ONA Item Essential Elements for Use with ADL/IADL and Medication Management Only (Updated 6/29/2021)

ONA Item Essential Elements For use with ADL/IADL and Medication Management Only (updated 6/29/2021)

This document is intended to be used as a supplement to the ONA Manual and FAQs which can be found by clicking on the following link: ONA Assessor Resource Page

Instructions:

Use this document along with the Coding Decision Tree and Coding Key to accurately determine which essential elements to consider for each item when coding ADL/IADL and Medication items.

If the individual needs a support person’s help at least 50% of the days the activity takes place with any or all of the steps listed in the “Setup or Clean-up” column and needs no help in the “During the Activity” column, code ‘Setup/clean-up’.

If the individual needs help with any or all of the steps listed in the “During the Activity” column, identify what kind of help is needed at least 50% of the days the activity takes place. Then consider the following options for coding:

If the individual needs full 100 % physical assistance for all steps in the “During the Activity” column, code ‘Dependent’ regardless if help is needed in the “Setup/clean-up” column.

Or, if some help is needed at least 50% of the days the activity takes place for some or all of the steps during the activity, code the kind of help that is needed: ‘Supervision’, ‘Partial/Moderate’ or ‘Substantial/Maximal’.

Please note:

The list below is not exhaustive. There could be elements in a person’s life that are not listed such as using conditioner in the shower, using lotion as part of a general hygiene routine or using fabric softener while doing laundry, etc. Also, don’t include activities from the list that don’t represent the person; for example, if the person always wears slip on shoes, don’t focus on the support to tie shoes. Use your best judgment .

1 ONA Item Essential Elements For use with ADL/IADL and Medication Management Only (updated 6/29/2021)

During the Activity Setup or Clean-up Do NOT Include (Includes reminders/cues (Includes (Do not consider items Item and encouragement during reminders/cues before listed in this column (See ONA manual the activity) and/or after when coding support for item intent) * All steps in this column can the activity) needs) be considered physical steps.

• Items that are not put • Lift arms on and taken off while • Get clothes out of • Put clothing on dressing (e.g., a back drawers and/or closets • Button, snap and zip brace worn only while 3a: Upper Body Dressing • Choose appropriate • Put on back brace while lifting heavy objects) clothing (clean vs. dirty, dressing • Individual talking weather, etc.) • Adjust clothing correctly support person through the steps of dressing

• Items that are not • Raise legs put on and taken off • Get clothes out of • Pull up clothing while dressing (e.g., drawers and/or closets • Button, snap and zip 3b: Lower Body Dressing leg braces only worn • Choose appropriate • Put on leg braces while during OT/PT) clothing (clean vs. dirty, dressing • Individual talking weather, etc.) • Adjust clothing correctly support person through the steps of dressing

• Items that are not put • Bend down to put footwear on/taken off while on putting on/taking off • Get footwear out of closets 3c: Putting on/taking off • Put feet in footwear/socks footwear (e.g., or off the floor footwear • Put shoes on the right feet compression socks for • Choose appropriate • Tie, buckle or fasten brief periods during footwear (for weather, footwear the day) etc.) • Put on orthotics, support • Individual talking hose, compression socks, support person TED hose, AFOs through steps of putting on/taking off footwear

2 ONA Item Essential Elements For use with ADL/IADL and Medication Management Only (updated 6/29/2021)

During the Activity Setup or Clean-up (Includes reminders/cues Do NOT Include Item (Includes and encouragement during (Do not consider items (See ONA manual reminders/cues before the activity) listed in this column for item intent) and/or after * All steps in this column can when coding support the activity) be considered physical steps. needs)

• Ambulating • Get assistive devices in • Use legs to bear weight • Individual talking 4a: Sit to stand place such as a walker or • Use arms to bear weight support person cane • Rise up to a standing position through the steps of • Put assistive devices away the transfer

• Ambulating • Get assistive devices in • Use legs to bear weight 4b: Chair/bed to • Individual talking place such as a walker or • Use arms to bear weight chair support person cane • Sit down in a chair or bed transfer through the steps of • Put assistive devices away the transfer

• Positioning to prevent • While lying down, roll from skin breakdown (if one side to another • Get sidelyer or otherwise • Use side rails or devices to 4c: Roll left and right another assistive independent with roll device in place rolling left and right) • Use arms to pull oneself to • Put assistive devices away • Individual talking one side and/or the other support person through the steps of rolling left and right

• Bear weight to walk (could • Use of a 5b: Walks 150 feet • Get assistive devices in include carrying someone) wheelchair or (Consider all methods of place such as a walker or • Crawl or scoot scooter mobility such as: walking, cane • Use of adaptive devices in • Individual talking crawling, scooting, etc.) • Put assistive devices away place such as walkers and support person rails if currently used to through the steps of ambulate walking

3 ONA Item Essential Elements For use with ADL/IADL and Medication Management Only (updated 6/29/2021)

During the Activity Setup or Clean-up Do NOT Include (Includes reminders/cues (Includes (Do not consider items Item and encouragement during reminders/cues before (See ONA manual for the activity) listed in this column item intent) and/or after * All steps in this column can be when coding support the activity) considered physical steps. needs)

• Bear weight to go up and • Stairs • Get assistive devices in down a curb or step (could • Individual talking place such as a walker or include carrying someone) support person through 5c: Step onto/off a curb cane • Take a step the steps of stepping • Put assistive devices away • Use of adaptive devices such as onto/off of curbs canes, walkers, etc., if currently used to ambulate

• Bear weight to go up and • Curbs • Get assistive devices in down stairs (could include • Individual talking 5d: 12 steps place such as a specialized carrying someone) support person through rail • Take steps the steps of going • Put assistive devices away • Bear weight with arms to use up/down steps rails to go up and downstairs

• A stroller or • Use arms to propel manual wheelchair used • Get wheelchair into wheelchair/stroller for the support position for use 5f: Wheels 150 feet • Use controller to propel person’s • Plug or unplug electric wheelchair convenience wheelchair from • Maneuver wheelchair/ • Walking charger scooter/stroller around • Individual talking corners/obstacles support person through the steps of wheeling

4 ONA Item Essential Elements For use with ADL/IADL and Medication Management Only (updated 6/29/2021)

During the Activity Setup or Clean-up (Includes reminders/cues Do NOT Include Item (Includes and encouragement during (Do not consider items (See ONA manual for reminders/cues before the activity) listed in this column and/or after the when coding support item intent) * All steps in this column can activity) needs) be considered physical steps.

• Arrange plate, drink • Cut-up food while eating • Modifying food and/or utensils in a • Bring food and drink to the consistency specific way on the table mouth • Cutting up food during 6b: Eating before eating due to • Eat in a safe manner (choke meal prep vision or agility needs risk may be present if food is • Individual talking eaten too rapidly) support person through the steps of eating

• Pour nutrition into bag or syringe • Watch for residuals and • Stoma care • Set out supplies for feeding physically make adjustments • Individual talking 6c: Tube feeding • Put supplies away • Flush tubing support person through • Adjust or change g-tube the steps of tube settings/process asneeded feeding • Vent air from tube

• Adjust clothing before • Transferring on and off use the toilet • Adjust clothing after use • Washing hands • Identify the need • Use toilet effectively and • Cleaning up soiled to eliminate wipe after use bedding and/or 7a: Toilet hygiene • Get supplies out for use • Flush the toilet bathroom • Put supplies away • Empty bedpan or commode • Individual talking • Change and clean up soiled support person through area of body and briefs after the steps of elimination incontinence • Use/care of catheter, colostomy, urostomy

5 ONA Item Essential Elements For use with ADL/IADL and Medication Management Only (updated 6/29/2021)

• Steps of using the toilet • Set up rails or handles • Bear weight to get on and off of • Individual talking 7b: Toilet transfer to assist with transfer a toilet support person through • Put supplies away • Sit down on toilet • Consider use of adaptive the steps of devices to transfer if transferring on/off already in place toilet

• Adjust water temperature • General hygiene • Judge water temperature activities 8a: Shower/bathe self • Set out and open supplies • Get in/out of shower • Individual talking • Put supplies away • Use soap to clean body support person through • Use shampoo to clean hair the steps of • Rinse off body showering/bathing • Dry off body

• Set out toothpaste • Apply toothpaste to • General hygiene 9a: Oral Hygiene and toothbrush toothbrush activities • Open toothpaste • Brush teeth and rinse • Treatments • Put toothbrush • Floss provided by dentist and toothpaste • Clean and soak dentures • Individual talking away • Oral care for gums support person through the steps of oral hygiene

6 ONA Item Essential Elements For use with ADL/IADL and Medication Management Only (updated 6/29/2021)

During the Activity Setup or Clean-up Do NOT Include (Includes (Includes reminders/cues and (Do not consider items Item encouragement during the reminders/cues before listed in this column (See ONA manual activity) for item intent) and/or after the when coding support activity) * All steps in this column can be needs) considered physical steps.

• Brush hair • Apply deodorant • Wash face and/or hands as • Services provided by needed during the day professionals outside • Clean ears and nose • Set out and open supplies ofthe home • Wash hands after using the 10a: General Hygiene for use (hairdresser, barber, toilet • Put supplies away nail salon) • Nail care • Individual talking • Shaving support person • Menses care through the steps of • Other hygiene specific to general hygiene individual

• Usual tasks to clean all rooms of the home such as: vacuum, • Paid housekeeping dust, put items away, sweep, services • Set out and open supplies 12a: Housework mop, make beds, clean dishes, (housecleaner) for cleaning counters and toilets • Occasional deep • Put cleaning supplies away • Use chemicals and cleaning appliances to clean • Individual talking • Clean up items used support person through for ADL/IADL activities the steps of housework

7 ONA Item Essential Elements For use with ADL/IADL and Medication Management Only (updated 6/29/2021)

Setup or Clean-up During the Activity (Includes Do NOT Include (Includes reminders/cues and Item (Do not consider items reminders/cues encouragement during the (See ONA manual listed in this column when before and/or after activity) for item intent) coding support needs) the activity) * All steps in this column can be considered physical steps.

• Use knives • Making complex • Use utensils meals, such as a • Use stove, Thanksgiving dinner, microwave and other or other meal appliances • Set out and open preparation that is not 13a: Make a light meal • Use list of ingredients and supplies for making usual for the (Consider all the cooking instructions meals individual food/drink the • Complete steps of • Take items out of • Making nutritional choices individual usually making meals cupboards/fridge • Decision of what to make consumes and the • Complete steps of preparing • Individual talking support support to prepare it) formula/ ingredients for tube person through the steps feeding of making meals • Cut up food before being served

• Put dirty laundry in basket • Physically sort laundry • Take laundry to washer • Dry cleaning services • Put laundry in washer • Clothing repair • Set out and open • Put soap in washer • Ironing 14a: Laundry supplies for laundry • Push buttons/turn dials on • Sewing tasks • Put supplies away washer/dryer to start • Individual talking support • Put laundry in dryer person through the steps • Take laundry out of dryer of laundry • Fold laundry • Take laundry to room • Put laundry away

8 ONA Item Essential Elements For use with ADL/IADL and Medication Management Only (updated 6/29/2021)

During the Activity Do NOT Include Setup or Clean-up (Includes reminders/cues and (Do not consider items Item (Includes reminders/cues encouragement during the listed in this column (See ONA manual before and/or after activity) when coding support for item intent) the activity) * All steps in this column can be needs) considered physical steps.

• Plan and arrange the ride • Walking public 15a: Use • Plan/figure out routes • Riding a bike transportation (Consider • Provide bus schedule to • Open/close vehicle doors • Electric bikes any motorized individual • Get in/out of vehicle • Kick scooters (scooter transportation) • Reminders to set up a ride • Fasten seat belt that one stands on on) • Drive • School bus used for • Navigate transporting to/from school • Budgeting for and obtaining a bus pass • Opening and closing 15b: Car transfer vehicle doors • Get assistive devices in *Consider supervision • Bear weight with legs • Fastening/unfastening required for behavior in place such as a walker or • Bear weight with arms seatbelts this item if it impacts cane • Transfer in/out of vehicles • Individual talking support ability to get in/out of • Put assistive devices away safely and as expected person through the steps car safely of the car transfer • Know money has value and understands some denominations • Manage finances for food, personal items, clothing and • Special needs trusts • Set out and open bank shelter 16a: Money Management • Retirement accounts statements and bills • Count money • Applying for social • Reminders to pay bills • Make change benefits (e.g. self- • Reminders to save money • Pay bills • Write checks sufficiency benefits, • Balance a checkbook/bank Social Security) account • Save and budget for larger purchases • Budget for use of debit/atm card

9 ONA Item Essential Elements For use with ADL/IADL and Medication Management Only (updated 6/29/2021)

Setup or Clean-up During the Activity Do NOT Include (Includes (Includes reminders/cues (Do not consider items Item reminders/cues before and encouragement during listed in this column (See ONA manual and/or after the activity) when coding for item intent) the * All steps in this column can support needs) activity) be considered physical steps.

• Figure out what is needed to purchase while shopping • Create a shopping list 17a: Light Shopping • Shop from a list • Put groceries away • Locate and select items • Budgeting • Reminders to shop (Consider all shopping for • Take items from shelves • Support for mobility only food groceries and • Reminders to shop for • Take cart to checkout • Interactions with store personal items required needed items • Pay for items personnel for the individual) • Complete steps of online shopping

• Know the correct oral • Meds used less • Get oral medication out medication to take than monthly 47c: Medication of where it is stored • Take the correct dose • Ordering or picking management • Open oral medication • Put the pill in the mouth up prescriptions – oral medication • Reminders to take • Set-up pill minder and refills medication • Cut/prepare medicine for • Swallowing medication • Put medication away dispensing

47d: Medication • • Know and dispense the • Meds used less management Get inhaler/mist out of where it is stored correct amount of than monthly – inhalant/mist inhaler/mist • Ordering or picking medications (includes nebulizer) • Open medication • Hold mask or inhaler in the up prescriptions correct position • Reminders to use and refills • medication Turn on machine • Taking breaths • Put medication away

10 ONA Item Essential Elements For use with ADL/IADL and Medication Management Only (updated 6/29/2021)

During the Activity Setup or Clean-up Do NOT Include (Includes reminders/cues (Includes (Do not consider items Item and encouragement during reminders/cues before listed in this column (See ONA manual for the activity) item intent) and/or after * All steps in this column can be when coding the activity) considered physical steps. support needs)

• Meds used less • 47e: Medication Get injectable • Know the correct amount of than monthly management medication out of injectable medication • Injections administered where it is stored – injectable medications • Inject the medication in by medical • Open medication correct area of body professionals • Reminders to use • Inject the correct amount • Ordering or picking medication of medicine up prescriptions • Dispose of sharps and refills • Put medication away

• Know the correct amount of • Get topical medication medication • Meds used less 47f: Medication out of where it is stored • Apply the topical medication than monthly management • Open medication to the correct area of the body • Ordering or picking up – topical medications • Reminders to use • Apply eye and ear drops prescriptions and refills medication • Put medication away

• Get suppository/enema • Meds used less 47g: Medication • Know the correct dose out of where it is stored than monthly management • Insert the suppository/ enema • Open medication • Ordering or picking up – suppository medications into the correct area of body • Reminders to use • Insert the correct amount of prescriptions and refills medication medicine • Put medication away • Know the correct dose • Prepare tube for medication 47h: Medication • Get medication and • Flush tube management supplies out of where it is • Push medication through • Meds used less – medications through tube stored the tube than monthly • Open medication • Watch for residuals • Ordering or picking up • Reminders to use • Flush with water prescriptions and refills medication • Turn on pump • Put medication away • Unkink tubing • Vent air through tube