Healthcare Areas

Information in this chart comes from the Activities of Daily Living Self-Performance Hierarchy Scale and shows the prevalence of long term care residents with different performance levels in relation to activities of daily living. Activities of daily living refer to the basic skills that a person requires in order to care for and look after one’s self and body (e.g., bathing, dressing).

The ability to perform activities of daily living depends on cognitive functioning as well as motor (e.g., balance) and perceptual abilities. Physical, cognitive, and sensory changes occur over time, which can impact functional performance. This scale describes a resident’s ability to perform four key activities of daily living during the last seven days at the time of assessment.

Each of these activities of daily living is evaluated to create an overall score that ranges from 0 (conducts task independently) to 6 (staff performed the task for the resident). A higher score indicates more impairment in the performance of activities of daily living.

This chart shows the percentage of long term care residents within each category of performance:

• Independent (score of 0): Resident can complete a task (e.g., dressing) independent of staff or others.
• Supervision required (score of 1): Resident requires oversight or prompting (e.g., cuing) to complete a task (e.g., dressing).
• Limited assistance required (score of 2): Resident is very involved in a task (e.g., dressing), but staff help providing non-weight bearing assistance, such as guiding limbs through a piece of clothing.
• Extensive assistance required (score of 3 or 4): Resident is involved in a task (e.g., dressing), but staff provide assistance and weight-bearing support, such as lifting legs to put into clothing.
• Dependent (score of 5 or 6): Resident is not involved in the task and staff perform the entire activity daily.

When thinking about this information, providers and leaders can consider a number of things to better understand these results. Some questions they should consider before taking action include:

• How would you describe the degree of support that Alberta’s long term care population needs to complete activities of daily living? What might varying levels of independence mean for program planning? Quality improvement? Resource allocation?
• How can disease (e.g., Alzheimer’s disease, vascular dementia) impact the functional performance of long term care residents in relation to activities of daily living? What about motivational (e.g., offering activities that are of interest to the residents), organizational (e.g., culture of care), and/or environmental factors (e.g., size of the site, arrangement of furniture)? How can planning at the system level anticipate the impact of these factors, to best support long term care residents and help ensure quality of life and safety?

The Health Quality Council of Alberta uses the Alberta Quality Matrix for Health as a way of organizing information and thinking around the complexity of the healthcare system. This measure can be used as input to assess long term care’s performance in these dimensions of quality: Acceptability, Accessibility, Appropriateness, Effectiveness, and Safety.

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