If you are a child applying for MPC services, the department will complete a CARE assessment and:
(1) Consider and document the role of your legally responsible natural/step/adoptive parent(s).
(2) The CARE tool will determine your needs as met based on the guidelines outlined in the following table:
| Activities of Daily Living (ADLs) |
| Ages |
| ▪ = Code status as Met | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 |
| Medication Management | | | | | | | | | | | | | | | | | | |
Independent, self-directed,
administration required, or
must be administered | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ |
| Locomotion in RoomNote | | | | | | | | | | | | | | | | | | |
Independent, supervision,
limited or extensive | ▪ | ▪ | ▪ | ▪ | | | | | | | | | | | | | | |
| Total | ▪ | ▪ | | | | | | | | | | | | | | | | |
Locomotion Outside
RoomNote | | | | | | | | | | | | | | | | | | |
| Independent or supervision | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | | | | | | | | | | | | |
| Limited or extensive | ▪ | ▪ | ▪ | ▪ | | | | | | | | | | | | | | |
| Total | ▪ | ▪ | | | | | | | | | | | | | | | | |
| Walk in RoomNote | | | | | | | | | | | | | | | | | | |
Independent, supervision,
limited or extensive | ▪ | ▪ | ▪ | ▪ | | | | | | | | | | | | | | |
| Total | ▪ | ▪ | | | | | | | | | | | | | | | | |
| Bed Mobility | | | | | | | | | | | | | | | | | | |
Independent, supervision,
limited or extensive | ▪ | ▪ | ▪ | | | | | | | | | | | | | | | |
| Total | ▪ | ▪ | | | | | | | | | | | | | | | | |
| Transfers | | | | | | | | | | | | | | | | | | |
Independent, supervision,
limited, extensive or total
& under 30 pounds | ▪ | ▪ | ▪ | | | | | | | | | | | | | | | |
(Total & 30
pounds or more = no age limit) | | | | | | | | | | | | | | | | | | |
| Toilet Use | | | | | | | | | | | | | | | | | | |
Support provided for
nighttime wetting only
(independent, supervision,
limited, extensive) | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | | | | | | | | | | |
Independent, supervision,
limited, extensive | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | | | | | | | | | | | | |
| Total | ▪ | ▪ | ▪ | ▪ | | | | | | | | | | | | | | |
| Eating | | | | | | | | | | | | | | | | | | |
Independent, supervision,
limited, extensive, or total | ▪ | ▪ | ▪ | | | | | | | | | | | | | | | |
| Bathing | | | | | | | | | | | | | | | | | | |
| Independent or supervision | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | | | | | | |
Physical help/transfer only
or physical help/part of
bathing | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | | | | | | | | | | |
| Total | ▪ | ▪ | ▪ | ▪ | ▪ | | | | | | | | | | | | | |
| Dressing | | | | | | | | | | | | | | | | | | |
| Independent or supervision | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | | | | | | |
| Limited or extensive | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | | | | | | | | | | |
| Total | ▪ | ▪ | ▪ | ▪ | ▪ | | | | | | | | | | | | | |
| Personal Hygiene | | | | | | | | | | | | | | | | | | |
| Independent or supervision | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | | | | | | |
| Limited or extensive | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | | | | | | | | | | |
| Total | ▪ | ▪ | ▪ | ▪ | ▪ | | | | | | | | | | | | | |
| Instrumental Activities of Daily Living |
| Ages |
| ▪ = Code status as Met | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 |
| Telephone | | | | | | | | | | | | | | | | | | |
| Independent, supervision, limited, extensive, or total | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ |
| Transportation | | | | | | | | | | | | | | | | | | |
| Independent, supervision, limited, extensive, or total | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ |
| Shopping | | | | | | | | | | | | | | | | | | |
| Independent, supervision, limited, extensive, or total | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ |
| Wood Supply | | | | | | | | | | | | | | | | | | |
| Independent, supervision, limited, extensive, or total | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ |
| Housework | | | | | | | | | | | | | | | | | | |
| Independent, supervision, limited, extensive, or total | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ |
| Finances | | | | | | | | | | | | | | | | | | |
| Independent, supervision, limited, extensive, or total | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ |
| Meal Preparation | | | | | | | | | | | | | | | | | | |
| Independent, supervision, limited, extensive, or total | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ |
NOTE: If the activity did not occur, the department codes self performance as total and status as met.
| Ages |
| 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 |
Additional guidelines based
on age | | | | | | | | | | | | | | | | | | |
Diagnosis
Is client comatose? = No | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | | | | | | | | | | | | |
| Pain Daily = No | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | | | | | | | | | | | | |
| Any foot care needs | | | | | | | | | | | | | | | | | | |
| Status = Need met | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ |
Any skin care (other than
feet) | | | | | | | | | | | | | | | | | | |
| Status = Need met | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ |
| Speech/Hearing | | | | | | | | | | | | | | | | | | |
Score comprehension as
understood | ▪ | ▪ | ▪ | | | | | | | | | | | | | | | |
MMSE
can be administered = no | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ |
| Memory | | | | | | | | | | | | | | | | | | |
| Short term memory ok | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | | | | | | |
| Long term memory ok | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | | | | | | |
| Depression | | | | | | | | | | | | | | | | | | |
Select interview = unable to
obtain | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | | | | | | |
| Decision making | | | | | | | | | | | | | | | | | | |
Rate how client makes
decisions = independent | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | | | | | | |
| Bladder/Bowel | | | | | | | | | | | | | | | | | | |
Support provided for
nighttime wetting only - Individual management =
Does not need/use | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | | | | | | |
Support provided for daytime
wetting - Individual Management = Does not
need/use | ▪ | ▪ | ▪ | ▪ | ▪ | ▪ | | | | | | | | | | | | |
| Treatment | | | | | | | | | | | | | | | | | | |
Passive range of motion
Need = No | ▪ | ▪ | ▪ | ▪ | | | | | | | | | | | | | | |
(3) In addition, determine that the status and assistance available are met or partially met over three-fourths of the time, when you are living with your legally responsible natural/step/adoptive parent(s).
[Statutory Authority: RCW 74.08.090, 74.09.520. 07-24-026, § 388-106-0213, filed 11/28/07, effective 1/1/08; 07-10-024, § 388-106-0213, filed 4/23/07, effective 6/1/07. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.010 and 74.39A.020. 06-05-022, § 388-106-0213, filed 2/6/06, effective 3/9/06. Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, § 388-106-0213, filed 5/17/05, effective 6/17/05.]