When you’re a student or new occupational therapist practicing on your own, it can be hard to decide which Basic Activities of Daily Living (BADL) occupational therapy assessments to use in order to track your patient’s self-care progress. There are so many to choose from, so it can be overwhelming trying to comb Google trying to figure out which OT assessments will be best for your patients.
Choosing the appropriate OT assessment is important to show that our treatments are objective and measurable (how many times have you heard that in school?). This shows the payers (like Medicare and other health insurance companies) that the individual is benefiting from your OT services as evidenced by their progress and it helps you write more client centered and objective goals (check out the ebook: Occupational Therapy Goal Writing, Objective Measures + Goals Bank (for adults!) for more details on how to use occupational therapy assessments to write amazing goals!)
So which geriatric occupational therapy assessment tool should you choose?
There are quite a few and it can be a little overwhelming if you have to pick one yourself. In order to make your choices a little easier, this post will highlight the top occupational therapy assessments that focus on BADLS, so you can use in the adult and geriatric rehab settings.
The FIM is widely used in pretty much all acute inpatient rehab facilities and acute care units among all disciplines (OT, PT, SLP, and nursing) with different domains for each discipline. The objective of the Occupational Therapy portion of the FIM is to measure your patient’s burden of care with self care and functional mobility at evaluation, during weekly progress notes, and at discharge.
The OT portion of the FIM consists of grooming, feeding, upper body dressing, lower body dressing, bathing, toileting, toilet transfers and shower/tub transfers.
The FIM scores range from 1-7, from dependent (1) to independent (7). The in between ranges include maximal assist (2) , moderate assist (3), minimal assist/contact guard assist (which are the same number for some reason) (4), standby assist (5) and modified independent (6).
The scoring can get pretty detailed based on how much of each task the patient can complete. Because of this, many settings require training before you begin using it. If this is the case, training will be provided on the job if the FIM is required for each patient.
Once you get the hang of the FIM, you can use it in pretty much any rehab setting if your facility accepts it. It’s definitely a must to review before any hospital fieldwork in the adult setting and really is a great measurement due to the detail.
This is also a very commonly used self-care assessment in the adult and geriatric settings and is very easy to administer and score. It can be used in hospital settings as well as subacute settings. The Barthel Index measures feeding, bathing, grooming, dressing, bowel function, bladder function, toilet use, bed to chair transfers, functional mobility and stairs.
The Modified Barthel Index measures the same domains, but with 0-20 as a score versus 0-100.
The Barthel/Modified Barthel are my personal assessments of choice in my part time position working with geriatrics in the ALF setting since our system is not set up for using the FIM. It was probably the easiest BADL assessment for me to learn as a student as well.
The Katz ADL is another commonly used basic ADL assessment designed for older adults. This assessment measures the individual’s ability performing feeding, bathing, dressing, toileting, transfers, and continence. It may be one of the easiest assessments to score, since the patient either gets a 1 for Independent or 0 for “Very Dependent.” The scores only will range from 0-6.
While it’s super easy to score, it may not be the most detailed assessment if you’re looking for levels of assist, since patients have more range than just independent or very dependent.
This is an ADL assessment used based on Allen’s model of cognitive disabilities. It’s designed for adults and older adults with cognitive impairments. Along with BADLs (grooming, dressing, walking, feeding, and toileting), the RTI also has separate measurements for instrumental ADLs, communication, and work readiness if you choose to assess these components as well.
To score the assessment, you as the OT can either observe the patient’s performance, or use self-report of the patient or caregiver. Scores given range from 1-6 and the assessment states the scores can model the FIM numbers, 6 equally 6-7 on the FIM (yet another reason to learn the FIM!)
I also really like the KELS assessment, but did not add it to the actual list as you do have to purchase it versus locating it freely online. If your facility will reimburse you for purchasing it, I do recommend adding it to your assessment repertoire. It can be purchased through Amazon here.
The KELS assessment was updated in 2016, and updated the bill paying segment (optional online banking) and the safety photos. It covers 17 basic living skills, which not only covers your standard self care BADLs, but also IADLs like money management, home safety, transportation and work/leisure activities.
It was designed for pretty much every adult setting, from skilled nursing facilities to acute care hospitals. If your facility already owns a copy, it will be great to try out as an additional assessment.
And there you have the top BADL occupational therapy assessments for OT working in the adult and geriatric settings! I hope this post gave you a good idea of where to start when choosing a BADL assessment. Each OT assessment listed here can be used at evaluation, progress notes, and at discharge to measure your patient’s improvements with self-care tasks.
Do you have any other favorite BADL assessments you incorporate into your practice or fieldwork?
Guest post written by Sarah Stromsdorfer, OTR/L. She is an occupational therapist working in the adult inpatient rehab and geriatric settings. She is also the creator of the occupational therapy website, MyOTSpot.com.