Rehabilitation is graded in function, not in cure — and the single most consequential number you chart is the level of assist. The line between 5 and 4 is the line between hands-off and hands-on, and it decides staffing, reimbursement and where this person lives next. Watch each transfer, score it, build a charting line the night nurse can actually repeat, then send five patients to the right level of care.
Observation 1 of 8
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What is the level of assist? (7 = complete independence, 1 = total assistance)
Anchors. 7 complete independence · 6 modified independence (device, extra time or a safety consideration, but no helper) · 5 supervision or set-up only · 4 minimal assist, patient does 75 percent or more · 3 moderate assist, 50 to 74 percent · 2 maximal assist, 25 to 49 percent · 1 total assist, under 25 percent.
Enter what you measured
Timed Up and Go. Rise from a standard armchair, walk three metres, turn, return, sit. Never do a first TUG alone, and do not administer any of these to a patient who has not been cleared for weight bearing.
Pick a patient, then choose the level of care
Where do they go?
The assist ladder
Score it, do not describe it“Ambulated well” is uninterpretable at three in the morning by a nurse who has never met the patient. Pick a number for the observation on the left and this panel will tell you what that number promises the next shift.
0/8
Build the charting line
Choose all five fields and the note builds itself.
Five elements make the note repeatable: distance, device, number of helpers, level of assist, and why you stopped. A gait belt and the vital signs you took belong in there too.
What the screens mean
A perfect score is not a discharge planA Barthel of 100 means independent in those ten tasks — it does not mean this person can safely live alone. Nobody scores shopping, cooking, managing money or managing medications on a Barthel, and instrumental ADLs fail first. Unopened mail, a bounced cheque and a pill organiser that no longer matches the bottles are earlier signals than any forgotten name. Ask the family separately, because patients systematically over-report independence.
Level of care
Tolerance and skilled need, not enthusiasmChoose a patient on the left, then pick a setting. The level of care determines the ceiling of recovery, which is why getting this right at the team conference is one of the most consequential things a nurse contributes.
Setting
Therapy dose
Who it fits
IRF
About 3 h/day, 5 days/week, two or more disciplines
Stroke, spinal cord injury, brain injury, amputation, multiple trauma, hip fracture with good potential
Ventilator wean, complex wounds, prolonged IV therapy
Home health
Two to three visits/week
Homebound, has a caregiver, safe home environment
Outpatient
Two to five visits/week
Independent transport, community re-entry, return to work
The gate for inpatient rehabilitation: the patient must be able to participate in and benefit from about three hours of therapy a day. If they cannot sit up for ninety minutes at a stretch, they cannot yet do IRF.