8 Reasons Occupational Therapists Should Use the KELS Assessment

You may have heard of the Kohlman Evaluation of Living Skills (also known as the KELS assessment) and wondered if it is an effective standardized assessment to use in your OT practice. Well, it is!

This article is going to be highlighting 8 great reasons why occupational therapists should use the KELS assessment.

There is such a wide variety of assessments an occupational therapist can pick from, and it can be challenging to know when to use which one! It brings to mind the saying “which witch is which?”

Luckily for you, this article is going to highlight the purpose of the KELS assessment, the reasons to use it as well as important practical details to know before administering it. 

What is the Kohlman Evaluation of Living Skills (KELS)?

As mentioned above, KELS stands for the Kohlman Evaluation of Living Skills, which was created by Linda Kohlman Thompson in 1977. Linda is an occupational therapist herself, so this assessment is very OT focused. It is a standardized assessment tool used to evaluate function in basic living skills. What do they consider living skills? They are:

• Self-care
• Safety and Health 
• Money management
• Community mobility and telephone
• Employment and leisure participation

It also assesses: memory, attention span, ability to follow verbal and written instructions, figure ground and visual challenges.

Which patients can you do the KELS assessment with?

It was originally designed for inpatient psychiatric use, but has now been determined to be applicable to geriatrics, acute care, individuals with brain injuries, Alzheimer’s or cognitive impairments. 

What is it used for?

This assessment tool is used to recommend living situations for individuals to enable them to function as independently as possible. It considers what community setting is most appropriate for patients after discharge. 

How long does it take to administer?

30-45 minutes 

What equipment do I need for it?

The equipment you need for it varies based on which edition you are using. The 4th edition is the most recent one. Here are examples of some of the items needed in the editions:

• KELS assessment book
• Phone book
• Telephone
• Money
• Paper and pencil
• KELS flash drive with all documents needed (bank forms, utility bill etc.)

What settings is the KELS used in?

• Inpatient rehab units
• Skilled nursing facilities
• Acute care units
• Life skill training programs

It is not recommended for use in settings with long length of stays.  

Scoring:

• 17 items are scored either based on observation or the patient’s report to the interview questions.
• Each item is rated either as “needs assistance” or “independent.”
• You will need to just take note of how to score each item, but guidelines are provided in the manual. 

If my setting doesn’t have it, where can I purchase it?

• AOTA
• Amazon

How much does the KELS cost?

• AOTA: $109.95 (member price) or $157.95 (non-member price)
• Amazon: $189.00

What’s different with the 4th edition?

The 4th edition has been updated to be more relevant to our modern world, including updates to the safety photos and incorporating recent technology. It includes a flash drive with the items needed for the test, such as electronic banking items and admin forms. 

8 Reasons OTs Should Use the KELS Assessment

1. It was developed by an OT

It is a standardized assessment developed by an occupational therapist. I know I am biased, but I truly believe that knowing an OT designed it gives me the confidence that it is a more holistic assessment.  As well as knowing it is useful in determining a patient’s safety in being discharged back into the community and how much assistance they’ll need. 

2. Helpful for discharge planning

The results of the assessment can be used for the OT to make recommendations about the level of assistance the patient will need after discharge. A score of 6-17 indicates that the patient requires assistance to live in the community, whereas a score of 5.5 or less indicates that the patient is able to live independently. Furthermore, depending on where the patient score is low, the occupational therapist will be able to recommend in which area the patient requires support, e.g money management vs health. 

3. Considered an approved evaluation

It is listed under Medicaid and Medicare’s evaluations that are approved. 

4. Easy to use

This test is easy to administer and the manual provides clear instructions on what to say and do with the patient throughout the assessment. It is also easy to set up and transport. 

5. Accurate results

The KELS assessment has both high inter-rater and test-retest reliability and validity. This means that you can feel confident that this assessment will have results that are reproducible and it is accurately measuring what it is supposed to. 

6. Functional

The KELS assessment examines one’s ability to carry out necessary real word tasks. Unlike many assessments which are purely paper based, and do not incorporate functional tasks. What I also like about it is that parts can be omitted in order to be more relevant to your patient, such as bill paying. 

7. Versatile

The KELS assessment can be used with a wide variety of conditions, as well as across many different settings. 

8. Quick to score

There is a one page score sheet which is easy and quick to score. 

Some of the Downsides

No assessment is perfect, so I wanted to draw your attention to some of its weaknesses. 

1. It is not recommended for individuals that live in rural areas
2. It is more focused on interview as opposed to observation
3. 30-45 minutes is a long time to administer an assessment

Research Completed

A study including 200 community dwelling older adults (>65 years old) showed high convergent validity in assessing cognitive, executive, affective and functional measures that are often used to assess an older adult’s ability to live safely and independently (1).

In Summary

The Kohlman Evaluation of Living Skills is an OT-designed effective assessment tool to evaluate an individual’s safety and level of support needed when being discharged into the community.

It provides valuable information on a patient’s strengths and what is the least restrictive living environment that can match their current strengths to promote their health, safety and independence.

It is appropriate in a variety of occupational therapy settings, with a variety of individuals and is easy to use, quick to score and interpret. We hope this article helps you better understand the KELS assessment and why it’s a great assessment to add to your toolbox. 

Reference:

• Burnett. J, Dyer. C, Naik. A, National Library of Medicine, Convergent Validation of the Kohlman Evaluation of Living Skills as a Screening Tool of Older Adults’ Capacity to Live Safely and Independently in the Community’, 2010, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2855551/, date accessed: 16/05/2023.