Household management tasks usually require daily assistance. Objects will need to be stored within sight of their work area.

The ability to transfer off various surfaces at will reduces the risk of pressure sores.

Caregivers will still need to check for pressure sores due to poor fitting shoes and other poor fitting items.

If the person has reduced sensation, caregivers will need to provide appropriate pressure care as the person is unaware of the secondary consequences of poor pressure care.

Fall risks are increased by the fact that people functioning within ACL 4 rarely put things away and clutter accumulates around them. Their balance may not be steady enough for them to carry items around or up and down stairs.

Hair & Nail Care

Prevent ingrown or broken nails by cutting and smoothing nails. Remind to wash hair in the shower and make arrangements for haircuts. Remind to brush hair at routine times of the day. When brushing their hair, they are not apt to attempt to comb the back or sides of their hair.

Oral Hygiene

The person is apt to follow a familiar habit for brushing their teeth, but flossing may be difficult if the floss gets stuck. They may need assistance to pull the floss out. Flossing unseen teeth is unlikely until ACL 5.0.

Observations of eating become the evaluative activity of last resort when a person refuses to do any other activity. People who are trying to hide a cognitive disability often avoid doing anything that would give them away. Many people will do craft projects because they have no face validity.

Key eating observations are included in the following descriptions.

Routine toileting tasks maybe completed using usual manners. If the person encounters a problem, they may ignore the task or ask for help as they have limited problem solving skills.

The person can bath using familiar methods. Unusual challenges like running out of supplies like soap or shampoo may cause confusion.

The person is able to group the steps of dressing tasks so they can achieve a goal. They can dress in the correct order. They have an internal need to complete simple tasks. Unfamiliar tasks will likely cause confusion. Hidden items like the back of items are likely to be ignored.

The person can continue to complete customary self-care activities independently in their own bathroom so they can use their procedural memory, but within ACL 4 Low some daily or weekly assistance is usually required when unexpected challenges occur like running out of supplies. The lack of supplies maybe ignored or they may demand it now.

These predictions should only be treated as a suggestion. There are many confounding factors which often skew these predictions. Factors which often affect predictions are a person's procedural memory, individual differences, physical abilities, age of onset and variation in the support provided by caregivers.

Within ACL 4 Low, the concept of an activity frees the person from total dependence on habits to do self-care and household activities. The concept guides the person through a sequence of steps.