Over the next several months we will be taking an in-depth look at each of the 22 items on the HRST. The first major category is Functional Status, which deals with those activities each of us performs (and often takes for granted) on a daily basis. This broader category contains five separate items: Eating, Ambulation, Transfer, Toileting, and Clinical Issues Affecting Daily Life. We will cover each of those individually in the coming issues, but I feel it is important to give some background on the subject before we begin.

There are two very good reasons that issues with functional status appear on an instrument that concerns itself with risk identification and management. First, in their most extreme forms, these issues indicate extreme needs for support to prevent severe injury or even loss of life. Individuals requiring the most assistance with eating mobility also have demonstrably higher death rates. Incontinence and the need for catheterization carry significant risks for infection, skin breakdown and disorders of the urinary tract and bowel. Lastly, the degree to which a person’s health or behavioral issues impact their life has a direct impact upon their ability to participate in expected daily activities such as school, work or social activities.

One of the biggest disservices we do for individuals with special needs is to assume that health and wellness issues cannot be improved…

Secondly, loss of functional skills is often the first noticeable sign of declining health status. Examples of patterns which should raise red flags include:

• Going from eating independently to requiring direct assistance, an altered texture diet or a feeding tube.
• Going from being able to walk and move from one position to another to needing supervisory support, a wheelchair, mechanical seating support or lift equipment.
• Progressive loss of toileting skills involving hygiene, continence or requiring assistance to empty the bladder.
• Increasing numbers of days where usual activities are impacted by the need to address clinical issues.

One of the biggest disservices we do for individuals with special needs is to assume that health and wellness issues cannot be improved or, even worse, that progressive loss of skills over time is “normal” Deterioration, in spite of the most skilled intervention, may well be inevitable. It should never be regarded as normal. It is always a sign that something is going on. In many cases loss of skill is an early opportunity to begin looking for and correcting root cause. In those with long-standing functional deficits there are often opportunities to provide interventions that support the person more successfully around their issues or improve skills to lessen the risk.

Next month’s article will discuss issues with Eating, how they can negatively impact a person’s health and quality of life and how even serious issues can be addressed in ways that reduce the potential for unwanted health consequence.