Activities of Daily Living: The community feedback period for this idea began on 9/10/2019 and ended on 11/9/2019

What is the problem that needs to be addressed? Please describe how it is related to mental health.
Activities of daily living (ADLs) include eating, rest-rooming, transfer, dressing, personal hygiene. Advanced/Instrumental/Functional ADLs also exist. These activities are formalized and can be billed to a healthcare payer via a Current Procedural Terminology (CPT) code G0110. Sleep is not currently considered an ADL.

Why is this a concern for Orange County? What can Orange County and other counties learn from this project?
Lack of sleep is associated with degradation of orientation and delirium. Ask any person with a duty of care (police, fire, healthcare, etc) what it is like to interact with a person who lacks orientation or is experiencing delirium.

What is currently being done to resolve this problem in our county and throughout the United States? If applicable: Is it working; why or why not?
In the practitioner’s toolbox, a primary tool used is an off-label use of Seroquel (Quetiapine) given at night. Seroquel is an anti-psychotic. Most medications for sleep have issues with addiction, dependence and withdrawal. Seroquel has issues with grogginess and sedation – which, while sleep may have occurred, doesn’t mean a person wakes well rested..

What is new or different about this project idea? Please describe how this differs from what is already being done (Question 6). Please list any research that was done on this topic.
As far as this submitter knows, adding sleep to the list of ADLs and approving Sleep Hygiene assistance as a CPT code has never been tried. Sleep studies are highly invasive/expensive interventions that cost about $1,000. Less invasive/expensive interventions may be just as effective (i.e. sleeping in recovery position instead of CPAP). Conducting such a study to show effectiveness of less restrictive interventions may be needed as supporting evidence or refuting evidence may not exist.

What is the project idea? Please describe how this project will operate.
Add Sleep as an Activity of Daily living that may be assisted with a CPT code G0110 (or some other bill code) so that lower level providers (i.e. not prescribers) can provide less restrictive interventions for sleep. It is very possible that peer specialists/mentors may fill this role quite nicely.

Additional Information:
Respondent skipped this question


August 26, 2019


Thank you for your submission. The Innovation team will review this idea and post comments and updates when available.

The American Academy of Sleep Medicine (AASM) has many tools, protocols and evidence based practices for helping with sleep. Some of these may be within the scope of practice for a Peer Specialist/Peer Mentor/Success Coach.

Check out

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