CHILD REGISTRATION FORM DATE _____________________ Patient Name_______________________________________________________________________________________ First M. Initial Last Name you like to be called Birthdate _____/_____/_____ Age______ □ Male □ Female Mailing Address _______________________________________ Cell Phone (________)___________________________ City, State, Zip ___
Microsoft word - adl report for portfolio2ACTIVITIES OF DAILY LIVING ASSESSMENT REPORT
Date of Birth:
Child Support Agency (Department of Human Services) Type of Injury:
Date of Injury:
Date Referred for Assessment:
Date of Assessment:
Comcare referral documentation, previous medical reports Konekt Consultant:
Consultant Contact Number:
Comcare requested that Konekt conduct an ADL Assessment of Ms Russell’s living arrangement in order to assess the amount of household services Ms Russell requires as a result of her accepted compensable condition. To provide answers to the schedule of questions as per the Comcare referral. Konekt Australia Pty Ltd ABN 64 083 660 093
2/12 Technology Drive Warana QLD 4575
Tel 07 5437 1702 Fax 07 5438 8285
Ms Russell reported that she worked for the Child Support Agency, initially as a financial investigator, where she experienced difficulties with a reportedly unjust system (having to sign off on documents she didn’t agree with) and dealing with customers in vulnerable positions. Ms Russell reported that when she communicated her difficulties to her supervisor she was told to “suck it up”. During this time (2007), Ms Russell reported feeling quite depressed and identified her symptoms as weight loss, reduction of sleep and vomiting (most mornings). As a result, she reportedly made a threat of sick leave and was consequently moved to lighter duties before going into the objections team (2007) with In 2008, Ms Russell reported her best friend died (in August) and her father also past-away in the same year (October). In September 2008, Ms Russell reported ceasing work and attempting to commit suicide multiple times. Ms Russell stated that she was admitted to both Prince Charles Hospital (psychiatric admission) and Royal Brisbane hospital and also the New Farm Clinic over the past 5 years with the most recent admission being on the 19th Ms Russell reportedly underwent Transcranial Magnetic Stimulation (TMS) during her last hospital admission at Pine Rivers. Ms Russell reported minimal effect from the treatment although it was still “early days”. In addition, Ms Russell reported taking a variety of medications for her major depressive disorder. As per Dr Ng’s medical report dated 29th January 2013, Ms Russell is currently taking the following medications per day: Ms Russell reported that at her previous residence (Banyo) she was receiving fortnightly outreach assistance. The aim of this service was to improve Ms Russell’s motivation. Ms Russell reported that the outreach worker was endeavouring to source household assistance for Ms Russell however these attempts were unsuccessful because there was no funding through the government organisations as Ms Russell was not elderly or suffering from a physical condition. At the time, Ms Russell was not aware that she could request Injury / Medical History
Ms Russell has been diagnosed with major depressive disorder as outlined in Dr Bradley Ng’s (Psychiatrist) medical report dated 29th January 2013. Ms Russell also reported a diagnosis of Rheumatoid Arthritis (non-compensable condition). Psycho Social Situation
Konekt observed Ms Russell to reside alone at 33 Gipps Street, Nanango. Ms Russell’s mother Elaine Russell was present at the time of the assessment and resides a few streets away at 23 Chester Street, Nanango. Ms Russell reported not socialising with anyone other than close family members such as her mother and brother. Description of Dwelling
Konekt observed Ms Russell’s residence to be a four bedroom spacious home containing two bathrooms, two living rooms and a lock up garage. The home is a corner block, single level home with a moderate size front and backyard. SELF CARE
Ms Russell reported to Konekt that she experiences low mood, low energy and very poor motivation as a result of her depressive disorder. Ms Russell described her symptoms as a “constant daily occurrence”. As a result, Ms Russell reported being unable, most days, to shower or dress independently. This was evident to Konekt whereby Konekt observed Ms Russell to be dressed in pyjamas (at 11am) with a distinct odour possibly due to a lack of adequate bathing. Although Ms Russell reported she is physically able to shower she is currently lacking the motivation to do so. This was confirmed by her mother (present at the time of the assessment) who stated that she has to prompt her daughter to shower and eat on a daily basis. Nevertheless, Ms Russell reported to Konekt only showering approximately every 4 days. Konekt observed Ms Russell’s bathroom to be sound with Grooming
Ms Russell reported not having the motivation, energy or will to dress herself. Konekt observed Ms Russell to be wearing old, worn pyjamas with little effort demonstrated to be well presented for the assessment. When discussed, Ms Russell stated that she “cannot be bothered to get dressed”. Currently Ms Russell does not leave the house for any reason except every three weeks when she returns to Brisbane for her doctor’s appointments and treatments. Elaine Russell (Ms Russell’s mother) stated that even then sometimes Ms Russell does not dress appropriately whilst attending the doctor appointments. In addition, Elaine also reported that when Ms Russell did shower (approximately every 4 days) she doesn’t always put clean clothes on after a shower. Ms Russell reported no physical reason why she is unable to dress herself apart from occasionally finding buttons difficult to do up because of her Rheumatoid Arthritis (non-compensable condition). Ms Russell reported the main reason for not dressing is due to low motivation. Eating
Ms Russell reported to Konekt not eating regular meals. When discussed, Ms Russell could not recall the last time she cooked a meal. She stated that her mother comes daily with prepared meals or to prompt her to eat a sandwich. Ms Russell reported that she regularly makes a coffee every morning however doesn’t feel motivated to eat and specifically isn’t motivated to prepare meals. Konekt observed a spacious kitchen, well equipped, however with dirty dishes on the sink. It is important to note that Ms Russell has a history of Bulimic behaviour as outlined in Dr Bradley Ng’s medical report dated 29th of January 2013. Sleeping
Ms Russell reported to Konekt that she sleeps excessively. Her mother, Elaine, confirmed this statement and reported that she comes over around 10am on a daily basis to encourage her daughter to get out of bed. Ms Russell reported always feeling tired and upon waking would normally make a cup of coffee and lay on the couch to watch television. Ms Russell also reported she has no energy to make her bed. This was evident to Konekt as her bed was unmade at the time of the assessment and the smaller living room appeared utilised for regular television watching. Ms Russell reported that she doesn’t wash her bed sheets. Ms Russell reported that she has only recently bought a washing machine and hasn’t yet plugged it in therefore her mother is currently washing her sheets. The beds in the spare two rooms were made and the rooms appeared very tidy and unused. The remaining third spare room was used to store boxes but also was being made DOMESTIC AND HOME MANAGEMENT
Ms Russell reported the most difficultly with cleaning. She stated to Konekt that she often looks at the dirty dishes however is unable to get up to attend to them. Ms Russell stated that she does not have the energy or motivation to attend to cleaning tasks. Ms Russell reported to Konekt being so tired and unable to clean the dishes that on a few occasions she has simply thrown the dirty dishes away. Konekt observed Ms Russell’s house to be full of boxes that are not yet unpacked (Ms Russell moved to her residence in December 2012). Ms Russell stated that her goal was to unpack one box every day however she has been unable to do so due to poor motivation and a lack of energy. Ms Russell reported that her mother, Elaine, has been assisting with the unpacking of the boxes and cleaning the home. Konekt observed the kitchen to be messy with dirty dishes on the sink and many of Ms Russell’s belongings still in boxes around the home. Ms Russell also reported that she had organised self-funded home assistance (cleaning services) in her previous residence at Banyo due to being unable to attend to the cleaning tasks. Laundry / ironing
Currently Ms Russell is reportedly unable to complete laundry tasks. She has recently bought a washing machine however is waiting for her mother’s assistance to plug it in and help her use it. Currently Ms Russell’s mother is completing her washing for her. Ms Russell reported not ever doing the ironing and stated that she doesn’t even own an iron. Shopping
Ms Russell was unable to recall the last time she participated in shopping activities. She reported that her mother does the shopping for her and brings the food to her home. Ms Russell reported giving her mother money for the shopping but did not want to go outside where “people could see her”. Ms Russell reported that she uses the internet regularly and enjoys tipping the football however has not used the internet to grocery shop. In addition, Ms Russell reported not currently driving. Ms Russell stated that she was unable to drive in the mornings due to her medication however was not motivated to drive anywhere as she didn’t want to leave the house. The last time Ms Russell recalled driving was to her mother’s home (a few streets away) a couple of months ago. Ms Russell stated that she doesn’t drive the car to attend to shopping activities and when she is required to attend doctor’s appointments in Brisbane her mother drives her. Garden maintenance
Ms Russell reported difficulties with garden maintenance tasks due to a lack of energy and reported feelings of dizziness and light headedness. She also stated that she experiences pain in her hands and feet due to Rheumatoid Arthritis when attempting to participate in gardening activities. Ms Russell also reported being unable to leave the home as a result of her anxiety. When discussed, Ms Russell stated that she was afraid that people would see her. This was evident to Konekt when Ms Russell escorted Konekt to view her back yard. Ms Russell demonstrated anxious symptoms such as closed body language (hugging her body), appearing fearful and not leaving the back porch area (undercover patio). In addition, Ms Russell chose not to escort Konekt to view the front yard, possibly due to no covered areas and access to the street. Ms Russell also reported using self-funding garden services in her previous residence due to being unable to attend to the gardening tasks At her current residence, Ms Russell does attend to a small vegetable garden. She likes to water the vegetable garden and is currently growing herbs and vegetables. When discussed she reported to Konekt that she doesn’t use them because she doesn’t cook but she does enjoy watering them a few times a week. Ms Russell reported that her mother is Minor home maintenance
Ms Russell reported that she has recently purchased her current residence, 33 Gipps Street, Nanango by means of a bank loan. She stated that her previous residence at Banyo was being put on the market and she hoped to pay of her current residence when the Banyo property sells. Ms Russell stated that so far the home hasn’t required any maintenance however her mother has been prompting Ms Russell to unpack the boxes from her previous residence and is assisting her with any minor maintenance of the new home. Ms Russell stated that her only form of leisure is art and craft. She reported that she can “get lost” in the painting and forget about her troubles. Konekt observed the fourth spare room in Ms Russell’s residence to be set up for art/craft hobbies. Konekt encouraged the participation of the art hobbies. At her previous residence (Banyo) Ms Russell stated that she was walking to the post office every day to check her mail. Currently Ms Russell is not participating in any exercise activities mainly due to her lack of energy but also not wanting to leave the house. Konekt discussed the importance of exercise with regards to the release of “feel good” hormones (endorphins) as well as increasing energy levels. Konekt also discussed grading the activity of exercise by starting to walk to the letterbox every day for a week and then going a little further each week. Konekt discussed walking to her mother’s house (a few streets away) as a longer term goal. ADDITIONAL COMMENTS
1. Does Ms Russell require household and gardening assistance for her
compensable condition of major depressive disorder, single episode? Please
provide an explanation and specify the number of hours required.
Konekt recommend that Ms Russell receive 2 hours of fortnightly cleaning assistance and 2 hours of fortnightly gardening assistance during summer months and 2 hours of monthly gardening assistance during winter months due to her compensable condition of major depressive disorder. Konekt observed Ms Russell to demonstrate significant low mood, reduced energy and fatigue at the time of the assessment which would affect her ability to perform household and gardening tasks. For example, Ms Russell displayed slow, quiet, laboured speech and poor 2. What duties are required to be performed by a household assistance provider
due to Ms Russell’s compensable condition of major depressive disorder,
single episode? How many hours will be required to perform these tasks?
As mentioned previously, Konekt recommend that Ms Russell receive 2 hours of fortnightly cleaning assistance and 2 hours of fortnightly gardening assistance during summer months and 2 hours of monthly gardening assistance during winter months due to her compensable condition of major depressive disorder. The specific duties to be performed should include; general household cleaning (washing windows, cleaning kitchen and bathrooms and vacuuming floors) and general garden assistance (mowing lawns, trimming edges and general landscaping). 3. What restrictions are preventing Ms Russell from attending her household and
At the time of the assessment, Konekt observed Ms Russell to be experiencing severe depression and anxiety symptoms. These symptoms (low mood, low energy, poor self-efficacy, fatigue, fear and nervousness) are currently limiting Ms Russell’s ability to perform household and gardening duties. 4. What duties do you consider Ms Russell would be capable of performing?
At the time of the assessment, Ms Russell appeared to be incapable of performing household and gardening duties due to the symptoms mentioned previously. For example, Ms Russell reported only being able to perform basic activities of living (getting out of bed, showering and eating) due to her mother’s daily prompting and 5. How many people reside at residence, 33 Gipps Street, Nanango, QLD?
Ms Russell reported that she was the only resident at 33 Gipps Street, Nanango. 6. Is there anyone who can be reasonably expected to help Ms Russell with any
household or gardening duties? If so please provide a list of duties that are
reasonable to expect them to undertake?
Ms Russell reported that she was the only resident at 33 Gipps Street, Nanango. Her mother, Elaine, resides close by and is a significant support person for Ms Russell. Because Elaine Russell (mother) does not reside with Ms Russell and Elaine is providing essential daily help to her daughter in the form that resembles a carer (preparing meals and prompting her daughter to get out of bed and shower) it would be unreasonable to expect her to also attend to household and gardening tasks as she also has her own residence to attend to. 7. Which rooms does Ms Russell reside in on a daily basis?
Ms Russell reported that she resides in her bedroom every night and into late mornings (approximately 10am); subsequently she resides in the second, smaller, living room (an old single garage that has been converted into a second living area) to watch television. Konekt observed these two rooms to be well used in comparison to the other areas of the home. 8. Will there be a time when Ms Russell could be reasonable expected to self-
manage her home duties?
Konekt observed Ms Russell to be experiencing significant difficulties with household and gardening tasks due to her compensable major depressive disorder. Konekt is uncertain if there will be a time when Ms Russell could reasonably manage her home duties however recommend the provision of extensive treatment before an ADL review be performed in a further 12 months. 9. Are there any aids or appliances you would recommend to assist MS Russell in
achieving some independence regarding her activities of daily living?
Due to Ms Russell’s compensable condition being of a psychological nature there are no aids or appliances that Konekt recommend at this stage. Konekt gave strategies to enhance mood such as walking which in turn can enhance energy and motivation levels however without continual follow up and prompting, this may not occur. Konekt did recommend to discuss this with the local psychiatric nurse who Ms 10. In your opinion, was it reasonable for Miss Russell to receive 2 hours of
cleaning on the 17th of January 2013 at her former residence in Banyo as a
result of her accepted compensable condition?
Konekt are unable to determine whether it was reasonable for Ms Russell to receive cleaning services at her previous residence due to not seeing the residence or Ms Russell’s presentation at that time, however if Ms Russell was experiencing similar symptoms as was exhibited on the date of the current ADL assessment (2nd April, 2013) Konekt believe that it would have been reasonable for Ms Russell to receive 11. In your opinion, was it reasonable for Miss Russell to receive 3 hours of
cleaning on 6th of February 2013 at her former residence in Banyo as a result of
her accepted compensable condition?
Konekt are unable to determine whether it was reasonable for Ms Russell to receive gardening services at her previous residence due to not seeing the residence or Ms Russell presentation at the time, however if Ms Russell was experiencing similar symptoms as she was at the time of the ADL assessment (2nd April, 2013) Konekt believe that it would have been reasonable for Ms Russell to receive cleaning 12. Any other findings or comments you feel may assist Comcare?
Ms Russell reported daily pain when mobilising in and around the home due to her diagnosis of Rheumatoid Arthritis. Ms Russell stated that her rheumatoid arthritis does inhibit her ability to perform household duties due to pain and reduced range of motion in her hands and feet. At the time of the assessment, Ms Russell reported a pain scale of 5-6 out of 10 in her ankles when performing household duties. Konekt are aware that the rheumatoid arthritis is a non-compensable condition and have not taken this condition into account when making their recommendations. SUMMARY OF CONTACT WITH TREATING PROFESSIONALS
Konekt received a fax from Dr Galvin on the 5th of April 2013 stating that Dr Galvin agreed that Ms Russell required household assistance in the form of 2 hours of cleaning services per fortnight and 2 hours of gardening services per fortnight (during summer) and 2 hours of RECOMMENDATIONS
The following recommendations are based on upon reports and observations made at the time of the assessment. It should be noted that physically, Ms Russell is capable of completing these tasks however psychologically, due to her Major Depressive Disorder, she has extremely low mood, motivation and energy, which has decreased her ability to complete the following activities at the time of the assessment. Commencement of gardening services for 2 hours per fortnight during summer months and 2 hours per month during winter (please see appendix). Please note due to the location of Ms Russell’s residence, Konekt was unable to obtain multiple Commencement of household services for 2 hour per fortnight (please see appendix). Please note due to the location of Ms Russell’s residence, Konekt was unable to obtain multiple quotes for cleaning services. Should you require any further assistance with Ms Russell’s case please do not hesitate to Signature:
Konekt Consultant Name: Sarah Carew
Appendix have been removed
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