You are here
5.1.3. Principles for the Assessment of Activities of Daily Living
The definition of Activities of Daily Living (ADLs) provided under the Guide to the Assessment of the Degree of Permanent Impairment (PI Guide) Part 2 states –
‘Activities of Daily living are those activities that an employee needs to perform to function in a non-specific environment i.e. to live. The measure of activities of daily living is a measure of primary biological and psychosocial function.’ They are:
o Ability to receive and respond to incoming stimuli
o Feeding (includes eating but not the preparation of food)
o Control of Bladder and Bowel
o Self-Care (bathing, dressing etc.)
o Sexual Function
An activity of daily living should be seen as a purposeful activity and not just a biological action. It is the ability to perform the function in a way which is socially acceptable and which maintains one’s physical and psychological integrity.
ADLs are intentional, somewhat complex actions which require a combination of physical and cognitive skills. Abnormality of a basic biological function (such as the ability to see) is not really interference with an ADL, but rather a reason for there to be interference with ADLs.
Assessment of each measure of activities of daily living
The assessment of a person’s ADL routines should consider the individual and their capacity to perform activities such as self-care, cooking, feeding, moving and interaction with stimuli. Given that not all injuries are the same, the capacity of each person will differ. The ADL assessment should analyse the individuals’ ability to do purposeful activities, such as personal hygiene or feeding.
There are several evidence-based ADL assessment tools that are used by doctors and rehabilitation providers to complete these assessments, however there is no specific tool that is used for DVA’s compensation purposes and assessments. Therefore delegates should be seeking a report that identifies the degree to which an individual is limited and recommends alterations or assistance.
Assessment of the ADLs with specific regard to one of the measures or descriptors (for example, self-care or ability to receive and respond to incoming stimuli) should be based on a weighing up of the evidence (medical and other) relating to the client’s accepted condition.
Delegates must rely on the observations and opinions of the assessing professional (i.e. Doctor or Occupational Therapist (OT)) regarding the interference with a client’s activities of daily living due to an accepted condition. If the doctor or OT has reported an impact on one or a number of activities, they should be providing examples of how the client is unable to perform the activity. For example, how the person’s PTSD interferes with their ability to respond to incoming stimuli in conversations or noisy environments, or how the clients lower back condition affects their ability to perform self-care activities such as bathing and dressing.
Additional evidence on file including a Rehabilitation Report by an Occupational Therapist (OT) may provide further information about the impact of the accepted condition on the client’s usual capabilities and the impact on activities of daily living.
If the treating or assessing doctor has provided inconsistent information in the report about the impact on activities of daily living compared to other evidence on file or the reported level of impairment, a delegate should seek a more detailed assessment or clarity on contradictory elements of points the original report. The guidance of a CMA may also be appropriate in these cases if there is medical information which indicates something different to what the assessing doctor has reported.
If the impact of a loss of biological function and reduced ability to undertake normal activities of daily living is also assessable under a different table, the interference with this ADL should not also be compensated under Table 13.1 - Intermittent Conditions, as this would result in a duplication of compensation. In these cases, delegates should compare and take the higher rating for the purpose of determining the impairment.
Major vs Minor Interference with ADLs
The suggested approach is to consider a global assessment when determining the appropriate impairment rating based on the reported frequency and severity of the impairment on a person’s ADLs. Broadly speaking, the Administrative Appeals Tribunal (AAT) consideration of global assessments have confirmed that it would be appropriate to consider that interference with one function would not be sufficient to make a finding of a minor interference on ADLs.
There are no exhaustive guidelines provided about the assessment of a major or minor interference on ADLs because assessing and determining if there is a major or minor interference must be based on an assessing doctor’s interpretation of the PI Guide and these terms. The doctor must make an appropriate assessment based on their medical expertise and understanding of the interference with a client’s activities of daily living with respect of their accepted condition(s). The assessment may also recognise that the reported need or level for assistance required may reflect client resilience and other intrinsic factors that the doctor is aware of.
Ultimately, whether an interference is major or minor is a matter for the assessing doctor and the delegate to consider. The delegate should weigh up all of the evidence when determining whether the impact on the ADL constitutes a minor or major interference to award an appropriate rating. In some cases it may be required that clarification or a more detailed assessment is provided to justify a rating, or alternatively, the delegate may seek input from a CMA where there is contradictory evidence that may need further explanation of guidance of the medical evidence.
Relevant case law
In Re Langston v Comcare (2000), a condition that was present but reversible by medication was still found to amount to a “minor interference with the activities of daily living when the condition is present” which qualified the person to 10% WPI.
In the context of psychiatric conditions, the Federal Court case of Comcare v Emery (1993) confirmed the principle that the term “activities of daily living” is not limited to the basic mechanics of an action but also the psychosocial aspects of the function.
Re O’Rourke v Comcare (1997) looked at the impact of severe headaches on a person’s ADLs where those headaches only occurred 25 times per year. This was not seen to be an interference with activities of daily living.