Environmental Status Scale (ESS)

actual work status

normal (job, housework, school) or retired

0

works full time but in a less demanding position

1

works more than half time at job, home or school

2

works between 25% and 50%

3

works less than 25%

4

unemployed; unable to do work

5

financial/economic status

no disease-related financial problems

0

family maintains usual financial standard without external support despite some financial disadvantages

1

family maintains usual financial standard  with the aid of some external financial support

2

family maintains usual financial standard by receiving basic disability pension as defined in location of residence

3

family maintains usual financial standard only because receiving all available financial assistance

4

family unable to maintain usual financial standard despite receipt of all available financial assistance

5

personal residence/home

no change necessary

0

minor modification necessary

1

moderate modification necessary

2

major structural alteration or addition necessary

3

must move to satisfactory personal home

4

must live in a facility for dependent care because unable to continue any personal residence (institutionalized)

5

personal assistance required

none

0

minor help; relatives involved but personal independence is maintained

1

requires assistance for activities of daily living up to 1 hour per day from relatives or others in the home

2

requires assistance for activities of daily living up to 3 hours per day from relatives or others in the home

3

requires more than 3 hours of personal assistance per day but is able to live at home and does not need a constant attendant

4

requires a constant attendant or care in an institution (cannot be left alone for more than short periods)

5

transportation

uses public transportation with no problems, or drives

0

uses all forms of transport available despite minor difficulties; drives with minor difficulty

1

uses some public transport despite difficulties, or needs hand controls to drive

2

cannot use public transport but can use private transport; cannot drive but can be driven by others

3

requires community transport in a wheelchair

4

requires ambulance

5

community service

none required

0

requires service only once per month or less frequently

1

requires not more than 1 hour per week

2

requires not more than average of 1 hour per day

3

requires 1-4 hours per day

4

requires more than 4 hours per day

5

institutionalized

5

social activity

socially active as before with no changes in the usual pattern of social activity, and no difficulty maintaining this pattern

0

maintains usual patterns of social activity despite some difficulties

1

some restrictions on social activity such as change in type or frequency of some activities or increased dependence on others

2

significant restrictions on social activity, largely dependent on actions of others but still able to initiate some activity

3

socially inactive except for the initiative of others

4

no social activity, does not see friends or family, social contact is limited to that provided by community service providers (visiting nurse, etc.)

5