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Get DE DHSS Pre-Admission Evaluation (PAE) Long Term Care Tool-001 2014-2024

Th or without assistive devices (cane, wheelchair, walker) 1 Mobile with standby supervision 2 Physical assistance is always necessary for walking and wheeling. Actively participates in mobility. (1-3 days per week) 3 Totally dependent on others for mobility. Unable to actively participate in mobility. (4 or more days per week) Applicant s ability to self-propel a wheelchair without physical assistance from others. NOTE: Response is required IF applicant is usually not (2) or never (3) able to.

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