A functional assessment is used to evaluate the older adult’s overall well-being and self-care abilities. It helps identify individual needs and care deficits, provide a basis for developing a care plan that enhances the abilities of the older adult with coexisting disease and chronic illness, and provide feedback about treatment and rehabilitation. You can use the information to identify and match the older adult’s needs with such services as housekeeping, home health care, and day care to help the patient maintain independence. Any of several methods can help you perform a methodical functional assessment.

The Katz index of independence in activities of daily living is a widely used tool for evaluating a person’s ability to perform six daily personal care activities: bathing, dressing, toileting, transfer, continence, and feeding. It describes the patient’s functional level at a specific point in time and objectively scores his performance on a three-point scale.

The Lawton instrumental activities of daily living scale evaluates the ability of the patient to perform more complex personal care activities. It addresses the activities needed to support independent living, such as the ability to use the telephone, cook, shop, do laundry, manage finances, take medications, and prepare meals. The activities are rated on a three-point scale, ranging from independence, to needing some help, to complete disability. (See Lawton instrumental activities of daily living scale, page 316.)

The Barthel index evaluates the following 10 self-care functions: feeding, moving from wheelchair to bed and returning, performing personal toilet, getting on and off the toilet, bathing, walking on a level surface or propelling a wheelchair, going up and down stairs, dressing and undressing, maintaining bowel continence, and controlling the bladder. Each item is scored according to the degree of assistance needed; over time, results reveal improvement or decline.

A similar scale, called the Barthel self-care rating scale, is a more detailed evaluation of function. Both tools provide information to help you determine the type of assistance needed.

In an attempt to improve the quality of care in extended care facilities, the federal government instituted major reforms through the Omnibus Budget Reconciliation Act of 1981 and its amendments. A standardized assessment tool called the Minimum data set was developed to make patient assessments more consistent and reliable throughout the country. All extended care facilities that receive federal funding are required to use this method.

The Outcome and assessment information set (OASIS), now known as OASIS-B, is a standardized form required by the Health Care Financing Administration for Medicare-certified agencies. This form is a comprehensive assessment of home care patients. The OASIS-B was developed specifically to measure outcomes for adults who receive home care. The instrument allows the collection of data to measure changes in a patient’s health status over time. Typically, you’ll collect OASIS-B data when a patient starts home care, at the 60-day recertification point, and when the patient is discharged or transferred to another health care facility, such as a hospital or subacute care facility.