ADLs

I ask the claimant to describe an average day in his or her life in almost every hearing. In Social Security speak these questions about activities of daily living are called ADLs, of course. The point of this exercise is to get a better idea of the sorts of things a person can actually still do despite their disabling condition. Allowing for some inevitable exaggeration, this enquiry is often very enlightening.

I generally ask people to account for the 12 – 15 hours they are awake each day. What do they do for fun? What are their hobbies? Do they take care of any animals? A shockingly large number of people tell me they do nothing but doze in their recliner or watch TV all day. I've written about this before here: http://edpitts.blogspot.com/search/label/TV Still, at this point in the hearing many people relax somewhat and tell me things that really help me evaluate their case.

A person who lives on a small farm tells me about taking care of her goats.

A person tells me about how he doesn't throw a ball inside for his Chihuahua anymore after that time it broke its leg. “That was expensive.”

One person tells me about scrap booking; another about using the computer to make a family tree.

I ask everyone if they socialize at all. Even if they tell me they don't, I ask more probing questions. Do they ever visit with family members? How far away do they live? How do they get there? Do they go to church or AA meetings? How do they get to their doctor's appointments?

Recently I talked to an older guy who lived just outside of a rural town, who had worked as a janitor at a nursing home for quite a few years. He told me he never socialized with anyone, but he was a talkative and friendly sort of guy.

“Don't you ever go down to the Huddle House for a cup of coffee with your friends?”

“No Judge, I don't.” “Why's that?”

“Well Judge, I've got a little touch of homophobia, I think you call it.”

I heard a sharp intake of breath from Jane, the hearing monitor sitting next to me.

There was a 10 second pause as I tried to imagine what was he talking about. The possibilities seemed endless. I briefly tried to imagine that he might think the guys who hang out drinking coffee all day are gay – Nope, probably not.

The only thing to do was ask.

“What do you mean, how does that keep you from going for a cup of coffee?”

“See, I don't go to restaurants at all. I don't like to eat after anybody, like at a buffet or smorgasbord. I can't stand to use the same serving spoon as everybody else. I won't even eat off the same dishes as my wife.”

“Are there other things you are nervous about?” “Yeah, you know, like I can't stand it if my wife leaves even the smallest crumb on the kitchen counter. I've got to clean it up, or I can't do anything else. Or like one time at work one day a patient dropped a glass and I spent all morning cleaning up every little piece, then got real upset when someone found another tiny sliver.”

“Did you ever tell these things to your doctor?” “I think so.”

“Well sir, you seem to be describing something called Obsessive-Compulsive Disorder, or OCD.”

“Oh, right, I think my doc did say something about OCD.”

“A little OCD may not be a bad thing for a janitor, but if it's keeping you from seeing your friends you might want to talk to your doctor some more about it.”

“OK, judge.”