Level of Care Worksheet
Use the worksheet below to determine a person's level of care. The calculated level of care will determine which Adult Care Home offers the appropriate level of services.
Instructions: Check the box which matches the amount of help required by the person needing care for each activity of daily living.
Note: "Activities of Daily Living" (ADL) are routine activities we perform for self-care such as eating, bathing, toileting, dressing and grooming.
Independent: Does not need someone's help to perform the ADL; may need assistive devices or set-up.
Assist: Even with devices, person needs help with parts of the ADL including cueing or stand-by.
Full Assist: Even with assistive devices the person is unable to perform any part of the ADL.
For more information about ADL see: Appendix I Activities of Daily Living (ADL)