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Appendix 3: Functional Assessment Staging (FAST)

Check highest consecutive level of disability:

1. No difficulties

2. Complains of forgetting location of objects

3. Decreased job functioning noticeable by co-workers; difficulty in traveling to new places; decreased organizational ability

4. Decreased ability to perform complex tasks, handling personal finances

5. Requires assistance in choosing proper clothing to wear for day, season occasion

6A. Improperly putting on clothes without assistance or cueing

6B. Unable to bathe properly (difficulty adjusting bath temperature)

6C. Inability to handle mechanics of toileting (forgets to flush, does not wipe properly, dispose of tissue)

6D. Urinary incontinence (occasionally or more frequently)

6E. Fecal incontinence (occasionally or more frequently)

7A. Ability to speak limited to approximately a half dozen intelligible different words

7B. Speech ability limited to use of single intelligible word in average day

7C. Ambulatory ability lost

7D. Ability to sit up without assistance lost (will fall over if no lateral arm rests on chair)

7E. Lost ability to smile

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