Domain deep dive · 5
Domain 5: Personal Care / Health Supports
The specially designed instruction and supports a student needs for personal care, health, and medically-related care to attend school safely and access the educational environment. Boundaries first — built for when you have a student in front of you, rating this one domain.
What this domain covers
The specially designed instruction (SDI) and supports a student needs for personal care, health, and medically-related care to attend school safely and access the educational environment. It reflects physical support needs and medical complexity — not instruction or behavior. It includes toileting, feeding, mobility, and hygiene assistance, nursing services and health procedures, health-related equipment, and personal-care staffing.
These supports are rated on the student's educational need. They don't have to meet Medicaid's "medically necessary" standard — a support can be required for FAPE here without being Medicaid-billable.
The decision boundaries
Each of the four factors is rated 0–3, and the rating climbs as the student needs more care: 0 means none is required for FAPE, and 3 means the support is daily and pervasive enough to structure the student's day. For Personal Care / Health, Factor A reaches its top level when health or safety is at risk if the care is reduced or delayed.
| Factor | 0 | 1 | 2 | 3 |
|---|---|---|---|---|
| A — How much instruction | No direct personal-care/health SDI required for FAPE | Targeted, discrete; less than 60 minutes per week; schedules around instruction; at least one goal | Regular, consistent assistance and health monitoring tied to participation; allows periods of independence | Daily or near-continuous; health or safety risk if reduced or delayed; can't be postponed or clustered |
| B — Who delivers it | No specialized qualifications required for FAPE | No specialized credential beyond typical school training | Staff with specific health training or competencies; periodic clinical oversight | Advanced clinical licensure; continuous or frequent clinical judgment |
| C — Ratio | No reduced ratio required for FAPE | Intermittent; availability matters more than ratio | Planned reduced ratio for portions of the day, tied to health, mobility, or care needs | Continuous supervision or assistance for safe attendance; may dictate placement |
| D — Equipment | No equipment required for FAPE | Occasional mobility aid, basic positioning | Daily mobility or health-monitoring equipment needing staff assistance | Complex mobility, respiratory, or feeding systems essential for safe attendance; drives staffing |
Physical risk (Factor A)
What moves Factor A to its top level is the consequence of reducing the care, not the amount alone:
- Level 2 — regular, consistent assistance and health monitoring tied to participation, with periods of independence between supports.
- Level 3 — daily or near-continuous care that can't be postponed or clustered, because health or safety is at risk if it's reduced or delayed.
The nursing-credential ladder (Factor B)
The rubric describes Factor B abstractly and does not name specific nursing roles. Match the credential the IEP requires to the description, not to a job title:
- Level 1 — no specialized credential beyond typical school-based training.
- Level 2 — credentials or documented competencies, but not continuous clinical licensure, with periodic clinical oversight.
- Level 3 — advanced certifications or licensure, where continuous or frequent clinical judgment is necessary.
Reading this domain for specific cases
The general age and post-graduation principles are on the what is a domain page. What's specific to Personal Care / Health:
- Ages 3–5 (not in kindergarten): most young children need hands-on help from staff. Rate only supports that go far beyond what same-age peers require.
- Students continuing after meeting graduation requirements: the focus shifts toward supports needed across community-based settings — work sites, travel, healthcare management.
Differentiating between domains
Two boundaries come up often with Personal Care / Health:
- A personal-care ratio that incidentally helps behavior or independence stays in Personal Care / Health when health or care is the driver — it isn't also rated in Behavior (Domain 2) or Independent Functioning (Domain 4) unless it's required for FAPE there too.
- A communication system belongs in Communication (Domain 3) unless it's medically driven, in which case it belongs here.
What is a domain covers the full set of boundaries across all five, and how scores become a tier covers how the five domain scores are combined.