Housing Evaluation Exam

Capable of moving about independently. Able to seek and follow directions, able to evacuate independently in case of emergency.
Ambulatory with care or walker, independent with wheelchair but needs help in an emergency.
Requires occasional assistance to move about, but usually independent.
Requires occasional assistance due to confusion, poor vision, weakness or poor motivation.
May require assistance when transferring from bed, chair, and toilet.
Requires transfer and transport assistance, requires turning in bed and wheelchair.
Able to prepare own meals, eats meals without assistance.
Can do some meal preparation, needs main meal prepared daily.
Needs all meals prepared and served.
May require assistance getting to meals and or assistance when eating such as opening cartons or cutting food.
May be mostly or totally dependent on others for nourishment (includes reminders to eat and or assistance when eating)
Independent in all care including bathing, shaving, and dressing.
May require assistance with bathing or hygiene or may require reminders or initiation assistance.
Dependent on others for most or all personal hygiene tasks.
Independent in performing housekeeping functions (including bed making, vacuuming, cleaning, and laundry.
May need assistance with heavy housekeeping, vacuuming, laundry, and changing linens.
Needs laundry and housekeeping services provided.
Independent and dresses appropriately
May require assistance with shoelaces, zippers, medical appliances or garments, or may require reminders, motivation or initiation assistance.
Dependent on others for dressing.
Independent and completely continent.
May have incontinence, a colostomy or catheter but is independent in caring for self through proper use of supplies.
May have occasional problems with incontinence, colostomy, or catheter care, or may require assistance in caring for self through proper use of supplies.
May be unwilling or unable to manage own incontinence through proper use of supplies or may require physical assistance with toileting on a regular basis.
Regularly and uncontrollably incontinent, dependent or unable to communicate needs.
Responsible for self-administration of meds.
Able to self-administration of medications, but others need to remind and monitor the actual process.
Family or Home Health Agency has arranged a medication administration system with reminders and monitoring by family members or others.
Cannot administer own medications, even with supervision, Medications must be administered by licensed personnel.
Mental Status
Oriented to Person, Place and Time, memory intact but may have occasional forgetfulness with no pattern of memory loss. Able to reason, plan and organize daily events. Has mental capacity to identify environmental needs and meet them.
May require occasional direction or guidance in getting from place to place, or may have difficulty with occasional confusion that may result in anxiety, social withdrawal or depression, orientation to time, place or person may be minimally impaired.
Judgement may be poor, may attempt tasks that are not within capabilities, may require strong orientation assistance and reminders.
Disoriented to time, place, and person, or memory is severely impaired. Usually unable to follow directions.
Deals appropriately with emotions and uses available resources to cope with inner stress, deals appropriately with others.
May require periodic intervention from others to facilitate expression of feelings in order to cope with inner stress. May require periodic intervention from others to resolve conflicts and cope with stress.
May require regular intervention from others to facilitate expression of feelings and to deal with periodic outbursts of anxiety or agitation.
Maximum intervention is required to manage behavior. May pose physical danger to self or others, or is abusive or unacceptably uncooperative.