ALTCS Medical Assessment

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ALTCS Medical Assessment

This Calculator Is Intended For Educational And Illustrative Purposes Only.

The results of this calculator should not be relied upon to determine ALTCS eligiblility. Only the ALTCS program can made that determination.

Mobility:

Completly relies on another person for all mobility.

Mobile with hands-on assistance, but still able to participate in some way most of the time.

Independently mobile most of the time with set-up, standby assistance, and limited or occasional hands-on assistance.

Independently mobile most or all of the time, with or without assistive devices.

Transfering:

Relies completely on others for transfers OR is bedfast.

Needs to be physically lifted or moved, but does physically participate most of the time.

Transfers with just supervision, physical guidance, set-up, or limited or occasional hands-on assistance most of the time.

Able to transfer indepdently, with or without assistive devices most or all of the time.

Bathing:

Relies completely on another person for all bathing tasks.

Needs help with the following most of the time: Transfering in and out of the tub or shower AND moderate hands-on help OR standby assistance throughout bathing activities in order to maintain safety.

Requires set-up or reminding most of the time but can bathe safely without continuous assistance or supervision OR requires limited hands-on assistance or occasional hands-on assistance most of the time.

Able to bath independently most of the time, with or without assistive devices.

Dressing:

Requires a combination of full hands-on assistance for BOTH dressing AND undressing.

Needs physical assistance or significant verbal assistance most of the time, but is able to physically participate.

Requires supervision, reminding, or set-up assitance; or needs limited or occasional hands-on assistance most of the time.

Able to dress independently most of the time, with or without assistive devices.

Gooming:

Completely relies on another person for all grooming tasks.

Needs hands-on physical assistance with all grooming tasks most ofthe time, but can participate physically.

Needs set-up, supervision, reminding, limited hands-on assistance, or occasional hands-on assistance most of the time.

Able to groom independently most of the time, with or without assistive devices.

Eating:

Totally fed by another person, including being fed by another person through a stomach tube or vein access.

Needs assistance being fed some food by mouth by another person OR can eat on own, but needs stand-by assistance for frequent gatting, choking, difficulty swallowing, or aspiration.

Can feed, chew and swallow foods on their own, but need reminding to maintain adequate intake OR need setup (includes mechanically altered diet).

Able to eat independently most of the time, with or without assistive utensils, without safety issues.

Toileting:

Completely relies on others for the entire toileting process.

Needs hands-on physical assistance with most of the toileting components or stand-by assistance for safety most of the time OR at risk due to the inability to keep self clean.

Needs supervision, reminders, limited hands-on assistance or occasional hands-on assistance most of the time.

Able to safely complete the toileting task without assistance from another person with or without the use of assistive devices.

Bowel Continence:

Has two or more incontinent episodes a week OR no voluntary control.

Has incontinent episodes once a week.

Has incontinent episodes less than weekly.

Has complete voluntary control.

Bladder Continence:

Has incontinent episodes daily OR no voluntary control.

Has incontinent episodes one or more times per week, but not daily.

Has incontinent episodes less than weekly.

Has complete voluntary control, stress incontinence, or dribbling

Deterioration in Overall Function in last 90 days:

Unable to determine.

Deteriorated.

No deterioration.

Orientation to Place:

Does not know immediate enviornment, place of residence, city and state.

Knows one of the above (immediate enviornment, place of residence, city and state).

Knows two of the above (immediate enviornment, place of residence, city and state)

Knows three of the above (immediate enviornment, place of residence, city and state)

Knows all of the above (immediate enviornment, place of residence, city and state)

Dressing:

Does not know day, month, year and time of day.

Knows one of the above (day, month, year and time of day).

Knows two of the above (day, month, year and time of day)

Knows three of the above (day, month, year and time of day)

Knows all of the above (day, month, year and time of day)

Hearing:

Has highly impaired hearing, the absence of useful hearing, or is completely deaf.

Only able to hear in special situations, and only able to follow loud conversations? For example, the speaker has to adjust voice pitch or volume, speak distinctly, and look directly at the customer when speaking.

Has minimal difficulty when not in a quiet setting, but is able to understand conversations when in one-on-one situations.

Adequately able to hear conversations, the television, or when talking on the telephone

Vision:

Has severe impairment, in which they have no vision or are only able to see light, colors, or shapes

Has highly impaired vision and is unable to see large print OR Is the field of vision severely limited? For example: the customer has tunnel vision or central vision loss.

Has impaired vision making it difficult to focus at reading range OR can see large print and obstacles, but not details, or has monocular vision.

Is able to see adequately. For example: read the news, watch TV, read the labels on medication bottles

Dressing:

Rarely or never understood.

Sometimes understood, but their ability is limited to making concrete requests.

Usually understood, but they have difficulty finding words, finishing thoughts, or enunciating.

Usually understood without difficulty.

Wandering Frequency:

Occurs at least daily, posing a threat to the safety of self or others.

Occurs at least weekly but less than daily; posing a threat to the safety of self or others.

Occurs less than weekly, but poses a threat to the safety of self or others OR occurs weekly or more often, but only poses a safety threat less than weekly.

Has a history of wandering behavior that is not currently a problem, including chemically controlled OR wandering has not been observed.

Wandering Intervention:

Requires physical intervention or restraints, including chemical restraints.

Can be verbally redirected with difficulty.

Can be easily redirected.

Wandering does not require intervention.

Self-Injurious Frequency:

Occurs at least daily, posing a threat to the safety of self or others.

Occurs at least weekly but less than daily; posing a threat to the safety of self or others.

Occurs less than weekly, but poses a threat to the safety of self or others OR occurs weekly or more often, but only poses a safety threat less than weekly.

Has a history of self-injurious behavior that is not currently a problem, including chemically controlled OR self-injurious behavior has not been observed.

Self-Injurious Intervention:

Requires physical intervention or restraints, including chemical restraints.

Can be verbally redirected with difficulty.

Can be easily redirected.

Self-Injurious behavior does not require intervention.

Aggression Frequency:

Occurs at least daily, posing a threat to the safety of self or others.

Occurs at least weekly but less than daily; posing a threat to the safety of self or others.

Occurs less than weekly, but poses a threat to the safety of self or others OR occurs weekly or more often, but only poses a safety threat less than weekly.

Has a history of aggressive behavior that is not currently a problem, including chemically controlled OR aggressive behavior has not been observed.

Aggression Intervention:

Requires physical intervention or restraints, including chemical restraints.

Can be verbally redirected with difficulty.

Can be easily redirected.

Aggressive behavior does not require intervention.

Resistiveness Frequency

Occurs at least daily.

Occurs at least weekly but less than daily.

Occurs less than weekly.

Does not occur or occurs at a level not requiring intervention (including if chemically controlled).

Resistiveness Intervention:

Requires physical intervention or restraints, including chemical restraints.

Can be verbally redirected with difficulty.

Can be easily redirected.

Behavior does not require intervention.

Disruptiveness Frequency:

Occurs at least daily.

Occurs at least weekly but less than daily.

Occurs less than weekly.

Does not occur or occurs at a level not requiring intervention (including if chemically controlled).

Disruptiveness Intervention:

Requires physical intervention or restraints, including chemical restraints.

Can be verbally redirected with difficulty.

Can be easily redirected.

Behavior does not require intervention.

Does the customer have paralysis?:

Yes

Does the customer have Alzheimer's, Dementia or OBS?

Yes

Does the customer require oxygen?:

Yes