CONNECTICUT DEPARTMENT OF SOCIAL SERVICES
INTERPRETIVE CRITERIA GUIDELINES
The information below was provided to Ascend by the Connecticut Department of Social Services as the
interpretive guide for applying Connecticut Public Health Code to determine need for nursing facility Level of Care.
The Activities of Daily Living (ADL) ratings are not to reflect supports needed because of behavioral compliance
issues that are because of mental health conditions. Some individuals have the physical ability to perform an ADL
but refuse or resist doing so, due to a mental illness. If poor compliance with an ADL is due to mental illness and
might lead to risk of harm, then the compliance issue would be marked under one of the following behavior items:
“Unsafe or Unhealthy Hygiene/Habits” or “Threats to Health/Safety”.
Connecticut Level of Care Interpretive Guide—Medical and Functional Needs
A. Presence of uncontrolled and/or unstable and/or chronic condition requiring continuous skilled nursing
services (as evidenced by diagnosis[e], therapies/services/observation requirements, and frequency)
B. Chronic condition(s) requiring substantial assistance with personal care on a daily basis. Substantial personal
care is evidenced by one or more of the following:
1. Chronic condition in addition to at least hands on1 assistance required for 3 or more ADLs
2. Dementia which, supported with corroborative evidence, has resulted in cognitive deterioration to the
extent that a structured, professionally staffed environment is needed for daily monitoring, evaluating
and/or accommodating the individual’s changing needs
3. Chronic condition in addition to at least supervision2 level assistance with 3 or more ADLs daily in
addition to at least one Needs factor.
4. Chronic condition in addition to at least hands on3 assistance with at least 2 ADLs daily plus at least one
Need Factor.
NEEDS FACTORS include the following (a–d):
a) Rehabilitative Services 5X Week (PT, OT, ST, RT) with restorative potential at least five times a week.
b) Cognitive Need: daily caregiver supervision to prevent harm due to a cognitive impairment
c) Behavioral Need: Due to dementia4, the individual requires the presence of another person at least daily
for supervision to prevent harm due to one or more of the following: Abusive/Assaultive behavior,
Unsafe or Unhealthy Hygiene/ Habits, Wandering, Threats to Health/Safety
d) Medication Supports: Requires the assistance of another for administration of physician ordered daily
medications. Assistance include supports required beyond set ups and may include verbal or gestural
supports (e.g., instructions, coaching, pointing) –or‐physical assistance with some or all of the physical
steps of taking daily prescribed medications.
The ADL ratings are not to reflect supports needed because of behavioral compliance issues that are secondary to
mental health conditions. ADLS include: bathing, dressing, eating, toileting, continence, transferring, and
mobility. Measures used to rate ADLS are: Independent or Supervision < daily, Supervision/ cuing daily, Hands‐on
support, and Total Dependence. These are defined in Attachment 3.
1
Hands on Support: Physical assistance from another person is needed to initiate or complete the task or activity in a way that
assures health and safety. Even with diligent verbal or gestural cues the individual requires physical assistance or intervention
to accomplish the task.
2
Supervision: The individual requires support such as monitoring, observing, verbal or gestural prompting, verbal coaching and
gestural or pictorial cueing in order to accomplish the task. The support is needed daily. No hands‐on support is needed.
840 CRESCENT CENTRE DRIVE, SUITE 400 | FRANKLIN, TN 37067 | P. 877.431.1388 | F. 877.431.9568
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© Ascend Management Innovations
Revised 7.3.13 | 1
CONNECTICUT DEPARTMENT OF SOCIAL SERVICES
INTERPRETIVE CRITERIA GUIDELINES
CONNECTIC UT ADL MEASURES AND MEASUREMENTS
Measured
ADL Definition
ADL
Bathing
Supports needed to cleanse all parts of one’s body and hair, by showering, tub or sponge bath to
maintain proper hygiene and prevent body odor. Includes supports needed get into and out of
the tub or shower or make preparations needed for a sponge bath. Includes support to use a
transfer bench if needed to get into and out of a tub or shower. Excludes: getting to and from the
bath or shower room, which is addressed in mobility or routine hygiene throughout the day, which
is included in grooming.
Supports needed to select appropriate clothing; to put on, take off and adjust clothing items,
Dressing
including buttoning and fastening.. Excludes: Intensive restorative or therapeutic interventions
(applying salves or ointments for the treatment of infection) for teeth or nails, as those are
medication administration considerations.
Eating
Supports needed to use utensils or adaptive devices to get food from plate to mouth. Includes
supports needed for activities related to ingestion by nasogastric gastrostomy, jejunostomy or
parenteral route. Excludes: Supports needed for meal preparation or for supervision of obesity or
weight reduction.
Toileting
Supports needed to or appropriately use toileting equipment; to doff, don and adjust clothing; and
to attend to hygiene after toileting. Includes supports needed to transfer to/from the toilet and
supports needed to manage ostomy equipment or use a catheter.
Continence5 Includes supports needed to either: assist the individual to control one’s body to empty the
bladder and/or bowel appropriately, or, to appropriately change incontinence pads/briefs, cleanse
the changing pads, and dispose of soiled articles.
Transferring Supports needed to move from surface to surface or position to position safely (e.g., into and out
of chair or wheelchair, from bed or chair to standing and back) with or without the use of assistive
devices/ adaptive modifications. Excludes: getting into and out of bath or shower, which is
addressed in bathing –and‐ getting onto and off toilet, which is addressed in toileting.
Mobility
Supports needed to move safely about the environment, from and to locations that are a part of
the individual’s daily life, with or without assistive devices/adaptive modifications.
Measure
Definition
Independent or Supervision <
Daily
Individual independently accomplishes the activity in a way that assures health
and /or requires supervision less than daily.
Supervision/Cueing Daily
The individual requires support such as monitoring, observing, verbal or
gestural prompting, verbal coaching and gestural or pictorial cueing in order to
accomplish the task. The support is needed daily. No hands‐on support is
needed.
Hands-on Support
Physical assistance from another person is needed to initiate or complete the
task or activity in a way that assures health and safety. Even with diligent verbal
or gestural cues the individual requires physical assistance or intervention to
accomplish the task.
Total Dependence
The individual is incapable of performing the task without assistance of another
person or persons.
5
Revised 12/9: continence measured by supports needed
840 CRESCENT CENTRE DRIVE, SUITE 400 | FRANKLIN, TN 37067 | P. 877.431.1388 | F. 877.431.9568
WWW.ASCENDAMI.COM
© Ascend Management Innovations
Revised 7.3.13 | 2