II. Survey

  1. Based on 6 criteria (1 point each if independent, 0 points if dependent)
    1. Bathing with sponge, bath, or shower
      1. Dependent if needs help with bathing more than one body part, or in getting in or out of bath or shower
    2. Dressing
      1. Dependent if needs help dressing self or needs to be completely dressed
    3. Toilet Use
      1. Dependent if needs help Transferring self to toilet, cleaning self or uses bedpan or commode
    4. Transferring (in and out of bed or chair)
      1. Dependent if needs help moving from bed to chair or needs complete assistance
    5. Urine and Bowel Continence
      1. Dependent if partially or totally incontinent of bowel or Bladder
    6. Eating
      1. Dependent if needs partial or complete help with feeding or needs Parenteral feeding
  2. Each criteria is graded on level of dependence
    1. Performs independently (1 point assigned) OR
    2. Performs only with assistance

III. Interpretation

  1. Level of ADL Dependence graded via score
  2. Dependence in ADLs suggested by score of 0 to 1
  3. Independent in ADLs increases as score approaches 6

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