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    Home Health Supervision Rating Scale

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    Carol WIngfield
    The document is a supervision rating scale (SRS) used to rate the level of supervision a patient receives. It describes 5 levels of supervision from independent to full-time direct supervision. Level 1 refers to independent living without supervision. Level 2 is overnight supervision only. Level 3 is part-time supervision during waking and overnight hours but allows for some unsupervised time. Level 4 is full-time indirect supervision with checks every 30 minutes. Level 5 is full-time direct supervision with checks more than every 30 minutes.

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    Home Health Supervision Rating Scale

    Uploaded by

    Carol WIngfield
    288 views1 page
    The document is a supervision rating scale (SRS) used to rate the level of supervision a patient receives. It describes 5 levels of supervision from independent to full-time direct supervision. Level 1 refers to independent living without supervision. Level 2 is overnight supervision only. Level 3 is part-time supervision during waking and overnight hours but allows for some unsupervised time. Level 4 is full-time indirect supervision with checks every 30 minutes. Level 5 is full-time direct supervision with checks more than every 30 minutes.

    Original Description:

    Determine supervision requirements for home health patients.

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    The document is a supervision rating scale (SRS) used to rate the level of supervision a patient receives. It describes 5 levels of supervision from independent to full-time direct supervision. Level 1 refers to independent living without supervision. Level 2 is overnight supervision only. Level 3 is part-time supervision during waking and overnight hours but allows for some unsupervised time. Level 4 is full-time indirect supervision with checks every 30 minutes. Level 5 is full-time direct supervision with checks more than every 30 minutes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    288 views1 page

    Home Health Supervision Rating Scale

    Uploaded by

    Carol WIngfield
    The document is a supervision rating scale (SRS) used to rate the level of supervision a patient receives. It describes 5 levels of supervision from independent to full-time direct supervision. Level 1 refers to independent living without supervision. Level 2 is overnight supervision only. Level 3 is part-time supervision during waking and overnight hours but allows for some unsupervised time. Level 4 is full-time indirect supervision with checks every 30 minutes. Level 5 is full-time direct supervision with checks more than every 30 minutes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Name: Date: __________

    Rater:

    SUPERVISION RATING SCALE (SRS)

    Instructions: Circle the rating that is closest to the amount of supervision that the patient actually receives.
    "Supervision" means that someone is responsible for being with the patient.

    Rating Description

    Level 1: INDEPENDENT
    1 The patient lives alone or independently. Other persons can live with the patient, but they cannot
    take responsibility for supervision (for example, a child or elderly person).

    2 The patient is unsupervised overnight. The patient lives with one or more persons who could be
    responsible for supervision (for example, a spouse or roommate), but they are all sometimes
    absent overnight.

    Level 2: OVERNIGHT SUPERVISION


    3 The patient is only supervised overnight. One or more supervising persons are always present
    overnight but they are all sometimes absent for the rest of the day.

    Level 3: PART-TIME SUPERVISION


    4 The patient is supervised overnight and part-time during waking hours, but is allowed on
    independent outings. One or more supervising persons are always present overnight and are also
    present during part of waking hours every day. However, the patient is sometimes allowed to
    leave the residence without being accompanied by someone who is responsible for supervision.

    5 The patient is supervised overnight and part-time during waking hours, but is unsupervised during
    working hours. Supervising persons are all sometimes absent for enough time for them to work
    full-time outside the home.

    6 The patient is supervised overnight and during most waking hours. Supervising persons are all
    sometimes absent for periods longer than one hour, but less than the time needed to hold a full-
    time job away from home.

    7 The patient is supervised overnight and during almost all waking hours. Supervising persons are
    all sometimes absent for periods shorter than one hour.

    Level 4: FULL-TIME INDIRECT SUPERVISION


    8 The patient is under full-time indirect supervision. At least one supervising person is always
    present, but the supervising person does not check on the patient more than once every 30
    minutes.

    9 Same as #8 plus requires overnight safety precautions (for example, a deadbolt on outside door).

    Level 5: FULL-TIME DIRECT SUPERVISION


    10 The patient is under full-time direct supervision. At least one supervising person is always present
    and the supervising person checks on the patient more than once every thirty minutes.

    11 The patient lives in a setting in which the exits are physically controlled by others (for example, a
    locked ward).

    12 Same as #11 plus a supervising person is designated to provide full-time line-of-sight supervision
    (for example, an escape watch or suicide watch).

    13 The patient is in physical restraints.

    3/12/93
    Corwin Boake, Ph.D., TIRR, 1333 Moursund, Houston, TX 77030-3405, 713/799-6990

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