PACIFIC VALLEY

A. Cares for self at toilet completely, no incontinence

B. Needs to be reminded, or needs helping cleaning self, or has rare (weekly at most) accidents.

C. Soiling or wetting while asleep more than once a week.

D. Soiling or wetting while awake more than once a week.

E. No control of bowels or bladder

A. Eats without assistance.

B. Eats with minor assistance at mealtimes and/or with special preparation of food, or help in cleaning up after.

C. Feeds self with moderate assistance and is untidy.

D. Requires extensive assistance for all meals.

E. Does not feed self at all and resists efforts of others to feed him.

A. Dresses, undresses, and selects clothes from own wardrobe.

B. Dresses and undresses self, with minor assistance.

C. Needs moderate assistance in dressing or selection of clothes.

D. Needs major assistance in dressing, but cooperates with efforts of others to help

E. Completely unable to dress self and resists efforts of others to help.

A. Always neatly dressed, well-groomed, without assistance

B.  Grooms self adequately with occasional minor assistance, e.g., shaving.

C.  Needs moderate and regular assistance or supervision in grooming.

D.  Needs total grooming care, but can remain well-groomed after help from others

E.  Actively negates all efforts of others to maintain grooming.

A. Goes about grounds or city.

B. Ambulates within residence or about one block distant.

C. Sits unsupported in chair or wheelchair, but cannot propel self without help.

D. Bedridden more than half the time.

E. Ambulates with assistance of  another person, railing, cane, walker, wheel chair.

A. Bathes self (tub, shower, sponge bath) without help.

B. Bathes self with help in getting in and out of tub.

C. Washes face and hands only, but cannot bathe rest of body.

D. Does not wash self but is cooperative with those who bathe him.

E. Does not try to wash self and resists efforts to keep him clean.

A. Operates telephone on own initiative—lookup and dials numbers, etc.

B. Dials a few well-known numbers.

C. Answers telephone but does not dial.

D. Does not use telephone at all.

A. Takes care of all shopping needs independently

B. Shops independently for small purchases.

C. Needs to be accompanied on any shopping trip.

D. Completely unable toyshop.

A. Plans, prepares and serves adequate meals independently.

B. Prepares adequate meals if supplied with ingredients

C. Heats and serves prepared meals, or prepares meals but does not maintain adequate diet.

D. Needs to have meals prepared and served.

A. Maintains house alone or with occasional assistance (e.g., "heavy work-domestic help").

B. Performs light daily tasks such as dish-washing, bed making.

C. Performs light daily tasks but cannot maintain acceptable level of cleanliness.

D. Needs help with all home maintenance tasks.

E. Does not participate in any housekeeping tasks

A. Does personal laundry completely.

B. Launders small items- 1 rinses socks, stockings, etc.

C. All laundry must be done by others.

A. Travels independently on public transportation or drives own car.

B. Arranges own travel via taxi, but does not otherwise use public transportation.

C. Travels on public transportation when assisted or accompanied by another.

D. Travel limited to taxi  or automobile with assistance of another.

E. Does not travel at all.

A. Is responsible for taking medication in correct dosages at correct time.

B. Takes responsibility if medication is prepared in advance in separate dosages.

C. Is not capable of  dispensing own medication.

A. Manages financial matters independently (budgets, writes checks, pays rent, bills, goes to bank), collects and keeps track of income.

B. Manages day-to-day  purchases, but needs help with banking, major purchases, etc.

C. Incapable of handling  money.