What is the Barthel Index? How is it Scored, What Score Qualifies, Where to Get It, and the New 'No Barthel Index' Policy at a Glance
The Barthel Index is a scale that assesses a person's 'Activities of Daily Living (ADL),' measuring 10 self-care abilities such as feeding, transferring, toileting, bathing, and walking. The total score ranges from 0 to 100, with lower scores indicating greater need for assistance. In Taiwan, it has long been a core tool used by medical professionals when families apply for foreign home care workers. However, starting August 2025, a new policy takes effect: individuals aged 80 and above are exempt from the Barthel Index assessment, and the list of exempt groups has been expanded. The following explains how the scale is scored, what the scores mean, where to get it done, and who is now exempt. This is neutral information and does not constitute medical or legal advice.
What is the Barthel Index? What items does it assess?
It is an internationally used tool for assessing daily living functions, focusing on 'ability to care for oneself' rather than disease diagnosis:
- Assesses 10 daily living items: feeding, transferring (moving between bed and chair), personal hygiene (washing face and brushing teeth), toileting, bathing, walking on level ground, climbing stairs, dressing, bowel control, and bladder control.
- Each item is scored based on the level of independence, with a total score ranging from 0 to 100. Higher scores indicate greater self-care ability, while lower scores indicate greater dependence on others.
- It assesses 'functional and disability levels,' commonly used as a basis for care needs and resource allocation, not for diagnosing specific diseases.
What do the scores mean? How to interpret the score levels?
Clinically, score ranges are often used to determine the level of dependence (the following levels are general clinical references):
- 100 points: Completely independent in daily living (independent).
- 61 to 99 points: Mild dependence, requiring assistance with some items.
- 41 to 60 points: Moderate dependence; 21 to 40 points: Severe dependence; 20 points or below: Complete dependence (almost all items require assistance).
- Lower scores generally indicate higher care needs. However, whether you qualify for various services or employment eligibility should be based on the standards adopted by the competent authority and the latest announcements.
Where to get the Barthel Index? Who assesses it and how to prepare?
It must be assessed and issued by medical professionals; it is not something you fill out yourself:
- Generally, it is assessed and issued by a physician (or their team) at a hospital or designated medical institution. You can visit departments such as Geriatrics, Neurology, Rehabilitation, or Family Medicine. First, confirm with the hospital whether they provide assessment for foreign caregiver applications.
- The assessment looks at the elderly person's 'actual daily performance.' It is recommended that the primary caregiver accompany them, truthfully describe recent conditions (such as falls, incontinence, need for support), and bring medical records, diagnostic certificates, and identification documents.
- The assessment results and diagnostic certificate are one of the bases for subsequent applications for foreign home care workers. The validity and purpose of the documents should follow the regulations of the responsible agency.
New policy from August 2025: Who is exempt from the Barthel Index?
Amendment to Article 46 of the Employment Service Act, effective August 1, 2025, significantly expands the scope of exemption:
- Individuals aged 80 and above: Completely exempt from the Barthel Index assessment and can directly apply to hire a foreign home care worker.
- Individuals aged 70 to 79 diagnosed with stage II cancer or above: Exempt from assessment.
- Other diverse exempt groups (regardless of age): Such as stage IV cancer, total paralysis unable to get out of bed, diagnosed with mild or above dementia by a physician, holding a certificate of extremely severe disability or a catastrophic illness card, continuous use of home/day/family foster care for 6 months, having employed a caregiver within the past year, and re-employing a caregiver at age 75 or above, etc.
Exemption from assessment does not mean exemption from procedures: What to still pay attention to?
Even if exempt from the Barthel Index, hiring a foreign caregiver still involves legal procedures and timelines:
- Those aged 80 and above who are exempt save the medical evaluation step, but according to the law, they must first conduct a domestic recruitment process (recruiting local workers) for at least 7 days. Only if no one applies can they apply to hire a foreign caregiver.
- The entire process from application to the caregiver's arrival often takes several weeks to months, so early planning is recommended. You can proceed through a legal agency or the 'Direct Hiring Service Center.'
- If the elderly person does not meet the exemption criteria, they still need a professional assessment such as the Barthel Index. For whether they qualify and how to apply, it is recommended to first consult the Long-Term Care Management Center or the responsible agency. You can also cross-reference other pages on this site such as 'Foreign Caregivers or Institutions' and 'Long-Term Care Subsidies.' This page provides neutral information and is not medical or legal advice.
FAQ
What Barthel Index score is needed to apply for a foreign caregiver?
There is no single fixed score that applies universally, as the acceptance criteria are adjusted according to policy and have been significantly relaxed since August 2025. In the past, the Barthel Index was used to assess the level of disability (lower scores indicate greater dependence) as one of the conditions. Now, individuals aged 80 and above are exempt from assessment, and those aged 70–79 with stage II cancer or above are also exempt. Whether you actually qualify should be confirmed with the latest announcements from the competent authority and the responsible agency. This page provides neutral information and is not medical or legal advice.
Can I fill out the Barthel Index at home by myself?
No, it must be assessed and issued by a physician (or their team) at a hospital or designated medical institution to be valid. Online versions of the scale can help you understand the assessment items in advance, but the official document must be based on a professional evaluation. It is recommended that the primary caregiver accompany the elderly person, truthfully describe their recent condition, and bring medical records and diagnostic certificates.
Where should I go for the Barthel Index assessment? Which department should I visit?
Generally, you go to a hospital where a physician will assess and issue the document. You can visit departments such as Geriatrics, Neurology, Rehabilitation, or Family Medicine. First, confirm with the hospital whether they provide 'Barthel Index assessment for foreign caregiver applications.' The assessment looks at the elderly person's actual daily living performance. It is recommended to bring complete medical records, diagnostic certificates, and identification documents.
If someone is 80 or older, are they guaranteed to get a foreign caregiver?
Being 80 or older means exemption from the Barthel Index assessment, skipping the medical evaluation step, but it does not mean automatic approval. According to the law, you must first conduct a domestic recruitment process for at least 7 days. If no local caregiver applies, you can then apply to hire a foreign home care worker. Subsequent procedures such as recruitment, introduction, and employment permits are still required and take time.
Is a lower or higher Barthel Index score better?
It depends on the purpose. In terms of 'self-care ability,' a higher score indicates greater independence and better health. In terms of 'applying for care resources,' a lower score (indicating disability and high dependence) is more likely to meet the conditions for needing assistance. The scale reflects functional status, not a grade. The key is to truthfully assess the elderly person's actual condition.
I had a Barthel Index assessment before. Do I need to do it again now?
It depends on the situation and the validity of the document. If the elderly person now meets the exemption criteria (e.g., aged 80 or above), a reassessment may not be needed for renewal or reapplication. If assessment is still required, documents often have limitations on scope and validity. It is recommended to directly consult the Long-Term Care Management Center or the responsible agency to confirm current regulations and required documents.
· This page is a neutral compilation of information for reference only, not medical, legal, tax, or admission advice. For actual regulations and services, please refer to official announcements from competent authorities and the institutions themselves.