Intent:
To record the person's actual performance in making everyday decisions about the tasks or activities of daily living. These items are especially important for further assessment and care planning in that they can alert the assessor to a mismatch between a person's abilities and his or her current level of performance, as the family may inadvertently be fostering the person's dependence.
Definition:
Examples of Decision-making Tasks:
Choosing items of clothing;
Knowing when to eat meals;
Knowing and using space in the home appropriately;
Using environmental cues to organize and plan the day (e.g., clocks, calendars);
In the absence of environmental cues, seeking information appropriately (i.e., not repetitively) from family in order to plan the day;
Using awareness of one's own strengths and limitations in regulating the day's events (e.g., asks for help when necessary);
Making the correct decision concerning how and when to go out of the house; and acknowledging the need to use a walker or other assistive device and using it faithfully.
Process:
Interview and observe the person, then consult with a family member or other caregiver. Review the events of each day. The inquiry should focus on whether the person is actively making decisions about how to manage tasks of daily living, and not whether the caregiver believes that the person might be capable of doing so.
Remember the intent of this item is to record what the person is doing (actual performance). When a family member takes decision-making responsibility away from the person regarding tasks of everyday living, or the person otherwise chooses not to participate in decision-making (whatever his or her level of capability may be), the person should be considered as having impaired performance in decision-making.
Coding:
Enter the most correct response.
Independent — The person's decisions in organizing daily routines and making decisions were consistent, reasonable, and safe (reflecting lifestyle, culture, values).
Modified independence — The person organized daily routines and made safe decisions in familiar situations, but experienced some difficulty in decision-making when faced with new tasks or situations only.
Minimally impaired — In specific situations, decisions were poor or unsafe, with cues/supervision necessary at those times.
Moderately impaired — The person's decisions were consistently poor or unsafe; the person required reminders, cues, or supervision at all times to plan, organize, and conduct daily routines.
Severely impaired — The person never (or rarely) made decisions.
No discernable consciousness, coma – the person is non-responsive