ParaRegs-Medi-Cal-Personal-Care-Assessments
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Code |
Effective |
ParaReg Text |
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568-1 |
ADDED 12/06
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When assessing time for services (both within and outside the time guidelines), the time authorized shall be based on the recipient’s individual level of need necessary to ensure his/her health, safety, and independence based on the scope of tasks identified for service.
In determining the amount of time per task, the recipient’s ability to perform the tasks based on his/her functional index ranking shall be a contributing factor, but not the sole factor. Other factors could include the recipient’s living environment, and/or the recipient’s fluctuation in needs due to daily variances in the recipient’s functional capacity (e.g., "good days" and "bad days").
In determining the amount of time per task, universal precautions should be considered. Universal precautions are protective practices necessary to ensure safety and prevent the spread of infectious diseases. Universal precautions should be followed by anyone providing a service, which may include contact with blood or body fluids such as saliva, mucus, vaginal secretions, semen, or other internal body fluids such as urine or feces. Universal precautions include the use of protective barriers such as gloves or facemask depending on the type and amount of exposure expected, and always washing hands before and after performing tasks. More information regarding universal precautions can be obtained by contacting the National Center for Disease Control.
(MPP 30-757.1(a)) |
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568-1A |
ADDED 12/06
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For services in this section where time guidelines are specified, the services shall be subject to the specified time guideline unless the recipient's needs require an exception to the guideline. When assessing time for services (both within and outside the time guidelines), the time authorized shall be based on the recipient's individual level of need necessary to ensure his/her health, safety, and independence based on the scope of tasks identified for service. In accordance with Welfare and Institutions Code Section 12301.2, the dual purpose of the guidelines is to provide counties with a tool for both consistently and accurately assessing service needs and authorizing time.
An exception to the time guideline may result in receiving more or less time based on the recipient's need for each supportive service and the amount of time needed to complete the task.
Exceptions to the hourly task guidelines identified in this section shall be made when necessary to enable the recipient to establish and maintain an independent living arrangement and/or remain safely in his/her home or abode of his/her own choosing and shall be considered a normal part of the authorization process.
No exception shall result in the recipient's hours exceeding the maximum limits of 195 hours per month as specified at Section 30-765.121 for nonseverely impaired cases or 283 hours per month for severely impaired cases as specified in Section 30-765.111.
No exception shall result in the recipient's hours exceeding the maximum limit for PCSP cases as specified at Section 30-780.2(b).
No exceptions to hourly task guidelines shall be made due to inefficiency or incompetence of the provider.
When an exception to an hourly task guideline is made in a recipient's case, the reason for the exception shall be documented in the case file.
(30-757.1(a) |
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568-1B |
ADDED 3/07
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General The following are general regulatory standards that apply to all functions. The standards for each function are defined in more detail in individual scales that follow.
Rank 1: Independent: Able to perform function without human assistance although the recipient may have difficulty in performing the function, but the completion of the function, with or without a device or mobility aid, poses no substantial risk to his/her safety. A recipient who ranks a “1” in any function shall not be authorized the correlated service activity.
Rank 2: Able to perform a function but needs verbal assistance such as reminding, guidance, or encouragement.
Rank 3: Can perform the function with some human assistance, including, but not limited to, direct physical assistance from a provider.
Rank 4: Can perform a function but only with substantial human assistance.
Rank 5: Cannot perform the function with or without human assistance.
Rank 6: Paramedical Services needed.
Variable Functioning If the recipient’s functioning varies throughout the month, the functional rank should reflect the functioning on reoccurring bad days. It is not solely based on a “worst” day scenario (e.g., a recipient who suffers from arthritis will have days when pain is significant and days when pain is mild; therefore, in this case you would rank a recipient based on the reoccurring days where the frequency of pain is significant).
(All County Letter 06-34E1, attachment B, December 21, 2006) |
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568-2A |
ADDED 6/07
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Task Definition
Meal Preparation (MPP 30-757.131) Preparation of meals which includes planning menus; removing food from refrigerator or pantry; washing/drying hands before and after meal preparation; washing, peeling, and slicing vegetables; opening packages, cans, and bags; measuring and mixing ingredients; lifting pots and pans; trimming meat; reheating food; cooking and safely operating stove; setting the table; serving the meals; pureeing food; and cutting the food into bite-size pieces.
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-2B |
ADDED 6/07
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Functional Index for Meal Preparation
Rank 1: Independent: Can plan, prepare, serve, and cleanup meals.
Rank 2: Needs only reminding or guidance in menu planning, meal preparation, and/or cleanup.
Rank 3: Requires another person to prepare and cleanup main meal(s) on less than a daily basis (e.g., recipient can reheat food prepared by someone else, can prepare simple meals, and/or needs some help with cleanup but requires another person to prepare and cleanup with more complex meals which involve, peeling, cutting, etc., on less than a daily basis).
Rank 4: Requires another person to prepare main meal(s) and cleanup on a daily basis.
Rank 5: Totally dependent on another person to prepare and cleanup all meals.
Rank 6: Is tube-fed. All aspects of tube feeding are evaluated as a “paramedical service
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment B) |
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568-2C |
ADDED 6/07
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Grid for Meal Preparation
Low High Rank 2 3.02 7.00 Rank 3 3.50 7.00 Rank 4 5.25 7.00 Rank 5 7.00 7.00
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-2D |
ADDED 6/07
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Meal Preparation
Factors/Exception Examples
Factors For Consideration Include, But Not Limited To: · The extent to which the recipient can assist or perform tasks safely. · Types of food the recipient usually eats for breakfast, lunch, dinner, and snacks and the amount of time needed to prepare the food (e.g., more cooked meals versus meals that do not require cooking). · Whether the recipient is able to reheat meals prepared in advance and the types of food the recipient eats on days the provider does not work. · The frequency the recipient eats. · Time for universal precautions, as appropriate
Exceptions Include, But Not Limited To: · If the recipient must have meals pureed or cut into bite-sized pieces. · If the recipient has special dietary requirements that require longer preparation times or preparation of more frequent meals. · If the recipient eats meals that require less preparation time (e.g., toast and coffee for breakfast).
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-2E |
ADDED 6/08
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Q: If an IHSS recipient chooses to eat meals separately from other family members residing in the home, must the IHSS recipient's needs be prorated unless the recipient has a health and safety need requiring his/her meals to be prepared separately?
A: No, these services do not have to be prorated. The regulation does not require that there be a health and safety reason for the recipient to eat meals separately. Consequently, the recipient may have meals provided.
(All County Letter 08-18, April 23, 2008, question and answer 11) |
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568-2F |
REVISED 9/09
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Q: Can Meal Preparation and Meal Cleanup be performed outside of the recipient’s home?
A: Meal preparation and cleanup must be done in the recipient’s home. It is inferred from the language of the statute and regulations that the intent is to provide these services in the home of the recipient.
(All County Letter 08-18, April 23, 2008, question and answer 10)
There are unusual circumstances which could occasionally arise, necessitating that Meal Preparation and Meal Clean-Up services temporarily take place outside of the recipient’s home. Should such circumstances arise, measures should be adopted as necessary to ensure that authorized services are provided without interruption. It is assumed that Meal Preparation and Meal Clean-Up services provided outside the recipient’s home, if required at all, would be a temporary solution to a situation such as a broken stove or clogged sink in the recipient’s home, and not the regular means of providing those services. No time can be added for delivering meals prepared elsewhere. (ACL 09-30, June 30, 2009 correcting answer to ACL 08-18) |
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568-3A |
ADDED 6/07
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Task Definition
Meal Cleanup (MPP 30-757.132) Loading and unloading dishwasher; washing, rinsing, and drying dishes, pots, pans, utensils, and culinary appliances and putting them away; storing/putting away leftover foods/liquids; wiping up tables, counters, stoves/ovens, and sinks; and washing/drying hands.
Note: This does not include general cleaning of the refrigerator, stove/oven, or counters and sinks, as these IHSS services are assessed as “domestic services” (MPP 30-757.11).
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-3B |
ADDED 6/07
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Functional Index for Meal Cleanup
Rank 1: Independent: Can plan, prepare, serve, and cleanup meals.
Rank 2: Needs only reminding or guidance in menu planning, meal preparation, and/or cleanup.
Rank 3: Requires another person to prepare and cleanup main meal(s) on less than a daily basis (e.g., recipient can reheat food prepared by someone else, can prepare simple meals, and/or needs some help with cleanup but requires another person to prepare and cleanup with more complex meals which involve, peeling, cutting, etc., on less than a daily basis).
Rank 4: Requires another person to prepare meal(s) and cleanup on a daily basis.
Rank 5: Totally dependent on another person to prepare and cleanup all meals.
Rank 6: Is tube-fed. All aspects of tube feeding are evaluated as a “paramedical service
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment B) |
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568-3C |
ADDED 6/07
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Grid for Meal Cleanup
Low High Rank 2 1.17 3.50 Rank 3 1.75 3.50 Rank 4 1.75 3.50 Rank 5 2.33 3.50
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-3D |
ADDED 6/07
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Meal Cleanup
Factors/Exception Examples
Factors For Consideration Include, But Not Limited To: · The extent to which the recipient can assist or perform tasks safely. o EX: A recipient with a Rank 3 in “meal cleanup” who has been determined able to wash breakfast/lunch dishes and utensils and only needs the provider to clean up after dinner would require time based on the provider performing cleanup for the dinner meal only. o EX: A recipient who has less control of utensils and/or spills food frequently may require more time for cleanup. · The types of meals requiring the cleanup. o EX: A recipient who chooses to eat eggs and bacon for breakfast would require more time for cleanup than a recipient who chooses to eat toast and coffee. · If the recipient can rinse the dishes and leave them in the sink until provider can wash them. · The frequency that meal cleanup is necessary. · If there is a dishwasher appliance available. · Time for universal precautions, as appropriate.
Exceptions Include, But Not Limited To: · If the recipient must eat frequent meals which require additional time for cleanup. · If the recipient eats light meals that require less time for cleanup.
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-4A |
ADDED 6/07
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Task Definition
Bowel and Bladder Care (MPP 30-757.14(a)) Assistance with using, emptying, and cleaning bed pans/bedside commodes, urinals, ostomy, enema and/or catheter receptacles; application of diapers; positioning for diaper changes; managing clothing; changing disposable barrier pads; putting on/taking off disposable gloves; wiping and cleaning recipient; assistance with getting on/off commode or toilet; and washing/drying recipient’s and provider’s hands.
Note: This does not include insertion of enemas, catheters, suppositories, digital stimulation as part of a bowel program or colostomy irrigation, as these are assessed as “paramedical services” (MPP 30-757.19).
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-4B |
ADDED 6/07
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Functional Index for Bowel and Bladder Care
Rank 1: Independent: Able to manage Bowel, Bladder, and Menstrual Care with no assistance from another person.
Rank 2: Requires reminding or direction only.
Rank 3: Requires minimal assistance with some activities but the constant presence of the provider is not necessary.
Rank 4: Unable to carry out most activities without assistance.
Rank 5: Requires physical assistance in all areas of care.
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment B) |
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568-4C |
ADDED 6/07
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Grid for Bowel and Bladder Care
Low High Rank 2 0.58 2.00 Rank 3 1.17 3.33 Rank 4 2.91 5.83 Rank 5 4.08 8.00
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-4D |
ADDED 6/07 |
Bowel and Bladder Care
Factors/Exception Examples
Factors For Consideration Include, But Not Limited To: · The extent to which the recipient can assist or perform tasks safely. · The frequency of the recipient’s urination and/or bowel movements. · If there are assistive devices available which result in decreased or increased need for assistance. o EX: Situations where elevated toilet seats and/or Hoyer lifts are available may result in less time needed for “bowel and bladder” care if the use of these devices results in decreased need for assistance by the recipient. o EX: Situations where a bathroom door is not wide enough to allow for easy wheelchair access may result in more time needed if its use results in an increased need. · Time for universal precautions, as appropriate.
Exceptions Include, But Not Limited To: · If the recipient has frequent urination or bowel movements. · If the recipient has frequent bowel or bladder accidents. · If the recipient has occasional bowel or bladder accidents that require assistance from another person. · If the recipient’s morbid obesity requires more time. · If the recipient has spasticity or locked limbs. · If the recipient is combative.
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-5A |
ADDED 6/07
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Task Definition
Feeding (MPP 30-757.14(c)) Includes assistance with consumption of food and assurance of adequate fluid intake consisting of feeding or related assistance to recipients who cannot feed themselves or who require other assistance with special devices in order to feed themselves or to drink adequate liquids.
Includes assistance with reaching for, picking up, and grasping utensils and cup; cleaning recipient’s face and hands; washing/drying hands before and after feeding.
Note: This does not include cutting food into bite-sized pieces or puréeing food, as these are assessed as part of “meal preparation” (MPP 30-757.131).
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-5B |
ADDED 6/07
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Functional Index for Feeding
Rank 1: Independent: Able to feed self.
Rank 2: Able to feed self, but needs verbal assistance such as reminding or encouragement to eat.
Rank 3: Assistance needed during the meal (e.g., to apply assistive device, fetch beverage or push more food within reach, etc.) but constant presence of another person is not required.
Rank 4: Able to feed self some foods, but cannot hold utensils, cups, glasses, etc., and requires constant presence of another person.
Rank 5: Unable to feed self at all and is totally dependent upon assistance from another person.
Rank 6: Is tube fed. All aspects of tube feeding are evaluated as a “paramedical service.
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment B) |
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568-5C |
ADDED 6/07
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Grid for Feeding
Low High Rank 2 0.70 2.30 Rank 3 1.17 3.50 Rank 4 3.50 7.00 Rank 5 5.25 9.33
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-5D |
ADDED 6/07
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Feeding
Factors/Exception Examples
Factors For Consideration Include, But Not Limited To: · The extent to which the recipient can assist or perform tasks safely. · The amount of time it takes the recipient to eat meals. · The type of food that will be consumed. · The frequency of meals/liquids. · Time for universal precautions, as appropriate.
Exceptions Include, But Not Limited To: · If the constant presence of the provider is required due to the danger of choking or other medical issues. · If the recipient is mentally impaired and only requires prompting for feeding him/herself. · If the recipient requires frequent meals. · If the recipient prefers to eat foods that he/she can manage without assistance. · If food must be placed in the recipient’s mouth in a special way due to difficulty swallowing or other reasons. · If the recipient is combative.
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-6A |
ADDED 6/07
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Task Definition
Routine Bed Baths (MPP 30-757.14(d)) Cleaning basin or other materials used for bed/sponge baths and putting them away; obtaining water/supplies; washing, rinsing, and drying body; applying lotion, powder, and deodorant; and washing/drying hands before and after bathing.
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-6B |
ADDED 6/07
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Functional Index for Routine Bed Baths
Rank 1: Independent: Able to bathe, brush teeth, and groom self safely without help from another person.
Rank 2: Able to bathe, brush teeth, and groom self with direction or intermittent monitoring. May need reminding to maintain personal hygiene.
Rank 3: Generally able to bathe and groom self, but needs assistance with some areas of body care (e.g., getting in and out of shower or tub, shampooing hair, or brushing teeth).
Rank 4: Requires direct assistance with most aspects of bathing, oral hygiene, and grooming. Would be at risk if left alone.
Rank 5: Totally dependent on others for bathing, oral hygiene, and grooming
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment B) |
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568-6C |
ADDED 6/07
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Grid for Routine Bed Baths
Low High Rank 2 0.50 1.75 Rank 3 1.00 2.33 Rank 4 1.17 3.50 Rank 5 1.75 3.50
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-6D |
ADDED 6/07
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Bed Baths
Factors/Exception Examples
Factors For Consideration Include, But Not Limited To: · The extent to which the recipient can assist or perform tasks safely. · If the recipient is prevented from bathing in the tub/shower. · If bed baths are needed in addition to baths in the tub/shower. · Time for universal precautions, as appropriate.
Exceptions Include, But Not Limited To: · If the recipient is confined to bed and sweats profusely requiring frequent bed baths. · If the weight of the recipient requires more or less time. · If the recipient is combative.
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C)
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568-7A |
ADDED 6/07
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Task Definition
Dressing (MPP 30-757.14(f)) Washing/drying of hands; putting on/taking off, fastening/unfastening, buttoning/unbuttoning, zipping/unzipping, and tying/untying of garments, undergarments, corsets, elastic stockings, and braces; changing soiled clothing; and bringing tools to the recipient to assist with independent dressing.
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-7B |
ADDED 6/07
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Functional Index for Dressing
Rank 1: Independent: Able to put on, fasten and remove all clothing, special devices, prosthetic devices, and self-administer medication without assistance. Clothes self appropriately for health and safety.
Rank 2: Able to dress self; put on, fasten, and remove all special/prosthetic devices and/or hearing aid; and self-administer medication but requires reminding or direction.
Rank 3: Unable to dress self completely without the help of another person (e.g., tying shoes, buttoning, zipping, putting on hose, brace, hearing aid, etc.).
Rank 4: Unable to put on most clothing items, special/prosthetic devices, and/or hearing aid by self. Without assistance recipient would be inappropriately or inadequately clothed.
Rank 5: Unable to dress self at all, requires complete assistance from another.
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment B) |
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568-7C |
ADDED 6/07
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Grid for Dressing
Low High Rank 2 0.56 1.20 Rank 3 1.00 1.86 Rank 4 1.50 2.33 Rank 5 1.90 3.50
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-7D |
ADDED 6/07
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Dressing
Factors/Exception Examples
Factors For Consideration Include, But Not Limited To: · The extent to which the recipient can assist or perform tasks safely. · The type of clothing/garments the recipient wears. · If the recipient prefers other types of clothing/garments. · The weather conditions. · Time for universal precautions, as appropriate.
Exceptions Include, But Not Limited To: · If the recipient frequently leaves his/her home, requiring additional dressing/undressing. · If the recipient frequently bathes and requires additional dressing or soils clothing, requiring frequent changes of clothing. · If the recipient has spasticity or locked limbs. · If the recipient is immobile. · If the recipient is combative.
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-8 |
ADDED 12/06
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Task Definition
Menstrual Care (MPP 30-757-14(j)) Menstrual care is limited to external application of sanitary napkins and external cleaning and positioning for sanitary napkin changes, using, and/or disposing of barrier pads, managing clothing, wiping and cleaning, and washing/drying ands before and after performing these tasks.
EX: In assessing menstrual care, it may be necessary to assess additional time in other service categories such as “laundry,” “dressing,” “domestic, “bathing, oral hygiene, and grooming” (MPP 30-757).
EX: In assessing menstrual care if the recipient wears diapers, time for menstrual care would not be necessary. This time would be assessed as part of “bowel and bladder” care.
Grid
Low High Functional 0.28 0.80 rank does not apply
Factors/Exception Examples
Factors For Consideration Include, But Not Limited To: · The extent to which the recipient can assist or perform tasks safely. · If the recipient has a menstrual cycle. · The duration of the recipient’s menstrual cycle. · If there are medical issues that necessitate additional time. · Time for universal precautions, as appropriate.
Exceptions Include, But Not Limited To: · If the recipient has spasticity or locked limbs. · If the recipient is combative.
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-9A |
ADDED 6/07
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Task Definition
Ambulation (MPP 30-757.14(k)) Assisting a recipient with walking or moving from place to place inside the home, including to and from the bathroom; climbing or descending stairs; moving/retrieving assistive devices, such as a cane, walker, or wheelchair, etc., and washing/drying hands before and after performing these tasks. “Ambulation” also includes assistance to/from the front door to the car (including getting in and out of the car) for medical accompaniment and/or alternative resource travel.
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-9B |
ADDED 6/07
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Functional Index for Ambulation
Rank 1: Independent: Requires no physical assistance though recipient may experience some difficulty or discomfort. Completion of the task poses no risk to his/her safety.
Rank 2: Can move independently with only reminding or encouragement (e.g., needs reminding to lock a brace, unlock a wheelchair or to use a cane or walker).
Rank 3: Requires physical assistance from another person for specific maneuvers (e.g., pushing wheelchair around sharp corner, negotiating stairs or moving on certain surfaces).
Rank 4: Requires assistance from another person most of the time. Is at risk if unassisted.
Rank 5: Totally dependent upon others for movement. Must be carried, lifted, or assisted into a wheelchair or gurney at all times.
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment B) |
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568-9C |
ADDED 6/07
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Grid for Ambulation
Low High Rank 2 0.58 1.75 Rank 3 1.00 2.10 Rank 4 1.75 3.50 Rank 5 1.75 3.50
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-9D |
ADDED 6/07
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Ambulation
Factors/Exception Examples
Factors For Consideration Include, But Not Limited To: · The extent to which the recipient can assist or perform tasks safely. · The distance the recipient must move inside the home. · The speed of the recipient’s ambulation. · Any barriers that impede the recipient’s ambulation. · Time for universal precautions, as appropriate.
Exceptions Include, But Not Limited To: · If the recipient’s home is large or small. · If the recipient requires frequent help getting to/from the bathroom. · If the recipient has a mobility device, such as a wheelchair that results in a decreased need. · If the recipient has spasticity or locked limbs. · If the recipient is combative.
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-9E |
ADDED 6/08
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Q: Can time be authorized for a provider to “shadow/follow” the recipient for ambulation if they have an unsteady gait or experience dizziness?
A: Yes. County staff would determine the recipient’s level of ability and dependence upon verbal or physical assistance by another.
If a recipient has an unsteady gait or experiences dizziness, the social worker would not assess him/her as “independent” in these tasks and time for assistance with ambulating
(All County Letter 08-18, April 23, 2008, question and answer 19) |
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568-9F |
REVISED 9/09
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Q: Can the maintenance exercise of assistive walking (MPP 30-757.14(g)(2) (A)) be performed outside of the recipients home?
A: Yes, the maintenance exercise of assistive walking can be provided outside the recipient’s home if necessary to meet the needs of the recipient. In accordance with MPP Section 30-757.14(g)(2)(A) and MPP Section 30-780.1(a)(5)(B) “such exercises shall include the carrying out of maintenance programs, i.e., the performance of repetitive exercises required to maintain function, improve gait, maintain strength, or endurance; passive exercises to maintain range of motion in paralyzed extremities; and assistive walking.”
(All County Letter 08-18, April 23, 2008, question and answer 20)
Assistive walking as part of a maintenance program can be performed outside the home; however no time can be authorized for travel or assistance into or out of a vehicle for this service. (ACL 09-30, June 30, 2009 correcting answer to ACL 08-18))
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568-10A |
ADDED 6/07
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Task Definition
Moving in and out of Bed - Renamed to Transfer (MPP 30-757.14(h)) Assisting from standing, sitting, or prone position to another position and/or from one piece of equipment or furniture to another. This includes transfer from a bed, chair, couch, wheelchair, walker, or other assistive device generally ccurring within the same room.
Note: Transfer does not include: · Assistance on/off toilet, as this is evaluated, as ‘bowel and bladder” care specified at MPP 30-757.14(a). · Changing the recipient’s position to prevent skin breakdown and to promote circulation. This task is assessed as part of “repositioning/rubbing skin” at section MPP 30-757.14(g).
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-10B |
ADDED 6/07
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Functional Index for Transfers
Rank 1: Independent: Able to do all transfers safely without assistance from another person though recipient may experience some difficulty or discomfort. Completion of task poses no risk to his/her safety.
Rank 2: Able to transfer and reposition, but needs encouragement or direction.
Rank 3: Requires some help from another person (e.g., routinely requires a boost or assistance with positioning).
Rank 4: Unable to complete most transfers or reposition without physical assistance. Would be at risk if unassisted.
Rank 5: Totally dependent upon another person for all transfers. Must be lifted or mechanically transferred. Must be repositioned often and have skin rubbed daily
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment B) |
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568-10C |
ADDED 6/07
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Grid for Transfers
Low High Rank 2 0.50 1.17 Rank 3 0.58 1.40 Rank 4 1.10 2.33 Rank 5 1.17 3.50
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-10D |
ADDED 6/07
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Transfers
Factors/Exception Examples
Factors For Consideration Include, But Not Limited To: · The extent to which the recipient can assist or perform tasks safely. · The amount of assistance required. · The availability of equipment, such as a Hoyer lift. · Time for universal precautions, as appropriate.
Exceptions Include, But Not Limited To: · If the recipient gets in and out of bed frequently during the day or night due to naps or use of the bathroom. · If the weight of the recipient and/or condition of his/her bones requires more careful, slow transfer. · If the recipient has spasticity or locked limbs. · If the recipient is combative.
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-11A |
ADDED 6/07
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Task Definition
Bathing, Oral Hygiene, and Grooming (MPP 30-757.14 (e)) Bathing (Bath/Shower) includes cleaning the body in a tub or shower; obtaining water/supplies and putting them away; turning on/off faucets and adjusting water temperature; assistance with getting in/out of a tub or shower; assistance with reaching all parts of the body for washing, rinsing, and drying and applying lotion, powder, deodorant; and washing/drying hands.
Oral Hygiene includes applying toothpaste, brushing teeth, rinsing mouth, caring for dentures, flossing, and washing/drying hands.
Grooming includes hair combing/brushing; hair trimming when recipient cannot get to the barber/salon; shampooing, applying conditioner, and drying hair; shaving; fingernail/toenail care when these services are not assessed as “paramedical services” for the recipient; and washing/drying hands.
Note: This does not include getting to/from the bathroom. These tasks are assessed as mobility under “ambulation” (MPP 30-757.14(k)).
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-11B |
ADDED 6/07
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Functional Index for Bathing, Oral Hygiene, and Grooming
Rank 1: Independent: Able to bathe, brush teeth, and groom self safely without help from another person.
Rank 2: Able to bathe, brush teeth, and groom self with direction or intermittent monitoring. May need reminding to maintain personal hygiene.
Rank 3: Generally able to bathe and groom self, but needs assistance with some areas of body care (e.g., getting in and out of shower or tub, shampooing hair, or brushing teeth).
Rank 4: Requires direct assistance with most aspects of bathing, oral hygiene, and grooming. Would be at risk if left alone.
Rank 5: Totally dependent on others for bathing, oral hygiene, and grooming
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment B) |
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568-11C |
ADDED 6/07
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Grid for Bathing, Oral Hygiene, and Grooming
Low High Rank 2 0.50 1.92 Rank 3 1.27 3.15 Rank 4 2.35 4.08 Rank 5 3.00 5.10
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-11D |
ADDED 6/07
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Bathing, Oral Hygiene and Grooming
Factors/Exception Examples
Factors For Consideration Include, But Not Limited To: · The extent to which the recipient can assist or perform tasks safely. · The number of times the recipient may need help to bathe. · If the recipient requires assistance in/out of tub/shower. · If the recipient needs assistance with supplies. · If the recipient requires assistance washing his/her body. · If the provider must be present while the recipient bathes. · If the recipient requires assistance drying his/her body and/or putting on lotion/powder after bathing. · If the recipient showers in a wheelchair. · Time for universal precautions, as appropriate.
Exceptions Include, But Not Limited To: · If the provider’s constant presence is required. · If the weight of the recipient requires more or less time. · If the recipient has spasticity or locked limbs. · If a roll-in shower is available. · If the recipient is combative.
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-12A |
ADDED 6/07
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Task Definition
Repositioning/Rubbing Skin (MPP 30-757.14(g)) Includes rubbing skin to promote circulation and/or prevent skin breakdown; turning in bed and other types of repositioning; and range of motion exercises which are limited to: · General supervision of exercises which have been taught to the recipient by a licensed therapist or other health care professional to restore mobility restricted because of injury, disuse, or disease. · Maintenance therapy when the specialized knowledge and judgment of a qualified therapist is not required and the exercises are consistent the patient’s capacity and tolerance. o Such exercises include carrying out of maintenance programs (e.g., the performance of repetitive exercises required to maintain function, improve gait, maintain strength, or endurance; passive exercises to maintain a range of motion in paralyzed extremities; and assistive walking).
Note: “Repositioning and rubbing skin” does not include:
· Care of pressure sores (skin and wound care). This is assessed as part of “paramedical” specified at MPP 30-757.19. · Ultraviolet treatment (set up and monitor equipment) for pressure sores and/or application of medicated creams to skin. These tasks are assessed as part of “assistance with prosthetic devices” at MPP 30-757.14(i).
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-12B |
ADDED 6/07
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Grid for Repositioning/Rubbing Skin
Low High Functional 0.75 2.80 rank does not apply
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-12C |
ADDED 6/07
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Repositioning/Rubbing Skin
Factors/Exception Examples
Factors For Consideration Include, But Not Limited To: · The extent to which the recipient can assist or perform tasks safely. · If the recipient’s movement is limited while in the seating position and/or in bed, and the amount of time the recipient spends in the seating position and/or in bed. · If the recipient has circulatory problems. · Time for universal precautions, as appropriate.
Exceptions Include, But Not Limited To: · If the recipient has a condition that makes him/her confined to bed. · If the recipient has spasticity or locked limbs. · If the recipient has or is at risk of having decubitus ulcers which require the need to turn the recipient frequently. · If the recipient is combative.
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-13A |
ADDED 6/07
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Task Definition
Care and Assistance with Prosthetic Devices and Assistance with Self-Administration of Medications (MPP 30-757.14(i)) Assistance with taking off/putting on, maintaining, and cleaning prosthetic devices, vision/hearing aids, and washing/drying hands before and after performing these tasks.
Also includes assistance with the self-administration of medications consisting of reminding the recipient to take prescribed and/or over-the-counter medications when they are to be taken, setting up Medi-sets and distributing medications.
Grid
Low High Functional 0.47 1.12 rank does not apply
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-13B |
ADDED 6/07
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Grid for Care and Assistance with Prosthetic Devices and Assistance with Self-Administration of Medications
Low High Functional 0.47 1.12 rank does not apply
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-13C |
ADDED 6/07
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Care and Assistance with Prosthetic Devices and Assistance with Self-Administration of Medications
Factors/Exception Examples
Factors For Consideration Include, But Not Limited To: · The extent to which the recipient is able to manage medications and/or prosthesis independently and safely. · The amount of medications prescribed for the recipient. · If the recipient requires special preparation to distribute medications (e.g., cutting tablets, putting medications into Medi-sets, etc.) · If the recipient has cognitive difficulties that contribute to the need for assistance with medications and/or prosthetic devices. · Time for universal precautions, as appropriate.
Exceptions Include, But Not Limited To: · If the recipient takes medications several times a day. · If the pharmacy sets up medications in bubble wraps or Medi-sets for the recipient. · If the recipient has multiple prosthetic devices. · If the recipient is combative.
(ACL 06-34 errata, HTG Quick Reference Task Tool, Attachment C) |
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568-14 |
ADDED 12/06
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When assessing the need for domestic services, the guideline time shall not exceed 6 hours per household unless the recipient’s needs require an exception. (§30-758.11 renumbered to 30-757.11(k)(1) effective September 1, 2006)) |
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568-14A |
ADDED 12/06
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State law provides that a time-per-task guideline may be used only if appropriate in meeting the individual's particular circumstances. (Welfare and Institutions Code (W&IC) §12301.2) Counties may establish such guidelines for services other than personal care services, meal preparation and cleanup, and paramedical services. (§30-758.2 repealed effective September 1, 2006) |
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568-14B |
ADDED 12/06
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Where laundry services are available in the home, the guideline time shall not exceed 1 hour total per week per household unless the recipient’s needs require an exception to exceed this limit. (§30-758.121 renumbered to 30-757.134(c))
Laundry services are available in the home if, at a minimum, there exists a washing machine and a capability to dry clothes on the premises. (§30-757.134(a)) Where laundry facilities are not available in the home, the guideline time shall not exceed 1.5 hours total per week per household, unless the recipient’s needs require an exception to exceed this limit. (§§30-757.135(b) and §30-758.122 renumbered to §30-757.134(d) effective September 1, 2006) |
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568-14C |
ADDED 12/06
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The guideline time for "food shopping" shall not exceed 1 hour per week per household. unless the recipient’s needs require an exception to exceed this limit. (§30-758.13 renumbered to §30-757.135(b)(1) effective September 1, 2006) The time for shopping is limited to the nearest available stores or facilities which meet the client's economy and needs; no time is allowable for the recipient to accompany the provider. (§30-757.136 renumbered to §30-757.135 effective September 1, 2006) |
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568-14D |
ADDED 12/06
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The guideline time for "other shopping and errands" shall not exceed .5 hours per week per household unless the recipient’s needs require an exception to exceed this limit. (§30-758.14 renumbered to (§§30-757.135(c)(1) effective September 1, 2006.) |
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568-14E |
ADDED 12/06
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Exceptions to the guideline times for domestic services, laundry, food shopping, and other shopping and errands can be made when necessary to enable the recipient to establish and maintain an independent living arrangement and/or remain safely in his/her home or abode of choice. (§30-758.4 repealed and renumbered in various sections of 30-757) |
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568-15 |
ADDED 12/07
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Respiration is limited to nonmedical services such as assistance with self-administration of oxygen and cleaning IPPB machines. (§30-757.14(b)) |
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