This letter from CMS explains the definitions of activities of daily living (ADLs) and how nursing homes and other healthcare facilities should assess and intervene when a resident is unable to perform them. It defines oral care, speech, language, and other functional communication systems, assistance with the bathroom, and transfer. It also outlines the guidance for determining whether a decline in a resident's ability to perform ADLs is unavoidable, and provides definitions for independent, supervision, limited assistance, extensive assistance, and total dependence. Lastly, it outlines procedures for evaluating a resident's ADLs, recognizing and assessing an inability to perform them, developing and implementing interventions, monitoring and evaluating a resident's response to care plan interventions, and revising approaches as appropriate. This letter requires nursing homes and other healthcare facilities to assess and intervene when a resident is unable to perform ADLs, and to recognize and assess any decline in their ability to do so. Facilities must also develop and implement interventions in accordance with the resident's assessed needs, goals for care, and preferences, as well as monitor and evaluate the resident's response to care plan interventions. Facilities must also revise approaches as appropriate.

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