Activities of Daily Living (ADLs):How Georgia Medicaid Measures Need

Activities of daily living (ADLs) are the basic self-care tasks, like eating, bathing and dressing, that Georgia Medicaid looks at to measure how much help a person needs. Georgia scores them with a tool called the DON-R, short for Determination of Need-Revised. The score helps decide who can get in-home care through the Elderly and Disabled Waiver Program (EDWP). It also shapes the care plan once a person is approved.

"ADL services" simply means hands-on help with those tasks. In EDWP, that help usually comes as personal support services at home, or from a live-in relative through Structured Family Caregiving (SFC).

This guide shows the exact tasks Georgia scores, how the scoring works, and what it means for your family.

ADLs at a glance

• What they are: basic self-care tasks a person does every day
• IADLs: "instrumental" tasks needed to run a home, like cooking, laundry and handling money
• Georgia's scoring tool: the DON-R, which rates six ADLs and nine IADLs
• Two scores per task: how impaired the person is, and how much of their need goes unmet
• Who uses it: Area Agency on Aging screeners by phone, then an EDWP nurse at home
• What it decides: whether the person moves forward for assessment, their place on any waiting list, and the help in the care plan

Do ADLs decide who qualifies for EDWP and SFC in Georgia?

They are a big part of it, but not the whole picture. The DCH EDWP fact sheet lists several requirements. Your loved one must have a functional impairment caused by physical limitations. They must have an unmet need for care. A physician must approve an intermediate nursing home level of care. They must also be Medicaid eligible, or likely to become eligible.

ADLs feed into the functional part. The EDWP case management manual (Section 1821) says a new applicant needs a DON-R impairment score at or above a minimum set in the manual. They also need an identified unmet need for care.

SFC is one of the services inside EDWP. So a family hoping to use SFC goes through the same scoring. The live-in caregiver then has separate rules of their own.

Georgia's functional test asks about:

• Impairment: at least some difficulty with daily tasks, caused by a physical condition
• Unmet need: help that is missing or not enough today
• Medical backing: a diagnosis and a physician's approval of the level of care
• Choice: the person wants care at home instead of in a nursing home

Which ADLs and IADLs does Georgia measure?

Georgia publishes the DON-R as form EDWP CM 43. It lists fifteen tasks in two groups.

Notice that the IADL list includes "being alone." That item matters for people with memory loss. A parent may be able to dress but may not be safe if left alone all day.

What is the difference between ADLs and IADLs?

ADLs are about the body: eating, washing, dressing and moving. IADLs are about running a life: cooking, cleaning, paying bills and handling health tasks. Georgia scores both, because trouble with either can leave a person unsafe at home.

How does Georgia score ADLs on the DON-R?

Each task gets two scores. Column A rates the level of impairment. Column B rates the unmet need for care. Both use a scale from zero to three.

The form adds a few rules that families rarely hear about:

• The assessor scores impairment first. If impairment is zero, unmet need is also zero.
• Unmet need takes the family caregiver into account. If a daughter already handles bathing well, that need may be scored as met.
• The assessor writes down why a task is hard, such as a bad leg or dementia.
• The assessor asks what will happen if the person cannot get help, and notes the answer in the person's own words.
• For someone in a nursing home or personal care home, the score reflects the care they would get if they went home.

Who scores ADLs, and when?

The scoring happens more than once. Each step uses the same fifteen tasks.

1. 1

   Phone screening

   Area Agency on Aging staff ask DON-R questions by phone. The case management manual (Section 1824) says this checks functional eligibility and sets priority for an in-home assessment.

2. 2

   Waiting list check-ins

   If there is a waiting list, Section 1824 says applicants are re-screened every four months. Section 1825 says DON-R scores are used to set waiting list priority.

3. 3

   Nurse visit at home

   An EDWP nurse completes a longer assessment called the MDS-HC. Section 1826 says the DON-R questions are built into it.

4. 4

   Care plan

   The nurse uses the assessment to write the first Comprehensive Care Plan, which lists the services to be arranged.

5. 5

   Yearly review

   The manual says level of care and eligibility are checked again at least once a year, and after a change in condition.

One rule helps people already in the program. Section 1821 says an unmet need is not required for continued enrollment. Once services meet a need, that success does not count against your loved one at review time.

For the bigger picture of how the doctor and the state confirm level of care, read our guide to what nursing home level of care means in Georgia.

What are ADL services under Georgia Medicaid?

"ADL services" are the help that fills the gaps the DON-R finds. In EDWP, the main one is personal support services. The EDWP general services manual (Section 603.6) describes help with eating, bathing, dressing, personal hygiene, meal preparation, light housekeeping and other activities of daily living.

• Personal support

  An aide helps at home with bathing, dressing, eating and hygiene

• Extended personal support

  Longer help for people who need ADL support and a break for their usual carers

• Structured Family Caregiving

  A relative who lives with the member provides daily help, with coaching from an SFC agency

• Respite

  Short breaks for family caregivers who handle most of the daily tasks

The care coordinator and your family choose services together. The DCH fact sheet says the Area Agency on Aging decides eligibility and the type of services needed.

How do ADLs affect Structured Family Caregiving?

In SFC, the ADL needs found in the assessment become the caregiver's daily work. The relative helps with the tasks that scored as impaired. The SFC agency's health coach supports them.

ADLs also connect to pay. SFC caregivers are paid by direct deposit every two weeks; the amount is set by the loved one's assessed level of care. For the details, see how SFC pay is set in Georgia.

What do you need to be a caregiver for ADL help?

That depends on the path. Agency aides who provide personal support work for an approved provider and meet its staffing rules. A family caregiver in SFC must live with the member and pass a background check, among other steps.

Our SFC requirements checklist covers the full list. If you are married to the person who needs care, read whether a spouse can be paid as a caregiver in Georgia.

How can you describe ADL needs clearly?

The DON-R scores what the assessor hears. Clear, concrete examples help. Before the call or visit, walk through each of the fifteen tasks in the table above.

For each task, note three things:

1. What your loved one can still do alone
2. What someone else has to do, and who does it now
3. What goes wrong when no one helps, such as a missed meal, a fall or a skipped medicine

Write these down in plain words. Then you will not forget the IADLs, such as laundry or using the phone, in a stressful moment.

How A1-GA Healthcare Agency helps

A1-GA Healthcare Agency is a Georgia DCH-approved Medicaid home care provider in Norcross, serving metro Atlanta. We have provided in-home care since 2008 and have staffed caregivers since 2004.

We do not score the DON-R or decide eligibility. Once your loved one is approved for EDWP, they can choose us to provide EDWP services such as personal support and respite. If a relative lives with your loved one, ask us about Structured Family Caregiving.

• Phone: 678-446-1832
• Hours: Monday to Friday, 8am to 6pm
• Email: [email protected]
• Quick check: fill in our eligibility form or visit our eligibility page