Area 4 - Functioning in Daily Activities


Due to the severity of her mental illness, Brenda has been cared for by other adults for most of her life. Tasks she normally would have learned to do herself were instead done for her by family members, R&B staff, case managers, etc. As a result, when Brenda needs to obtain information or schedule an appointment with an outside provider (housing program, utility company, PCP, etc.) she calls her mental health worker rather than calling the provider directly. This leads to delays, misunderstandings, and unnecessary back-and-forth calls.

Martha's personal hygiene used to be very good, but after her husband passed away in 2006, she stopped taking care of herself. Now, due to lack of motivation and energy, and a sense of hopelessness, Martha showers and changes into clean clothes about once every 2 weeks. This is a problem because Martha begins to smell strongly of body odor, which interferes with her ability to have normal social interactions.

Due to lack of initiative, diminished self-awareness, and a tendency to engage in eccentric behaviors, Manuel only shaves part of his face and then quits, causing him to look strange and unkempt. Manuel reports, “I don’t shave until it starts to bother me, then I cut that part off.” Manuel's strange appearance causes others to laugh at him or react unfavorably in public situations, and was a factor in his not getting hired for a job earlier this year.

Due to angry outbursts and repeated physical altercations with housemates, Gloria was exited from her R&B and has been homeless for the last 2 months. As a result, she does not have easy access to facilities in which she can shower and clean-up. For this reason, Gloria often goes weeks without bathing and becomes disheveled and malodorous as a result. This is a problem because it causes Gloria to become self-conscious, impairs her ability to interact comfortably with others, and causes others to react negatively to her in social situations.

Janice maintains good hygiene. She changes into clean clothes several times a week and prepares meals for herself. She pays her bills and schedules her own doctor's appointments without prompting by others. Due to paranoia and delusional thinking, however, Janice believes that she will be attacked by someone if she tries to ride the bus, or transported to some distant location that she will never be able to return from. For this reason, Janice refuses to use the bus system or apply for ACCESS, and is dependent on others to drive her everywhere she needs to go.

Eugene was able to perform ADLs effectively until about 3 years ago, when his mother passed away and his symptoms of depression began to get worse. Eugene first stopped performing IADLs such as preparing meals for himself and keeping his apartment clean. Later, as his depression got worse, he stopped performing basic ADLs as well, such as bathing, toileting, and putting on clean clothes. By the end of last year, Eugene was so depressed that he would not even get out of bed to use the toilet. Currently Eugene is getting up to use the bathroom, eat meals, and smoke, but he does not attempt to manage his own finances, shop, or do any household chores.

When Crystal's mood is stable, she is able to perform ADLs competently, without assistance from others. When Crystal becomes manic, however, her racing thoughts and preoccupation with new ideas cause her to go days without eating, sleeping, showering, or changing clothes. When concerned family members try to talk to her, she tells them they aren't intelligent enough to understand what is happening and warns them to mind their own business. During these episodes, the only ADLs Crystal will attend to are toileting and occasionally feeding herself.

Due to disorganized thinking and diminished self-awareness, Tyrone has difficulty recognizing his basic needs and attending to them. He often does not provide himself with enough food or maintain adequate hygiene. He has trouble shopping due to his paranoia regarding the intentions of others. He does not use public transportation because in the past, when he’s tried to ride the bus, his anxiety has been so severe that he's gotten sick to his stomach. These impairments presents major challenges for Tyrone in terms of becoming more self-sufficient and less reliant on others.

Denise performs ADLs without prompting or assistance. She showers on a daily basis, wears clean clothes, and is well-groomed. However, due to trouble concentrating and low tolerance for frustration, Denice has difficulty managing IADLs that require sustained focus, such as filling out paperwork or remembering important dates and times. This is a problem because failing to complete and return required documents, and missing important meetings, interferes with Denice's ability to access resources that are available to her.

George is able to feed himself, shower, and put on clean clothes. IADLs are mixed: Although he can shop for food, cook, and do laundry, George becomes extremely apprehensive when he receives bills and other correspondence in the mail, and is afraid to take any type of action on his own. He has no system for organizing his mail and often relies on his PSC to sort through it and take whatever action is necessary. This is a problem because it leaves George dependent on others and makes it hard for him to acquire new skills.

Tonya's ADLs are marginal. Due to disorganized thinking and limited self-awareness, she often appears disheveled and wears clothes that are dirty or inappropriate to the season or situation. She also has memory problems, and frequently loses her ID, SSA card, and other important documents. This makes it difficult for Tonya to access programs or services that require identification and forces her to spend large amounts of time applying and re-applying for the same documents over and over again.

Juan is capable of completing his ADLs and can complete IADLs unless they require sustained focus. Due to trouble concentrating and being easily distracted, Juan's focus drifts and he forgets about the tasks he is working on or becomes frustrated and gives up. His R&B manager reports that many of his chores are left half-done, for example, and last month he forgot to attend an orientation at Goodwill Works despite being reminded the day before.


All PHI has been de-identified per HIPAA Privacy Rule