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) 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. • 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