.0 The Person Can Grasp Objects

64% Cognitive Assistance: The person needs 24 hour nursing care to place safe objects in front of the person and assist

with toileting, bathing, grooming and dressing. 64% moderate cognitive assistance is required to elicit and sustain

habitual motions for self-care. Individual preferences for handling different objects may be honored.


to prevent getting lost and attempting to walk on anything other than flat surfaces without an escort.

-Will reach for, grasp, hold, and feel material objects to perceive and evaluate common objects for feeding and self-care,

with 64% cognitive assistance (feeding) and 64% cognitive (other self-care) assistance to initiate/sustain actions,

sequence steps to complete activities.

-Will recognize need to use toileting and perform toileting with 64% cognitive assistance to initiate/sustain actions,

sequence steps for completing pericare, dressing and hygiene.

-Will name common objects and use associate verb to communicate the ordinary use of the object.

-Will grasp and name a sequence of objects with continuous cueing to differentiate between objects.

-Will state own name when asked “What is your name?”

3.2 The Person Can Distinguish between Objects

60% Cognitive Assistance: The person needs 24 hour nursing care to place objects in front of the person and assist with

toileting, bathing, grooming and dressing. One to one supervision requires 60% moderate cognitive assistance to sustain

actions. Individual preferences in what the person likes to move may be honored.



-Will distinguish between familiar self-care objects by size, shape, or color (ie hair vs toothbrush)

-Will spontaneously grasp objects and move in a back and forth motion in approximate location to: brush teeth, comb

hair, wash body, perform toileting hygiene, wipe mouth after eating, and pull self along hall-way railing with 60%

cognitive assistance to initiate/sustain/stop actions , sequence steps to completed activities.


-Will grasp and begin correct actions of donning familiar garments, with 60% % cognitive assistance to sustain actions

and sequence steps to complete activity.

-Will “walk” while seated in a wheelchair, with 60% cognitive assistance to initiate/sustain actions and 60% cognitive

assistance to steer chair (pt. will not be able to use rims to steer).

-Will use short phrases to communicate memories of familiar objects.

-Will write name with dominant hand (with simple adaptive aids, as needed), with 60% cognitive assistance to initiate

and sustain actions.

3.4 A Person Can Sustain Actions on Objects

54% Cognitive Assistance: The person needs 24 hours nursing care to sequence through the routine steps of toileting,

bathing, grooming and dressing. 54% moderate cognitive assistance is required to go to the next step in self-care

activities. Individual preferences for repetitive actions that the person lines to do may be honored.



-Will sustain familiar repetitive actions and move the location of actions when cues to perform self-care and

instrumental activities with 54% cognitive assistance to set up tools, initiate/stop perseveration actions, sequence steps;

54% cognitive assistance for flossing,, arranging hair, applying correct liquid amounts, doing unusual/unseen fasteners,

checking results/correcting errors; 54% cognitive assistance for safety.

-Will initiate and complete toileting in familiar environment with 54% cognitive assistance.

-Will sustain and move the location of actions when cued to perform mobility activities with 54% cognitive assistance to

initiate actions, sequence steps. 54% cognitive assistance for safety.

-Will alter ambulation pace on command, with cueing to sustain pace when distracted.

-Will learn simple, daily routine events with long-term (more than 3 weeks) repetition.

-Will move about resident with knowledge of where frequently used rooms are located with supervision for safety.

-Will pick up and place objects in a row to create order in the use of objects.

-Will name actions while doing it to conceive of language associated with actions.

3.6 The Person Can Note the Effects of Actions on Objects

50% Cognitive Assistance: The person needs 24 hour supervision to provide the supplies needed for activities of daily

living, sequence through the steps of toileting, bathing, grooming and dressing and remove access to dangerous objects.

50% cognitive assistance is required to finish all steps and check results. Individual preferences for the effects that the

repetitive actions have on objects may be honored.



-Will sequence self through self-care actions when objects needed are set up in a linear sequence, with 50% cognitive

assistance to finish necessary steps and check results.


-Will note effects that actions have on perimeter of body/objects while eating, doing self-care and instrumental activities

with 50% cognitive assistance to modify actions to improve results.

-Will imitate actions to modify movements to perform mobility activities with 50% cognitive assistance to sustain

actions; 50% cognitive assistance for safety.

-Will take turns in receiving assistance or playing a game when cues to wait a minute to avoid conflict.

-Will use short phrases about the effects of actions, and pronouns to differentiate between male and female.

3.8 A Person Can Use All Objects and Sense Completion of an Activity

46% Cognitive Assistance: The person needs 24 hour supervision to get supplies out for all activities of daily living, to

check results, and to remove dangerous objects. The person may think that an activity is finished when the results are

inadequate. 46% moderate cognitive assistance is required to complete self-care and protect from harm. Individual

preferences for using up supplies can be honored.



-Will follow a highly valued mealtime routine (including presenting self at regularly scheduled times, checking

surroundings for spilled food, and wiping mouth with napkin) in 3 weeks, with set-up and 46% cognitive assistance to

train one step at a time; 46% cognitive assistance with difficult neuromuscular adjustments.

-Will use all objects/supplies to cover all visible space until done to achieve a sense of completion to perform self-care

and instrumental activities with set-up and 46% cognitive assistance to complete necessary steps, attend to unseen

areas, modify actions for better results; 46% cognitive assistance with difficult/unseen fasteners, check for and correct

socially unacceptable errors.

-Will imitate a sequence of 3 actions to learn and remember new actions to use familiar adaptive equipment to perform

self-care, mobility and instrumental activities.

-Will learn daily routine of events in 3 weeks.

-Will learn new destinations in resident and recognize destination on arrival to avoid getting lost, in 3 weeks.

-Will name an activity as a goal, but may change or forget to self-direct actions.

-Will say “I’m done”, express surprise, satisfaction, dissatisfaction on task completion.

4.0 The Person Can Sequence Self through the Steps to Do a Short Term Activity

42% Cognitive Assistance: The person needs 24 hours supervision to remove dangerous objects and solve problems due

to minor changes in routine activities. May fix self a cold snack or sandwich. 42% minimum cognitive assistance requires

on-site supervision to recognize and correct hazards. Individual preferences in doing 1 or 2 important activities may be

honored.




-Will be goal-directed to sequence self through steps to complete a familiar self-care routine with set-up, increased

time, and 42% cognitive assistance to solve new problems, make new motor adjustments, and to remember safety

precautions.

-Will recognize a physical disability and the need for assistance.

-Will comply with 42% cognitive assistance needed to perform mobility and instrumental activities effectively and safely.

-Will use adaptive equipment with familiar movement patterns to complete routine tasks, with 42% cognitive assistance

to remember safety precautions.

-Will be oriented to name, place and familiar daily routine.

-Will set own priorities for preferred activities to establish individual differences

-Will recognize errors when doing instrumental activities, ask for assistance and attempt to fix mistakes, or abandon the

task to comply with social standards.

-Will recognize own possessions and engage in rituals for giving and sharing to preserve social order.

-Will recognize group membership and use verbal means to resolve social conflicts.

4.2 The Person Can Differentiate Between the Parts of an Activity

38% Cognitive Assistance: The person needs 24 hours supervision to remove dangerous objects outside of the visual

field to solve problems arising from minor changes in the environment. The person may spend a daily allowance, walk to

familiar locations in the neighborhood, or follow simple, familiar bus route. 38% minimum cognitive assistance is

required to recognize and correct hazards in routine activities.

8% Physical Assistance for fine motor actions on all objects used in activities of daily living.

-Will initiate and complete routine ADL’s with available supplies, with 38% cognitive assistance to solve new problems,

making new motor adjustments, attend to unseen areas, and to remember safety/medical precautions.

-Will perform new exercises and mobility routines with 38% cognitive assistance to make new motor adjustments,

remember safety/medical precautions.


to remember safety/medical precautions.

-Will be able to sequence self through simple instrumental activities with set-up and sample, matching one striking

feature at a time.

-Will learn way around building, neighborhood to avoid getting lost.

-Will ask for assistance if lost

-Will ask about day and date to keep track of the passage of time.

4.4 The Person Can Complete A Goal

34% Cognitive Assistance: The person may live with someone who does a daily check on the environment, removing any

safety hazards and solving problems when minor changes in home occur. May be alone for part of the day with a

procedure for obtaining help by phone or from neighbor. May have a daily allowance and go to familiar places in the

neighborhood. 34% minimum cognitive assistance is required to set-up new activities and clean-up after routine

activities.


8% Physical Assistance is needed to assist with fine motor activities.

-Will initiate, set self up, and complete routine ADL’s with available supplies, with 34% cognitive assistance to solve new

problems, make new motor adjustments, attend to unseen areas, and remember safety/medical precautions.


to remember safety/medical precautions.

-Will perform new exercise and mobility routines with 34% cognitive assistance to make new motor adjustments,


-Will perform familiar instrumental activities with 34% cognitive assistance to adjust to new motor impairments,


-Will be able to sequence self through simple instrumental activities with set-up, sample, matching 2 features at a time.

-Will be able to recognize trash when cues and follow verbal directions to clean up.

-Will try to act in a self-controlled manner when cued to demonstrate reliability in a social context.

-Will learn daily schedule of events and know day and date to follow a routine.

4.6 The Person Can Scan the Environment

30% Cognitive Assistance: The person may live alone with daily assistance to monitor personal safety and provide a daily

allowance. Bills and other money management concerns require assistance. Reminders may be required to do

household chores, attend familiar community events, or any other additions to household routines.

8% Physical Assistance is needed to assist with fine motor activities.

-Will scan environment to locate and get needed objects and avoid obvious hazards.

-Will learn adaptive dressing techniques with 30% cognitive assistance to anticipate/solve new problems, make new

motor adjustments, and remember safety/medical precautions.

-Will make brief motor adjustments to use adaptive equipment to complete routine tasks, with 30% cognitive assistance

to anticipate/solve new problems and remember safety/medical precautions.

-Will perform new exercise and mobility routines with 30% cognitive assistance to identify hazards and remember

safety/medical precautions.

-Will use past experience to personalize performance of instrumental activities, with 30% cognitive assistance to

anticipate/solve new problems, make new motor adjustments, and remember safety/medical precautions.

-Will note conflicts in own schedule and seek assistance to resolve scheduling problems.

4.8 The Person Con Memorize New Steps

26% Cognitive Assistance: The person can live alone with daily assistance to monitor safety and check problem solving

effectiveness. The person may get to a regularly scheduled community activity without assistance. With a job coach, the

person may succeed in supportive employment. 26% minimum cognitive assistance is required to set-up new activities

and verify results.

8% Physical Assistance is needed with fine motor activities.


-Will use rote memory and perceive 90* angles to learn adaptive ADL/mobility techniques and equipment to complete

routine tasks safely and inflexibly with 26% cognitive assistance to anticipate potential hazards and solve new problems.

-Will scan environment and note all visible cues for safety hazards; with 26% cognitive assistance.

-Will check work when done to identify possible mistakes.

-Will be compliant with checklists to identify potential problems, compensate for decrease memory, with 26% cognitive

assistance for planning relevant activities and identifying potential problems.

-Will memorize list of word or verbal directions with associated actions to learn to do a new activity or follow a new

procedure inflexibly.

-Will estimate waiting for assistance for a few minutes to avoid intruding on others.

-Will seek verification or new learning to conform to external expectations of others.

5.0 The Person Can Learn To Improve The Effects of Actions

22% Cognitive Assistance: The person may live alone with weekly checks to monitor safety and check problem solving

effectiveness. With a job coach, the person may be able to work in support employment. 22% standby cognitive

assistance is required to anticipate environmental hazards and prevent social conflict.

6% Physical Assistance is needed with fine motor activities.

-Will cluster new information, perceive angles > 90*, and use continuous motor adjustments to learn adaptive

ADL/mobility techniques and use of equipment to complete routine tasks safely and effectively with 22% cognitive

assistance to use written directions, demonstrate new actions, anticipate potential hazards, remember safety/medical

precautions, and solve new problems for surface/spatial properties.

-Will travel to desired new locations in facility with 22% cognitive assistance to identify potential safety hazards.

-Will estimate internal adjustments of actions needed to produce different effects to normalize tone for more effective

task performance with 22% cognitive assistance to plan actions.

-Will clean up after doing ADLs with cueing to conform with social standards.

-Will recognize time constraints and request more time when needed to complete a task.

-Will earn effective use of a memory book to compensate for residual memory problems, remember valued information,

schedule infrequent events.

-Will participate in scheduled verbal groups and social games to practice socially acceptable behavior with 22% cognitive

assistance to reality test and identify potentially damaging consequences of verbal actions and being late for

appointments.

5.2 The Person Can Learn to Improve the Fine Details of Actions

18% Cognitive Assistance: The person may live alone with weekly checks to monitor home safety and assist with

finances. 18% standby cognitive assistance is required to anticipate hazards and prevent social conflict. Individual

preferences may be honored in improving the appearance of material objects.

4% Physical Assistance is required for fine motor actions.


-Will discriminate surface properties of tangible objects in the environment, rotate objects while working, adjust

posture, and use diagrams to learn adaptive ADL/mobility techniques and use of equipment to complete routine tasks

safely and effectively with 18% cognitive assistance to demonstrate new actions, anticipate potential hazards,

remember safety/medical precautions, and solve new spatial problems.

-Will travel to desire new locations in facility with 18% cognitive assistance to identify potential safety hazards.

-Will estimate internal adjustments of actions needed to produce different effects and adjust posture to normalize tone

for more effective task performance with 18% cognitive assistance to plan actions.

-Will learn effective use of memory aids to tangible compensate for decreased memory, keep schedules.

-Will spontaneously consult clock for time to orient self.

-Will talk and work at the same time to enhance the social environment.

-Will participate in scheduled verbal groups and social games to practice socially acceptable behavior with 18% cognitive

assistance to reality test and identify observed patterns of behavior that may be potentially damaging in intended

activities.

5.4 The Person Can Engage in Self-Directed Learning

15% Cognitive Assistance: The person may live alone and work in a job with a wide margin of error. 14% standby

cognitive assistance is needed to anticipate hazards and prevent industrial accidents. Individual preferences for

improving the appearance of activities can be honored.

2% Physical Assistance is needed for fine motor activities.

-Will improve spatial properties of objects, make multiple and fine-motor adjustments to learn adaptive ADL/mobility

techniques and use of equipment to complete routine tasks safely and effectively with 14% cognitive assistance to

identify/explain potential hazards, plan/prioritize actions, and remember safety/medical precautions.

-Will vary work pace a short time to meet a deadline, with 14% cognitive assistance to estimate time required to do

instrumental activities.

-Will participate in schedule verbal groups and social games to practice socially acceptable behavior with 14% cognitive

assistance to reality test, identify observed patterns of behavior that may be potentially damaging in intended activities.

-Will consider group membership and possible exclusion to prevent censure and reprimand, to conform with social

standards

5.6 The Person Can Consider Social Standards

10% Cognitive Assistance: The person may live alone of with family and work in situations where hazards are consistent

and predictable. 10% cognitive assistance is requires to point out hazards that are a secondary effect of actions. May be

relied on to follow safety precautions consistently with training.

0% Physical Assistance

-Will discuss/compare methods, estimate volumes in space, persist with fine motor adjustments to learn adaptive

ADL/mobility techniques and use of adaptive equipment to complete routine tasks safely and effectively with 10%


cognitive assistance to point out potential secondary effects of surface/spatial properties to avoid harmful effects.

-Will follow safety/medical precautions consistently with training.

-Will share common work area by collaborating with others in instrumental activities.

-Will seek out estimates of time required for an activity, after work pace to meet an external time constraint, with 10%

cognitive assistance to cue when preoccupied.

5.8 The Person Can Consult with Other People

6% Cognitive Assistance: The person may live and work independently. 6% standby cognitive assistance is needed to

plan for the future, anticipate the need for joint protection, functional positioning and the consequences of fatigue.


-Will understand verbal/written instructions, seek clarification of potential harmful effects to learn adaptive

ADL/mobility techniques and use of adaptive equipment to complete routine tasks safely and effectively with

consultation/6% cognitive assistance to instruct in new procedures and provide consultation.

-Will estimate time required for doing an activity and vary own pace as needed with consultation/6% cognitive

assistance to provide verification.

-Will read safety precautions on labels to anticipate hazards with consultation/6% cognitive assistance to provide

clarification as needed.

6.0 The Person Can Plan Activities

0% Cognitive Assistance: The person can live and work independently. No cognitive assistance is needed.


-Live long and prosper

These examples are from Understanding Cognitive Performance Modes by Claudia Kay Allen, Tina Blue and Catherine A. Earhart.

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