Ohio’s Medicaid waiver programs like the PASSPORT and MyCare Ohio waiver services cover everything from personal care down to cooking meals, housekeeping and medication support and management.
How do they decide if you qualify to receive help and if so, how much? They use specific criteria based on the physical and cognitive status of your loved one or care recipient to determine if they qualify for whatever accommodations they are applying for and then provide them with those resources.
Eligibility and level of support are determined through a formal needs assessment conducted by a state-authorized assessor. During this assessment, they evaluate how well you or your loved one can manage two categories of everyday tasks — Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs).
Together, these two categories give assessors a complete picture of where someone needs support and how much.
This is how the state decides if a patient needs a Nursing-facility level of care, meaning they need help living on their own.
What Are ADLs (Activities of Daily Living)?
Activities of Daily Living (ADLs) are the basic self-care tasks we perform daily as part of our independent living. These are the tasks that people begin to struggle with due to aging or disability. Some core ADLs include:
- Mobility (Ambulating/Transferring): The ability to move around and about. Think walking, getting up from a chair or sitting back down safely, going up and down the stairs, or transferring from a bed to a wheelchair.
- Dressing: Being able to put on clothes, closing buttons or clasps, belts, and putting and tying shoes without assistance.
- Eating: Feeding oneself, using utensils or our hands to get food from plate to mouth and consuming it.
- Personal Hygiene: Bathing or showering and completing grooming tasks like shaving, brushing teeth, and combing hair independently.
- Toileting (Continence): Getting to the toilet in time, transferring on and off the toilet, and cleaning oneself after using it.
When someone cannot perform several of these tasks without help, it signals they may need ongoing care or assistance at home.
What Are IADLs (Instrumental Activities of Daily Living)?
Instrumental Activities of Daily Living (IADLs) are more complex skills that allow a person to live independently in a community. While not necessarily required every day, they are essential for managing one’s household and life. Key IADLs include:
- Shopping for Essentials: The ability to shop for groceries, pick up prescriptions, or purchase clothing and other necessities.
- Meal Preparation: Planning and cooking meals, including gathering ingredients and safely using and cleaning the kitchen.
- Housekeeping: Keeping the home clean through livable tasks like cleaning, laundry, and taking out the trash.
- Money Management: Handling finances, such as paying bills on time, managing bank accounts, and budgeting.
- Transportation: Getting around or arranging transportation, whether that’s driving oneself or using other means (public transit, ride shares, taxis) to go to appointments and run errands.
- Medication Management: Administering medications properly, remembering to take the right medicines at the right times, and refilling prescriptions.
- Communication: Using the phone or a computer to communicate (looking up phone numbers, making calls, sending emails) and staying connected with others.
Trouble with IADLs (like difficulty cooking or managing finances) is often an early warning of declining cognitive function and that more support will be necessary, even if basic ADLs are still manageable. It is important to keep an eye on IADLs as your loved one ages, especially if you suspect they could be at risk of worsening and may need assistance.
How the ADLs and IADLs Assessment Works
Ohio does not determine Nursing Facility Level of Care (NFLOC) solely on ADLs and IADLs. The assessment also evaluates cognitive needs, behavioral concerns, and medical/nursing requirements. ADLs and IADLs are important indicators, but people typically qualify when they have multiple ADL impairments or significant cognitive/medical needs that compromise their health and safety.
The ADLs and IADLs assessment is conducted by a state contracted case manager locally through Ohio’s Area Agencies on Aging. The goal is to see if your loved one can independently perform the tasks we have described above.
During the assessment, the case manager reviews abilities like transferring from bed to chair, walking safely, eating, toileting, preparing meals, managing money, and keeping up with housework. Cognitive issues (e.g., memory or time-awareness problems from dementia) also factor in, since they affect daily functioning. If someone cannot perform multiple ADLs or has significant difficulty with IADLs, they are likely to meet the level-of-care threshold.
IMPORTANT NOTE: It is very much encouraged for you and your loved ones to be honest about your difficulties, concerns, and expectations regarding your loved one’s condition. It may be tempting when being examined by a professional to want to assert independence: saying, for instance, that your loved one only struggles to move “on occasion,” or that they have “systems in place” for cognitive decline. Even if your intentions are pure, this could preclude you from qualifying, accessing full benefits, and getting what your loved one needs.
Tell the assessor about the worst-case scenario because that is what you are trying to get approved help for!
