PPT Slide

Parts II and III: Caregiver Assistance and Modification

Circle the appropriate score for Caregiver Assistance and Modification for each item.

SELF-CARE DOMAIN

A. Eating: eating and drinking regular meal; do not include cutting steak, opening containers or serving food from serving dishes

B. Grooming: brushing teeth, brushing or combing hair and caring for nose

C. Bathing: washing and drying face and hands, taking a bath or shower; do not include getting in and out of a tub/shower, water preparation, or washing back or hair

D. Dressing Upper Body: all indoor clothes, not including back fasteners; include help putting on or taking off splint or artificial limb; do not include getting clothes from closet or drawers

E. Dressing Lower Body: all indoor clothes; include putting on or taking off brace or artificial limb; do not include getting clothes from closet or drawers

F. Toileting: clothes, toilet management or external device use, and hygiene; do not include toilet transfers, monitoring schedule, or cleaning up after accidents

G. Bladder Management: control of bladder day and night, clean-up after accidents, monitoring schedule

H. Bowel Management: control of bowel day and night, clean-up after accidents, monitoring schedule

Self-Care Total

Self-Care Sum

Independent

Supervision

Minimal

Moderate

Maximal

Total

None

Child

Rehab

Extensive

Caregiver Assistance Scale

Modification Scale

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