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1. Coding G0110B1 would be coded 0 independent GO110B2 would be coded O no setup or physical help from staff Rationale Resident is independent each and every time she transferred during the 7 day look back period and required no setup or physical help from staff 2 Staff must supervise the resident as she transfers from her bed to wheelchair daily Staff must bring the chair next to the bed and then remind her to hold on to the chair and position her body slowly Coding G0110B1 would be coded 1 supervision GO110B2 would be coded 1 setup help only Rationale Resident requires staff supervision cueing and reminders for safe transfer This activity happened daily over the 7 day look back period 3 Mrs H is able to transfer from the bed to chair when she uses her walker Staff place the walker near her bed and then assist the resident with guided maneuvering as she transfers The resident was noted to transfer from bed to chair six times during the 7 day look back period Coding G0110B1 would be coded 2 limited assistance GO110B2 would be coded 2 one person physical assist Rationale Resident requires staff to set up her walker and provide non weight bearing assistance when she is ready to transfer The activity happened six times during the 7 day look back period 4 Mrs B requires weight bearing assistance of one staff member to partially lift and support her when being transferred The resident was noted to have been
2. Bed Mobility handing the resident the bar on a trapeze staff raises the 2 rails for the resident s use and then provides no further help October 2014 Page G 9 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0110 Activities of Daily Living ADL Assistance cont Transfer giving the resident a transfer board or locking the wheels on a wheelchair for safe transfer Locomotion o Walking handing the resident a walker or cane o Wheeling unlocking the brakes on the wheelchair or adjusting foot pedals to facilitate foot motion while wheeling Dressing retrieving clothes from the closet and laying out on the resident s bed handing the resident a shirt Eating cutting meat and opening containers at meals giving one food item at a time Toilet Use handing the resident a bedpan or placing articles necessary for changing an ostomy appliance within reach Personal Hygiene providing a washbasin and grooming articles e Supervision Code Supervision for residents seated together or in close proximity of one another during a meal who receive individual supervision with eating General supervision of a dining room is not the same as individual supervision of a resident and is not captured in the coding for Eating e Coding activity did not occur 8 Toileting would be coded 8 activity did not occur only if elimination did not occur during the entire look back period or if fa
3. These steps must be used in sequence Use the first instruction encountered that meets the coding scenario e g if 1 applies stop and code that level 1 When an activity occurs three or more times at any one level code that level 2 When an activity occurs three or more times at multiple levels code the most dependent level that occurred three or more times 3 When an activity occurs three or more times and at multiple levels but not three times at any one level apply the following a Convert episodes of full staff performance to weight bearing assistance when applying the third Rule of 3 as long as the full staff performance episodes did not occur every time the ADL was performed in the 7 day look back period It is only when every episode is full staff performance that Total dependence 4 can be coded Remember that weight bearing episodes that occur three or more times or full staff performance that is provided three or more times during part but not all of the last 7 days are included in the ADL Self Performance coding level definition for Extensive assistance 3 b When there is a combination of full staff performance and weight bearing assistance that total three or more times code extensive assistance 3 c When there is a combination of full staff performance weight bearing assistance and or non weight bearing assistance that total three or more times code limited assistance 2 If none of the above are
4. ostomy bag Personal hygiene how resident maintains personal hygiene including combing hair brushing teeth shaving applying makeup washing drying face and hands excludes baths and showers O U OU O OU OUD O UO O OU OUD April 2012 Page G 1 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0110 Activities of Daily Living ADL Assistance cont Item Rationale Health related Quality of Life Almost all nursing home residents need some physical assistance In addition most are at risk of further physical decline The amount of assistance needed and the risk of decline vary from resident to resident A wide range of physical neurological and psychological conditions and cognitive factors can adversely affect physical function Dependence on others for ADL assistance can lead to feelings of helplessness isolation diminished self worth and loss of control over one s destiny As inactivity increases complications such as pressure ulcers falls contractures depression and muscle wasting may occur Planning for Care Individualized care plans should address strengths and weakness possible reversible causes such as de conditioning and adverse side effects of medications or other treatments These may contribute to needless loss of self sufficiency In addition some neurologic injuries such as stroke may continue to improve for months after an acute event For some residents cognitive defic
5. 2014 2 Code 8 The ADL Activity or any part of the ADL was not performed by the resident or staff at all Code 7 Activity Occurred fewer than 3 times Instructions for the Rule of 3 Exceptions for the Rule of 3 Code 0 Code 4 and Code 8 as the definition for these coding levels is very specific and cannot be entered on the MDS unless it is the level that occurred every time the ADL occurred Code 7 as this code only applies if the activity occurred fewer than 3 times Rule of 3 1 When an activity occurs 3 or more times at any one level code that level When an activity occurs 3 or more times at multiple levels code the most dependent level that occurred 3 or more times When an activity occurs 3 or more times and at multiple levels but not 3 times at any one level apply the following a Convert episodes of full staff performance to weight bearing assistance When there is a combination of full staff performance and weight bearing assistance that total 3 or more times code extensive assistance 3 Do not proceed to c below if b applies When there is a combination of full staff performance weight bearing assistance and or non weight bearing assistance that total 3 or more times code limited assistance 2 If none of the above are met code Supervision 1 This box in the algorithm corresponds to a b and c under the third Rule of 3 above Th
6. Direct Care Staff Believe Resident Is Capable of Increased Independence in at Least Some ADLs 1 The nurse assistant who totally feeds Mrs W has noticed in the past week that Mrs W has made several attempts to pick up finger foods She believes Mrs W could become more independent in eating if she received close supervision and cueing in a small group for restorative care in eating Coding G0900B would be coded 1 yes Rationale Based upon observation of the resident the nurse assistant believes Mrs W is capable of increased independence October 2014 Page G 41
7. bathing Code 4 total dependence if the resident is unable to participate in any of the bathing activity Code 8 ADL activity itself did not occur during entire period if the activity did not occur or family and or non facility staff provided care 100 of the time for that activity over the entire 7 day period Coding Instructions for G0120B Support Provided Bathing support codes are as defined ADL Support Provided item GO110 Column 2 October 2014 Page G 24 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0120 Bathing cont Coding Tips e Bathing is the only ADL activity for which the ADL Self Performance codes in Item G0110 Column 1 Self Performance do not apply A unique set of self performance codes is used in the bathing assessment given that bathing may not occur as frequently as the other ADLs in the 7 day look back period e Ifa nursing home has a policy that all residents are supervised when bathing 1 e they are never left alone while in the bathroom for a bath or shower regardless of resident capability it is appropriate to code the resident self performance as supervision even if the supervision 1s precautionary because the resident 1s still being individually supervised Support for bathing in this instance would be coded according to whether or not the staff had to actually assist the resident during the bathing activity Examples 1 Resident received verbal cueing and encouragement to take t
8. coded 8 activity did not occur G0110F2 would be coded 8 ADL activity itself did not occur during entire period Rationale Activity did not occur at all October 2014 Page G 16 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0110 Activities of Daily Living ADL Assistance cont 2 Mr Q is a wheelchair bound and is able to self propel on the unit On two occasions during the 7 day look back period he self propelled off the unit into the courtyard Coding G0110F1 would be coded 7 activity occurred only once or twice GO110F2 would be coded O no setup or physical help from staff Rationale The activity of going off the unit happened only twice during the look back period with no help or oversight from staff 3 Mr H enjoyed walking in the nursing home garden when weather permitted Due to inclement weather during the assessment period he required multiple levels of assistance on the days he walked through the garden On two occasions he required limited assistance for balance of one staff person and on another occasion he only required supervision On one day he was able to walk through the garden completely by himself Coding G0110F1 would be coded 1 supervision GO110F2 would be coded 2 one person physical assist Rationale Activity did not occur at any one level for three times and he did not require physical assistance for at least three times The most support provided by staff was one person assist Examp
9. extensive assistance if resident performed part of the activity over the last 7 days and help of the following type s was provided three or more times Weight bearing support provided three or more times OR Full staff performance of activity three or more times during part but not all of the last 7 days October 2014 Page G 5 CMS s RAI Version 3 0 Manual CH 3 MDS Items G GO0110 Activities of Daily Living ADL Assistance cont Code 4 total dependence if there was full staff performance of an activity with no participation by resident for any aspect of the ADL activity and the activity occurred three or more times The resident must be unwilling or unable to perform any part of the activity over the entire 7 day look back period Code 7 activity occurred only once or twice if the activity occurred fewer than three times Code 8 activity did not occur if the activity did not occur or family and or non facility staff provided care 100 of the time for that activity over the entire 7 day look back period The Rule of 3 The Rule of 3 is a method that was developed to help determine the appropriate code to document ADL Self Performance on the MDS It is very important that staff who complete this section fully understand the components of each ADL the ADL Self Performance coding level definitions and the Rule of 3 In order to properly apply the Rule of 3 the facility must first note which ADL activi
10. hand held assist from one staff member the resident was noted to ambulate daily during the 7 day look back period Coding G0110C1 would be coded 2 limited assistance G0110C2 would be coded 2 one person physical assist Rationale Resident requires hand held non weight bearing assistance of one staff member daily for ambulation in his room October 2014 Page G 14 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0110 Activities of Daily Living ADL Assistance cont 4 Mr A has a bone spur on his heel and has difficulty ambulating in his room He requires staff to help support him when he selects clothing from his closet During the 7 day look back period the resident was able to ambulate with weight bearing assistance from one staff member in his room four times Coding G0110C1 would be coded 3 extensive assistance G0110C2 would be coded 2 one person physical assist Rationale The resident was able to ambulate in his room four times during the 7 day look back period with weight bearing assistance of one staff member 5 Mr J is attending physical therapy for transfer and gait training He does not ambulate on the unit or in his room at this time He calls for assistance to stand pivot to a commode next to his bed Coding G0110C1 would be coded 8 activity did not occur GO110C2 would be coded 8 ADL activity itself did not occur during entire period Rationale Activity did not occur Examples for G0110D Wa
11. herself She relied on one staff member for all nourishment during the 7 day look back period Coding G0110H1 would be coded 4 total dependence GO110H2 would be coded 2 one person physical assist Rationale Resident did not participate and required one staff person to feed her all of her meals during the 7 day look back period Mrs D receives all of her nourishment via a gastrostomy tube She did not consume any food or fluid by mouth During the 7 day look back period she did not participate in the gastrostomy nourishment process Coding G0110H1 would be coded 4 total dependence GO110H2 would be coded 2 one person physical assist Rationale During the 7 day look back period she did not participate in eating and or receiving of her tube feed during the entire period She required full staff performance of these functions October 2014 Page G 18 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0110 Activities of Daily Living ADL Assistance cont Examples for G0110I Toilet Use Is Mrs L transferred herself to the toilet adjusted her clothing and performed the necessary personal hygiene after using the toilet without any staff assistance daily during the entire 7 day look back period Coding G0110I1 would be coded 0 independent GO110I2 would be coded O no setup or physical help from staff Rationale Resident was independent in all her toileting tasks Staff member must remind resident to toilet frequ
12. resident who uses her wheelchair for mobility stands up from the edge of her bed sways to the right but then is quickly able to pivot and sits in her locked wheelchair in a steady fashion Coding GO300E would be coded 1 not steady but able to stabilize without staff assistance Rationale The resident was unsteady when transferring from bed to wheelchair but was able to steady herself without staff assistance or an object Additional examples for GO300A E Balance during Transitions and Walking 1 A resident sits up in bed stands up pivots and sits in her locked wheelchair She then wheels her chair to the bathroom where she stands pivots lifts gown and smoothly sits on the commode Coding GO0300A GO300D GO300E would be coded O steady at all times Rationale The resident was steady during each activity G0400 Functional Limitation in Range of Motion G0400 Functional Limitation in Range of Motion Code for limitation that interfered with daily functions or placed resident at risk of injury Enter Codes in Boxes Coding 0 No impairment A Upper extremity shoulder elbow wrist hand 1 Impairment on one side i B Lower extremity hip knee ankle foot Intent The intent of G0400 is to determine whether DEFINITION functional limitation in range of motion ROM interferes with the resident s activities of daily living or places him or her at FUNCTIONAL risk of injury When completing this item staff should
13. sleep furniture Transfer how resident moves between surfaces including to or from bed chair wheelchair standing position excludes to from bath toilet Walkin room how resident walks between locations in his her room Walk in corridor how resident walks in corridor on unit Locomotion on unit how resident moves between locations in his her room and adjacent corridor on same floor If in wheelchair self sufficiency once in chair Locomotion off unit how resident moves to and returns from off unit locations e g areas set aside for dining activities or treatments If facility has only one floor how resident moves to and from distant areas on the floor If in wheelchair self sufficiency once in chair 3 Dressing how resident puts on fastens and takes off all items of clothing including donning removing a prosthesis or TED hose Dressing includes putting on and changing pajamas and housedresses Eating how resident eats and drinks regardless of skill Do not include eating drinking during medication pass Includes intake of nourishment by other means e g tube feeding total parenteral nutrition IV fluids administered for nutrition or hydration Toilet use how resident uses the toilet room commode bedpan or urinal transfers on off toilet cleanses self after elimination changes pad manages ostomy or catheter and adjusts clothes Do not include emptying of bedpan urinal bedside commode catheter bag or
14. the motion on the pedals of a bicycle Extension might also be needed to don a shoe If assessing bending at the knee the motion would be similar to lifting of the leg when donning lower body clothing Upper Extremity includes shoulder elbow wrist and fingers For each hand instruct the resident to make a fist and then open the hand With resident seated in a chair instruct him or her to reach with both hands and touch palms to back of head Then ask resident to touch each shoulder with the opposite hand Alternatively observe the resident donning or removing a shirt over the head If assessing upper extremity ROM by observing the resident making a fist mimics useful actions for grasping and letting go of utensils When an individual reaches both hands to the back of the head this mimics the action needed to comb hair October 2014 Page G 36 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0400 Functional Limitation in Range of Motion cont Coding Tips e Do not look at limited ROM in isolation You must determine if the limited ROM impacts functional ability or places the resident at risk for injury For example if the resident has an amputation it does not automatically mean that they are limited in function He she may not have a particular joint in which certain range of motion can be tested however it does not mean that the resident with an amputation has a limitation in completing activities of daily living nor do
15. transferred 14 times in the 7 day look back period and each time required weight bearing assistance Coding G0110B1 would be coded 3 extensive assistance GO110B2 would be coded 2 one person physical assist Rationale Resident partially participates in the task of transferring The resident was noted to have transferred 14 times during the 7 day look back period each time requiring weight bearing assistance of one staff member 5 Mr T is in a physically debilitated state due to surgery Two staff members must physically lift and transfer him to a reclining chair daily using a mechanical lift Mr T is unable to assist or participate in any way Coding G0110B1 would be coded 4 total dependence GO110B2 would be coded 3 two t persons physical assist Rationale Resident did not participate and required two staff to transfer him out of his bed The resident was transferred out of bed to the chair daily during the 7 day look back period October 2014 Page G 13 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0110 Activities of Daily Living ADL Assistance cont 6 Mrs D is post operative for extensive surgical procedures Because of her ventilator dependent status in addition to multiple surgical sites her physician has determined that she must remain on total bed rest During the 7 day look back period the resident was not moved from the bed Coding G0110B1 would be coded 8 activity did not occur GO110B2 would b
16. 15 feet using his or her usual assistive device Walking G0300B should be rated at this time f Ask the resident to turn around Turning around G0300C should be rated at this time g Ask the resident to walk or wheel from a starting point in his or her room into the bathroom prepare for toileting as he or she normally does including taking down pants or other clothes underclothes can be kept on for this observation and sit on the toilet Moving on and off toilet G0300D should be rated at this time h Ask residents who are not ambulatory and who use a wheelchair for mobility to transfer from a seated position in the wheelchair to a seated position on the bed Surface to surface transfer should be rated at this time GO300E Balance During Transitions and Walking Algorithm Did the activity occur Code 8 Activity did notoccur Yes Did the person require physical assistance Code 2 Not steady Only able to stabilize with staff assistance Was the person steady with or withoutan assistive device thatis intentionally for and appropriate for the activity Code 1 Not Steady but able to stabilize without staff assistance October 2014 Page G 27 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0300 Balance During Transitions and Walking cont Coding Instructions G0300A Moving from Seated to Standing Position Code for the least steady episode using assistive device if appl
17. 2 one person physical assist Rationale A staff member had to complete part of the activity of personal hygiene for the resident 3 out of 7 days during the look back period The assistance although non weight bearing is considered full staff performance of the personal hygiene sub task of brushing and styling her hair Because this ADL sub task was completed for the resident 3 times but not every time during the last 7 days it qualifies under the second criterion of the extensive assistance definition Scenario Examples 1 Scenario The following dressing assistance was provided to Mr X during the look back period Two times he required guided maneuvering of his arms to don his shirt this assistance was non weight bearing assistance Four times he required the staff to assist him to put his shirt on due to pain in his shoulders During these four times that the staff had to assist Mr X to put his shirt on the staff had to physically assist him by lifting each of his arms This component of the dressing activity occurred six times in the 7 day look back period There were two times where Mr X required non weight bearing assistance and four times where he required weight bearing assistance therefore the appropriate code to enter on the MDS is Extensive assistance 3 Rationale This ADL activity component occurred six times in the 7 day look back period Mr X required limited assistance two times and weight bearing extensive assista
18. CMS s RAI Version 3 0 Manual CH 3 MDS Items G SECTION G FUNCTIONAL STATUS Intent Items in this section assess the need for assistance with activities of daily living ADLs altered gait and balance and decreased range of motion In addition on admission resident and staff opinions regarding functional rehabilitation potential are noted G0110 Activities of Daily Living ADL Assistance GO110 Activities of Daily Living ADL Assistance Refer to the ADL flow chart in the RAI manual to facilitate accurate coding Instructions for Rule of 3 When an activity occurs three times at any one given level code that level m When an activity occurs three times at multiple levels code the most dependent exceptions are total dependence 4 activity must require full assist every time and activity did not occur 8 activity must not have occurred at all Example three times extensive assistance 3 and three times limited assistance 2 code extensive assistance 3 When an activity occurs at various levels but not three times at any given level apply the following o When there is a combination of full staff performance and extensive assistance code extensive assistance When there is a combination of full staff performance weight bearing assistance and or non weight bearing assistance code limited assistance 2 lf none of the above are met code supervision 1 ADL Self Performance 2 ADL Support Provided Cod
19. aff assistance If any transition that involves turning around to face the opposite direction is not steady and the resident cannot stabilize without assistance from a staff If the resident fell when turning around to face the opposite direction during the look back period Residents coded in this category appear at high risk for falling during transitions Code 8 activity did not occur If the resident did not turn around to face the opposite direction while walking during the 7 day look back period Examples for GO300C Turning Around and Facing the Opposite Direction while Walking 1 A resident with Alzheimer s disease frequently wanders on the hallway On one occasion a nursing assistant noted that he was about to fall when turning around However by the time she got to him he had steadied himself on the handrail Coding G0300C would be coded 1 Not steady but able to stabilize without staff assistance Rationale The resident was unsteady when turning but able to steady himself on an object in this instance a handrail October 2014 Page G 31 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0300 Balance During Transitions and Walking cont 2 A resident with severe arthritis in her knee ambulates with a single point cane A nursing assistant observes her lose her balance while turning around to sit in a chair The nursing assistant is able to get to her before she falls and lowers her gentl
20. aits with increased risk for falling when standing up small shuffling steps or Code 2 not steady only able to stabilize wide based gaits with halting with staff assistance tentative steps If any of transitions from seated to standing or from standing to sitting are not steady and the resident cannot stabilize without assistance from staff If the resident cannot stand but can transfer unassisted without staff assistance If the resident returned back to a seated position or was unable to move from a seated to standing or from standing to sitting position during the look back period Residents coded in this category appear at high risk for falling during transitions If a lift device a mechanical device operated by another person is used because the resident requires staff assistance to stabilize code as 2 Code 8 activity did not occur if the resident did not move from seated to standing position during the 7 day look back period October 2014 Page G 28 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0300 Balance During Transitions and Walking cont Examples for G0300A Moving from Seated to Standing Position ie A resident sits up in bed stands and begins to sway but steadies herself and sits down smoothly into her wheelchair Coding G0300A would be coded 1 not steady but able to stabilize without staff assistance Rationale Resident was unsteady but she was able to stabiliz
21. be entered in Column 1 ADL Self Performance GO110B Transfer is Extensive assistance 3 3 Scenario Mrs F was in the nursing home for only one day prior to transferring to another facility While there she was unable to complete a component of the eating ADL activity without assistance three times The following assistance was provided Twice she required weight bearing assistance to help lift her fork to her mouth One time in the evening the staff fed Mrs F because she could not scoop the food on her plate with the fork nor could she lift the fork to her mouth The three times that Mrs F could not complete the activity the staff had to physically assist her by either holding her hand as she brought the fork to her mouth or by actually feeding her There were two times where the staff provided weight bearing assistance and one time where they provided full staff performance This component of the ADL eating activity where assistance was required occurred three times in the look back period October 2014 Page G 21 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0110 Activities of Daily Living ADL Assistance cont but not three times at any one level Based on the third Rule of 3 the final code determination is Extensive assistance 3 Rationale Eating occurred three times in the look back period during the day that Mrs F was in the nursing home Mrs F performed part of the activity by scooping the food and hol
22. ce 18 times The other two times toileting occurred during the 7 day look back period he required the assistance of staff to pull the zipper up on his pants This assistance 1s classified as non weight bearing assistance The assessor determined that the appropriate code for GOLOOI Toilet use was Code 1 Supervision Rationale Toilet use occurred 20 times during the look back period Non weight bearing assistance was provided two times and 18 times the resident used the toilet independently When the assessor began looking at the ADL Self Performance coding level definitions she determined that Independent 1 e Code 0 cannot be the code entered on the MDS for this ADL activity because in order to be coded as Independent 0 the resident must complete the ADL without any help or oversight from staff every time Since Mr S did require assistance to complete the ADL two times Code 0 does not apply Code 7 Activity occurred only once or twice did not apply to this scenario because even though assistance was provided twice during the look back period the activity itself actually occurred 20 times The assessor also determined that the assistance provided to the resident does not meet the definition for Limited Assistance 2 because even though the assistance was non weight bearing it was only provided twice in the look back period and that the ADL Self Performance coding level definitions for Codes 1 3 and 4 did not apply directly to this scena
23. ding her fork two times but staff had to assist by lifting her arm to her mouth resulting in two episodes of weight bearing assistance The other time the staff had to feed Mrs F The first Rule of 3 does not apply because even though the ADL assistance occurred three or more times it did not occur three times at any one level The second Rule of 3 does not apply because even though the ADL assistance occurred three or more times it did not occur three or more times at multiple levels The third Rule of 3 applies since the ADL assistance occurred three times at multiple levels but not three times at any one level Sub item a under the third Rule of 3 states to convert episodes of full staff performance to weight bearing assistance as long as the full staff performance episodes did not occur every time the ADL was performed in the 7 day look back period Therefore the one episode of full staff performance is considered weight bearing assistance and can be added to the other two episodes of weight bearing assistance This now totals three episodes of weight bearing assistance Therefore according to the application of the third Rule of 3 and the first two sub items a and b the correct code to enter in Column 1 ADL Self Performance GO110H Eating is Extensive assistance 3 Note that none of the ADL Self Performance coding level definitions apply directly to this scenario It is only through the application of the third Rule of 3 a
24. e instruction in this box only applies when the third Rule of 3 applies i e an activity occurs 3 or more times and at multiple levels but not 3 times at any one level e g 2 times non weight bearing 2 times weight bearing If the coding scenario does not meet the third Rule of 3 do not apply a b or c of the third Rule of 3 answer No and then continue down the algorithm Page G 8 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0110 Activities of Daily Living ADL Assistance cont Coding Instructions for G0110 Column 2 ADL Support Code for the most support provided over all shifts Code regardless of how Column I ADL Self Performance is coded Code 0 no setup or physical help from staff if resident completed activity with no help or oversight Code 1 setup help only if resident is provided with materials or devices necessary to perform the ADL independently This can include giving or holding out an item that the resident takes from the caregiver Code 2 one person physical assist if the resident was assisted by one staff person Code 3 twot person physical assist if the resident was assisted by two or more staff persons Code 8 ADL activity itself did not occur during the entire period if the activity did not occur or family and or non facility staff provided care 100 of the time for that activity over the entire 7 day period Coding Tips and Special Populations Some residents slee
25. e During Transitions and Walking GO0300 Balance During Transitions and Walking After observing the resident code the following walking and transition items for most dependent Enter Codes in Boxes A Moving from seated to standing position Coding 0 Steady at all times a B Walking with assistive device if used Not steady but able to stabilize without staff assistance Not steady only able to stabilize with staff assistance Activity did not occur D Moving on and off toilet E Surface to surface transfer transfer between bed and chair or wheelchair C Turning around and facing the opposite direction while walking Item Rationale DEFINITION Health related Quality of Life INTERDISCIPLINARY e Individuals with impaired balance and unsteadiness TEAM during transitions and walking Refers to a team that are at increased risk for falls includes staff from multiple disciplines such as may limit their physical and social activity physicians and other becoming socially isolated and despondent about advanced practitioners limitations and can become increasingly immobile Planning for Care e Individuals with impaired balance and unsteadiness should be evaluated for the need for rehabilitation or assistive devices supervision or physical assistance for safety and or environmental modification e Care planning should focus on preventing further decline of function and or on
26. e coded 8 ADL activity itself did not occur during entire period Rationale Activity did not occur 7 Mr M has Parkinson s disease and needs weight bearing assistance of two staff to transfer from his bed to his wheelchair During the 7 day look back period Mr M was transferred once from the bed to the wheelchair and once from wheelchair to bed Coding G0110B1 would be coded 7 activity occurred only once or twice GO110B2 would be coded 3 two t persons physical assist Rationale The activity happened only twice during the look back period with the support of two staff members Examples for G0110C Walk in Room 1 Mr R is able to walk freely in his room obtaining clothes from closet turning on TV without any cueing or physical assistance from staff at all during the entire 7 day look back period Coding G0110C1 would be coded 0 independent G0110C2 would be coded O no setup or physical help from staff Rationale Resident is independent 2 Mr B was able to walk in his room daily but a staff member needed to cue and stand by during ambulation because the resident has had a history of an unsteady gait Coding G01 10C1 would be coded 1 supervision G0110C2 would be coded O no setup or physical help from staff Rationale Resident requires staff supervision cueing and reminders daily while walking in his room but did not need setup or physical help from staff 3 Mr K is able to walk in his room and with
27. e for resident s performance over all shifts not including setup If the ADL activity Code for most support provided over all occurred 3 or more times at various levels of assistance code the most dependent except for shifts code regardless of resident s self total dependence which requires full staff performance every time performance classification Coding Coding 0 No setup or physical help from staff Setup help only One person physical assist Two persons physical assist 0 Independent no help or staff oversight at any time 1 1 Supervision oversight encouragement or cueing 3 2 Limited assistance resident highly involved in activity staff provide quided maneuvering 3 of limbs or other non weight bearing assistance oe hag anol e 3 Extensive assistance resident involved in activity staff provide weight bearing support i erpe aere 4 Total dependence full staff performance every time during entire 7 day period 100 of the time for that activity over the Activity Occurred 2 or Fewer Times 7 Activity occurred only once or twice activity did occur but only once or twice 8 Activity did not occur activity did not occur or family and or non facility staff provided care 100 of the time for that activity over the entire 7 day period entire 7 day period 1 2 Enter Codes in Boxes Bed mobility how resident moves to and from lying position turns side to side and positions body while in bed or alternate
28. e herself without assistance from staff A resident requires the use of a gait belt and physical assistance in order to stand Coding G0300A would be coded 2 not steady only able to stabilize with staff assistance Rationale Resident required staff assistance to stand during the observation period A resident stands steadily by pushing himself up using the arms of a chair Coding G0300A would be coded O steady at all times Rationale Even though the resident used the arms of the chair to push himself up he was steady at all times during the activity A resident locks his wheelchair and uses the arms of his wheelchair to attempt to stand On the first attempt he rises about halfway to a standing position then sits back down On the second attempt he is able to stand steadily Coding G0300A would be coded 1 not steady but able to stabilize without staff assistance Rationale Even though the second attempt at standing was steady the first attempt suggests he is unsteady and at risk for falling during this transition Coding Instructions G0300B Walking with Assistive Device if Used Code for the least steady episode using assistive device if applicable e Code 0 steady at all times If during the 7 day look back period the resident s walking with assistive devices if used is steady at all times If an assistive device or equipment is used the resident appropriately plans and integrates the use of the de
29. e rail that staff place in the up position when she is in bed October 2014 Page G 11 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0110 Activities of Daily Living ADL Assistance cont Coding G0110A1 would be coded 0 independent GO110A2 would be coded 1 setup help only Rationale Resident is independent at all times in bed mobility during the 7 day look back period and needs only setup help 2 Resident favors lying on her right side Because she has had a history of skin breakdown staff must verbally remind her to reposition off her right side daily during the 7 day look back period Coding G01 10A1 would be coded 1 supervision GO110A2 would be coded O no setup or physical help from staff Rationale Resident requires staff supervision cueing and reminders for repositioning more than three times during the look back period 3 Resident favors lying on her right side Because she has had a history of skin breakdown staff must sometimes cue the resident and guide non weight bearing assistance the resident to place her hands on the side rail and encourage her to change her position when in bed daily over the 7 day look back period Coding G01 10A1 would be coded 2 limited assistance GO110A2 would be coded 2 one person physical assist Rationale Resident requires cueing and encouragement with setup and non weight bearing physical help daily during the 7 day look back period 4 Mr Q has slid to the foo
30. e times during the 7 day look back period with the resident partially participating in the task Two staff members were required to physically support the resident so he could ambulate 4 Mrs J ambulated in the corridor once with supervision and once with non weight bearing assistance of one staff member during the 7 day look back period Coding G0110D1 would be coded 7 activity occurred only once or twice G0110D2 would be coded 2 one person physical assist Rationale The activity occurred only twice during the look back period It does not matter that the level of assistance provided by staff was at different levels During ambulation the most support provided was physical help by one staff member Examples for G0110E Locomotion on Unit 1 Mrs L is on complete bed rest During the 7 day look back period she did not get out of bed or leave the room Coding G0110E1 would be coded 8 activity did not occur G0110E2 would be coded 8 ADL activity itself did not occur during entire period Rationale The resident was on bed rest during the look back period and never left her room Examples for G0110F Locomotion off Unit 1 Mr R does not like to go off his nursing unit He prefers to stay in his room or the day room on his unit He has visitors on a regular basis and they visit with him in the day room on the unit During the 7 day look back period the resident did not leave the unit for any reason Coding GO110F1 would be
31. eady herself When she sits down on the toilet she leans to the side and must push herself away from the towel bar to sit upright steadily Coding G0300D would be coded 1 not steady but able to stabilize without staff assistance Rationale The resident was unsteady when disrobing to toilet but was able to steady herself with a grab bar A resident wheels his wheelchair into the bathroom stands begins to pull his pants down sways and grabs onto the grab bar to steady himself When he sits down on the toilet he leans to the side and must push himself away from the sink to sit upright steadily When finished he stands sways and then is able to steady himself with the grab bar Coding G0300D would be coded 1 not steady but able to stabilize without staff assistance Rationale The resident was unsteady when disrobing to toilet but was able to steady himself with a grab bar Coding Instructions G0300E Surface to Surface Transfer Transfer between Bed and Chair or Wheelchair Code for the least steady episode e Code 0 steady at all times If all of the observed transfers during the 7 day look back period are steady without assistance of a staff If the resident is stable when transferring using an assistive device identified for this purpose If an assistive device or equipment is used the resident uses it independently and appropriately plans and integrates the use of the device into the transition activit
32. eeding TPN or IV fluids Code extensive assistance 1 or 2 persons if the resident with tube feeding TPN or IV fluids did not participate in management of this nutrition but did participate in receiving oral nutrition This is the correct code because the staff completed a portion of the ADL activity for the resident managing the tube feeding TPN or IV fluids Code totally dependent in eating only if resident was assisted in eating all food items and liquids at all meals and snacks including tube feeding delivered totally by staff and did not participate in any aspect of eating e g did not pick up finger foods did not give self tube feeding or assist with swallow or eating procedure Example of a Probing Conversation with Staff 1 Example of a probing conversation between the RN Assessment Coordinator and a nursing assistant NA regarding a resident s bed mobility assessment RN Describe to me how Mrs L moves herself in bed By that I mean once she is in bed how does she move from sitting up to lying down lying down to sitting up turning side to side and positioning herself NA She can lay down and sit up by herself but I help her turn on her side RN She lays down and sits up without any verbal instructions or physical help NA No I have to remind her to use her trapeze every time But once I tell her how to do things she can do it herself RN How do you help her turn side to
33. ently during the day and to unzip and zip pants and to wash his hands after using the toilet This occurred multiple times each day during the 7 day look back period Coding G01 10I1 would be coded 1 supervision G01101I2 would be coded O no setup or physical help from staff Rationale Resident required staff supervision cueing and reminders daily Staff must assist Mr P to zip his pants hand him a washcloth and remind him to wash his hands after using the toilet daily This occurred multiple times each day during the 7 day look back period Coding G01 10I1 would be coded 2 limited assistance GO110I2 would be coded 2 one person physical assist Rationale Resident required staff to perform non weight bearing activities to complete the task multiple times each day during the 7 day look back period Mrs M has had recent bouts of vertigo During the 7 day look back period the resident required one staff member to assist and provide weight bearing support to her as she transferred to the bedside commode four times Coding G01 10I1 would be coded 3 extensive assistance GO110I2 would be coded 2 one person physical assist Rationale During the 7 day look back period the resident required weight bearing assistance with the support of one staff member to use the commode four times Miss W is cognitively and physically impaired During the 7 day look back period she was on strict bed rest Staff were unable to physically transf
34. er her to toilet during this time Miss W is incontinent of both bowel and bladder One staff member was required to provide all the care for her elimination and hygiene needs several times each day Coding G01 10I1 would be coded 4 total dependence G01101I2 would be coded 2 one person physical assist Rationale Resident did not participate and required one staff person to provide total care for toileting and hygiene each time during the entire 7 day look back period October 2014 Page G 19 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0110 Activities of Daily Living ADL Assistance cont Examples for G0110J Personal Hygiene 1 The nurse assistant takes Mr L s comb toothbrush and toothpaste from the drawer and places them at the bathroom sink Mr L combs his own hair and brushes his own teeth daily During the 7 day look back period he required cueing to brush his teeth on three occasions Coding G0110J1 would be coded 1 supervision GO110J2 would be coded 1 setup help only Rationale Staff placed grooming devices at sink for his use and during the 7 day look back period staff provided cueing three times 2 Mrs J normally completes all hygiene tasks independently Three mornings during the 7 day look back period however she was unable to brush and style her hair because of elbow pain so a staff member did it for her Coding G0110J1 would be coded 3 extensive assistance G0110J2 would be coded
35. es it mean that the resident is automatically at risk of injury There are many amputees who function extremely well and can complete all activities of daily living either with or without the use of prosthetics If the resident with an amputation does indeed have difficulty completing ADLs and is at risk for injury the facility should code this item as appropriate This item is coded in terms of function and risk of injury not by diagnosis or lack of a limb or digit Coding Instructions for GO400A Upper Extremity Shoulder Elbow Wrist Hand G0400B Lower Extremity Hip Knee Ankle Foot e Code 0 no impairment if resident has full functional range of motion on the right and left side of upper lower extremities e Code 1 impairment on one side if resident has an upper and or lower extremity impairment on one side that interferes with daily functioning or places the resident at risk of injury e Code 2 impairment on both sides if resident has an upper and or lower extremity impairment on both sides that interferes with daily functioning or places the resident at risk of injury Examples for G0400A Upper Extremity Shoulder Elbow Wrist Hand GO400B Lower Extremity Hip Knee Ankle Foot 1 The resident can perform all arm hand and leg motions on the right side with smooth coordinated movements She is able to perform grooming activities e g brush teeth comb her hair with her right upper extremity and is also able to p
36. f the unit The resident has an artificial leg that is applied each morning and removed each evening Once the prosthesis 1s applied the resident is able to ambulate independently Coding GO6OOD limb prosthesis would be checked Rationale The resident uses a leg prosthesis for ambulating October 2014 Page G 39 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0900 Functional Rehabilitation Potential Complete only on OBRA Admission Assessment A0310A 1 GO900 Functional Rehabilitation Potential Complete only if A0310A 01 EnterCode A Resident believes he or she is capable of increased independence in at least some ADLs 0 No 1 Yes 9 Unable to determine EnterCode B Direct care staff believe resident is capable of increased independence in at least some ADLs Item Rationale Health related Quality of Life e Attaining and maintaining independence is important to an individual s feelings of autonomy and self worth Independence is also important to health status as decline in function can trigger all of the complications of immobility depression and social isolation Planning for Care e Beliefs held by the resident and staff that the resident has the capacity for greater independence and involvement in self care in at least some ADL areas may be important clues to assist in setting goals e Even if highly independent in an activity the resident or staff may believe the resident can gain more independe
37. foot along the ground on most steps She has not had to steady herself using any furniture or grab bars Coding G0300B would be coded 1 not steady but able to stabilize without staff assistance Rationale Resident s gait is unsteady with or without an assistive device but does not require staff assistance 2 A resident with Parkinson s disease ambulates with a walker His posture is stooped and he walks slowly with a short stepped shuffling gait On some occasions his gait speeds up and it appears he has difficulty slowing down On multiple occasions during the 7 day observation period he has to steady himself using a handrail or a piece of furniture in addition to his walker Coding G0300B would be coded 1 not steady but able to stabilize without staff assistance Rationale Resident has an unsteady gait but can stabilize himself using an object such as a handrail or piece of furniture 3 A resident who had a recent total hip replacement ambulates with a walker Although she is able to bear weight on her affected side she is unable to advance her walker safely without staff assistance Coding G0300B would be coded 2 not steady only able to stabilize with staff assistance Rationale Resident requires staff assistance to walk steadily and safely at any time during the observation period 4 A resident with multi infarct dementia walks with a short stepped shuffling type gait Despite the gait abnormality she is stead
38. his walker which he needs to ambulate He has tremors of both upper extremities that make it very difficult to feed himself brush his teeth or write Coding G0400A would be coded 2 upper extremity impairment on both sides G0400B would be coded 2 lower extremity impairment on both sides Rationale Impairment due to Parkinson s disease affects the resident at the upper and lower extremities on both sides G0600 Mobility Devices GO0600 Mobility Devices l Check all that were normally used A Cane crutch B Walker C Wheelchair manual or electric D Limb prosthesis Z None of the above were used Item Rationale Health related Quality of Life Maintaining independence is important to an individual s feelings of autonomy and self worth The use of devices may assist the resident in maintaining that independence Planning for Care Resident ability to move about his or her room unit or nursing home may be directly related to the use of devices It is critical that nursing home staff assure that the resident s independence is optimized by making available mobility devices on a daily basis if needed October 2014 Page G 38 CMS s RAI Version 3 0 Manual CH 3 MDS Items G GO0600 Mobility Devices cont Steps for Assessment ie 2 3 Review the medical record for references to locomotion during the 7 day look back period Talk with staff members who work with the resident as well as family sig
39. icable Code O steady at all times If all of the transitions from seated to standing position and from standing to seated position observed during the 7 day look back period are steady If resident is stable when standing up using the arms of a chair or an assistive device identified for this purpose such as a walker locked wheelchair or grab bar If an assistive device or equipment is used the resident appropriately plans and integrates the use of the device into the transition activity If resident appears steady and not at risk of a fall when standing up Code 1 not steady but able to stabilize without staff assistance If any of transitions from seated to standing position or from standing to seated position during DEFINITION the 7 day look back period are not steady but the resident is able to stabilize without assistance from staff or object e g a chair or table UNSTEADY Residents may appear l l o l unbalanced or move with a If the resident is unsteady using an assistive device sway or with uncoordinated but does not require staff assistance to stabilize or jerking movements that If the resident attempts to stand sits back down make them unsteady They then is able to stand up and stabilize without might exhibit unsteady gaits assistance from staff or object such as fast gaits with large careless movements Residents coded in this category appear at abnormally slow g
40. ident cannot indicate any beliefs about his or her functional rehabilitation potential Example for GO900A Resident Believes He or She Is Capable of Increased Independence in at Least Some ADLs 1 Mr N is cognitively impaired and receives limited physical assistance in locomotion for safety purposes However he believes he is capable of walking alone and often gets up and walks by himself when staff are not looking Coding G0900A would be coded 1 yes Rationale The resident believes he is capable of increased independence Steps for Assessment for GO900B Direct Care Staff Believe Resident Is Capable of Increased Independence in at Least Some ADLs 1 Discuss in interdisciplinary team meeting 2 Ask staff who routinely care for or work with the resident if they think he or she is capable of greater independence in at least some ADLs Coding Instructions for GO900B Direct Care Staff Believe Resident Is Capable of Increased Independence in at Least Some ADLs e Code 0 no if staff believe the resident probably will stay the same and continue with current needs for assistance Also code 0 if staff believe the resident is likely to experience a decrease 1n his or her capacity for ADL care performance e Code 1 yes if staff believe the resident can gain greater independence in ADLs or if staff indicate they are not sure about the potential for improvement because that indicates some potential for improvement Example for GO900B
41. ing pajamas and housedresses Eating how resident eats and drinks regardless of skill Do not include eating drinking during medication pass Includes intake of nourishment by other means e g tube feeding total parenteral nutrition IV fluids administered for nutrition or hydration Toilet use how resident uses the toilet room commode bedpan or urinal transfers on off toilet cleanses self after elimination changes pad manages ostomy or catheter and adjusts clothes Do not include emptying of bedpan urinal bedside commode catheter bag or ostomy bag Personal hygiene how resident maintains personal hygiene including combing hair brushing teeth shaving applying makeup washing drying face and hands excludes baths and showers Coding Instructions For each ADL activity e Consider all episodes of the activity that occur over a 24 hour period during each day of the 7 day look back period as a resident s ADL self performance and the support required may vary from day to day shift to shift or within shifts There are many possible reasons for these variations to occur including but not limited to mood medical condition relationship issues e g willing to perform for a nursing assistant that he or she likes and medications The responsibility of the person completing the assessment therefore 1s to capture the total picture of the resident s ADL self performance over the 7 day period 24 hours a day 1 e no
42. its can limit ability or willingness to initiate or participate in self care or restrict understanding of the tasks required to complete ADLs DEFINITIONS ADL Tasks related to personal care any of the tasks listed in items GO110A J and G0120 ADL ASPECTS Components of an ADL activity These are listed next to the activity in the item set For example the components of G0110H Eating are eating drinking and intake of nourishment or hydration by other means including tube feeding total parenteral nutrition and IV fluids for hydration ADL SELF PERFORMANCE Measures what the resident actually did not what he or she might be capable of doing within each ADL category over the last 7 days according to a performance based scale A resident s potential for maximum function is often underestimated by family staff and the resident Individualized care plans should be based on an accurate assessment of the resident s self performance and the amount and type of support being provided to the resident Many residents might require lower levels of assistance if they are provided with appropriate devices and aids assisted with segmenting tasks or are given adequate time to complete the task while being provided graduated prompting and assistance This type of supervision requires skill time and patience May 2011 Page G 2 CMS s RAI Version 3 0 Manual CH 3 MDS Items G GO0110 Activities of Dai
43. ivot to her wheelchair with the assist of one person She is however unable to voluntarily move her left side limited arm hand and leg motion as she has a flaccid left hemiparesis from a prior stroke Coding G0400A would be coded 1 upper extremity impairment on one side GO0400B would be coded 1 lower extremity impairment on one side Rationale mpairment due to left hemiparesis affects both upper and lower extremities on one side Even though this resident has limited ROM that impairs function on the left side as indicated above the resident can perform ROM fully on the right side Even though there is impairment on one side the facility should always attempt to provide the resident with assistive devices or physical assistance that allows for the resident to be as independent as possible October 2014 Page G 37 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0400 Functional Limitation in Range of Motion cont 2 The resident had shoulder surgery and can t brush her hair or raise her right arm above her head The resident has no impairment on the lower extremities Coding G0400A would be coded 1 upper extremity impairment on one side G0400B would be coded O no impairment Rationale Impairment due to shoulder surgery affects only one side of her upper extremities The resident has a diagnosis of Parkinson s and ambulates with a shuffling gate The resident has had 3 falls in the past quarter and often forgets
44. k for injury e Code G0400 A B as appropriate based on the above assessment Assess the resident s ROM bilaterally at the shoulder elbow wrist hand hip knee ankle foot and other joints unless contraindicated e g recent fracture joint replacement or pain Staff observations of various activities including ADLs may be used to determine if any ROM limitations impact the resident s functional abilities Although this item codes for the presence or absence of functional limitation related to ROM thorough assessment ought to be comprehensive and follow standards of practice for evaluating ROM impairment Below are some suggested assessment strategies e Ask the resident to follow your verbal instructions for each movement e Demonstrate each movement e g ask the resident to do what you are doing e Actively assist the resident with the movements by supporting his or her extremity and guiding it through the joint ROM Lower Extremity includes hip knee ankle and foot While resident is lying supine in a flat bed instruct the resident to flex pull toes up towards head and extend push toes down away from head each foot Then ask the resident to lift his or her leg one at a time bending it at the knee to a right angle 90 degrees Then ask the resident to slowly lower his or her leg and extend it flat on the mattress If assessing lower extremity ROM by observing the resident the flexion and extension of the foot mimics
45. les for G0110G Dressing 1 Mrs C did not feel well and chose to stay in her room She requested to stay in night clothes and rest in bed for the entire 7 day look back period Each day after washing up Mrs C changed night clothes with staff assistance to guide her arms and assist in guiding her nightgown over her head and buttoning the front Coding G0110G1 would be coded 2 limited assistance G0110G2 would be coded 2 one person physical assist Rationale Resident was highly involved in the activity and changed clothing daily with non weight bearing assistance from one staff member during the 7 day look back period Examples for G0110H Eating 1 After staff deliver Mr K s meal tray he consumes all food and fluids without any cueing or physical help during the entire 7 day look back period Coding G0110H1 would be coded 0 independent GO110H2 would be coded O no setup or physical help from staff Rationale Resident is completely independent in eating during the entire 7 day look back period October 2014 Page G 17 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0110 Activities of Daily Living ADL Assistance cont 2 One staff member had to verbally cue the resident to eat slowly and drink throughout each meal during the 7 day look back period Coding G0110H1 would be coded 1 supervision G0110H2 would be coded O no setup or physical help from staff Rationale Resident required staff supervisio
46. lk in Corridor 1 Mr X ambulated daily up and down the hallway on his unit with a cane and did not require any setup or physical help from staff at any time during the 7 day look back period Coding G0110D1 would be coded 0 independent G0110D2 would be coded O no setup or physical help from staff Rationale Resident requires no setup or help from the staff at any time during the entire 7 day look back period 2 Staff members provided verbal cueing while resident was walking in the hallway every day during the 7 day look back period to ensure that the resident walked slowly and safely Coding G0110D1 would be coded 1 supervision G0110D2 would be coded O no setup or physical help from staff Rationale Resident requires staff supervision cueing and reminders daily while ambulating in the hallway during the 7 day look back period October 2014 Page G 15 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0110 Activities of Daily Living ADL Assistance cont 3 A resident had back surgery 2 months ago Two staff members must physically support the resident as he is walking down the hallway because of his unsteady gait and balance problem During the 7 day look back period the resident was ambulated in the hallway three times with physical assist of two staff members Coding G0110D1 would be coded 3 extensive assistance G0110D2 would be coded 3 twot persons physical assist Rationale The resident was ambulated thre
47. ly Living ADL Assistance cont e Most residents are candidates for nursing based rehabilitative care that focuses on maintaining and DEFINITION expanding self involvement in ADLs ADL SUPPORT e Graduated prompting task segmentation helping the PROVIDED resident break tasks down into smaller components Measures the most support and allowing the resident time to complete an activity provided by staff over the last can often increase functional independence 7 days even if that level of support only occurred once Steps for Assessment 1 2 Review the documentation in the medical record for the 7 day look back period Talk with direct care staff from each shift that has cared for the resident to learn what the resident does for himself during each episode of each ADL activity definition as well as the type and level of staff assistance provided Remind staff that the focus is on the 7 day look back period only When reviewing records interviewing staff and observing the resident be specific in evaluating each component as listed in the ADL activity definition For example when evaluating Bed Mobility observe what the resident is able to do without assistance and then determine the level of assistance the resident requires from staff for moving to and from a lying position for turning the resident from side to side and or for positioning the resident in bed To clarify your own understanding and observations about a
48. met code supervision October 2014 Page G 7 CMS s RAI Version 3 0 Manual CH 3 MDS Items G GO0110 Activities of Daily Living ADL Assistance cont ADL Self Performance Algorithm START HERE Remember to review the instructions for the Rule of 3 and the ADL Self Performance Coding Level Definitions before using the algorithm STOP at the first code that applies when moving down the algorithm Yes Yes Did the resident fully perform the ADL activity Code 0 Independent without ANY help or oversight from staff every time No Yes Code 4 Total Dependence Did the resident require full staff performance every time No Yes Did the resident require full staff performance at least 3 times but not every time OR weight bearing assistance 3 or more times Code 3 Extensive Assistance Did the resident require a combination of full staff performance and weight bearing assistance 3 or more times No Code 2 Did the resident require non weight bearing Limited assistance 3 or more times Assistance No Did the resident require a combination of full staff performance weight bearing assistance and or non weight bearing assistance that total 3 or more times N Code 1 Did the resident require oversight Supervision encouragement or cueing 3 or more times O No Yes If none of the above are met Code 1 Supervision October
49. mily and or non facility staff toileted the resident 100 of the time over the entire 7 day look back period Locomotion would be coded 8 activity did not occur if the resident was on bed rest and did not get out of bed and there was no locomotion via bed wheelchair or other means during the look back period or if locomotion assistance was provided by family and or non facility staff 100 of the time over the entire 7 day look back period Eating would be coded 8 activity did not occur if the resident received no nourishment by any route oral IV TPN enteral during the 7 day look back period if the resident was not fed by facility staff during the 7 day look back period or if family and or non facility staff fed the resident 100 of the time over the entire 7 day look back period e Coding activity occurred only once or twice 7 Walk in corridor would be coded 7 activity occurred only once or twice if the resident came out of the room and ambulated in the hallway for a weekly tub bath but otherwise stayed in the room during the 7 day look back period Locomotion off unit would be coded 7 activity occurred only once or twice if the resident left the vicinity of his or her room only one or two times to attend an activity in another part of the building October 2014 Page G 10 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0110 Activities of Daily Living ADL Assistance cont e Residents with tube f
50. n cueing and reminders for safe meal completion daily during the 7 day look back period Mr V is able to eat by himself Staff must set up the tray cut the meat open containers and hand him the utensils Each day during the 7 day look back period Mr V required more help during the evening meal as he was tired and less interested in completing his meal In the evening in addition to encouraging the resident to eat and handing him his utensils and cups staff must also guide the resident s hand so he will get the utensil to his mouth Coding G0110H1 would be coded 2 limited assistance GO110H2 would be coded 2 one person physical assist Rationale Resident is unable to complete the evening meal without staff providing him non weight bearing assistance daily Mr F begins eating each meal daily by himself During the 7 day look back period after he had eaten only his bread he stated he was tired and unable to complete the meal One staff member physically supported his hand to bring the food to his mouth and provided verbal cues to swallow the food The resident was then able to complete the meal Coding G0110H1 would be coded 3 extensive assistance GO110H2 would be coded 2 one person physical assist Rationale Resident partially participated in the task daily at each meal but one staff member provided weight bearing assistance with some portion of each meal Mrs U is severely cognitively impaired She is unable to feed
51. nce e g walk longer distances shower independently e Disagreement between staff beliefs and resident beliefs should be explored by the interdisciplinary team Steps for Assessment Interview Instructions for GO900A Resident Believes He or She Is Capable of Increased Independence in at Least Some ADLs 1 Ask if the resident thinks he or she could be more self sufficient given more time 2 Listen to and record what the resident believes even if it appears unrealistic e Itis sometimes helpful to have a conversation with the resident that helps him her break down this question For example you might ask the resident what types of things staff assist him with and how much of those activities the staff do for the resident Then ask the resident Do you think that you could get to a point where you do more or all of the activity yourself Coding Instructions for GO900A Resident Believes He or She Is Capable of Increased Independence in at Least Some ADLs e Code 0 no if the resident indicates that he or she believes he or she will probably stay the same and continue with his or her current needs for assistance October 2014 Page G 40 CMS s RAI Version 3 0 Manual CH 3 MDS Items G GO900 Functional Rehabilitation Potential cont e Code 1 yes if the resident indicates that he or she thinks he or she can improve Code even if the resident s expectation appears unrealistic e Code 9 unable to determine if the res
52. nce four times Lifting the resident s arms is considered weight bearing assistance The ADL activity component occurred three or more times at one level extensive thus this weight bearing assistance is the highest level of dependence identified that occurred three or more times The scenario is consistent with the ADL October 2014 Page G 20 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0110 Activities of Daily Living ADL Assistance cont Self Performance coding level definition of Extensive assistance and meets the first Rule of 3 The assessor uses the steps in the Rule of 3 in sequence and stops once one has been identified as applying to the scenario Therefore the final code that should be entered in Column 1 ADL Self Performance GO110G Dressing is Extensive assistance 3 2 Scenario The following assistance was provided to Mrs C over the last seven days Four times she required verbal cueing for hand placement during stand pivot transfers to her wheelchair and three times she required weight bearing assistance to help her rise from the wheelchair steady her and help her turn with her back to the edge of the bed Once she was at the edge of the bed and put her hand on her transfer bar she was able to sit She completed the activity without assistance the 14 remaining instances during the 7 day look back period The four times that she required verbal cueing from the staff for hand placement are considered supervi
53. nd the first two sub items that the facility is able to code this item as extensive assistance 4 Scenario Mr N was admitted to the facility but was sent to the hospital on the or day he was there The following assistance was provided to Mr N over the look back period Weight bearing assistance one time to lift Mr N s right arm into his shirt sleeves when dressing in the morning on day one non weight bearing assistance one time to button his shirt in the morning on day two and full staff performance one time on day two to put on his pants on after resting in bed in the afternoon Mr N was independent in the evening on day one when undressing and getting his bed clothes on Based on the application of the third Rule of 3s sub items the final code determination is Limited assistance 2 Rationale There was one episode where Mr N required full staff performance to put his pants on one episode of weight bearing assistance to put his right arm into his shirt sleeve and one episode of non weight bearing assistance to button his shirt The first Rule of 3 does not apply because even though the ADL assistance occurred three times it did not occur three times at any one level The second Rule of 3 does not apply because even though the ADL assistance occurred three times it did not occur three times at multiple levels The third Rule of 3 applies because the activity occurred three times and at multiple levels but not three times at any one le
54. nificant others about devices the resident used for mobility during the look back period Observe the resident during locomotion Coding Instructions Record the type s of mobility devices the resident normally uses for locomotion in room and in facility Check all that apply Check GOGOOA cane crutch if the resident used a cane or crutch including single prong tripod quad cane etc Check G0600B walker if the resident used a walker or hemi walker including an enclosed frame wheeled walker with without a posterior seat and lap cushion Also check this item if the resident walks while pushing a wheelchair for support Check GO600C wheelchair manual or electric if the resident normally sits in wheelchair when moving about Include hand propelled motorized or pushed by another person Check GO600D limb prosthesis if the resident used an artificial limb to replace a missing extremity Check GO600Z none of the above if the resident used none of the mobility devices listed in GO600 or locomotion did not occur during the look back period Examples l 2 The resident uses a quad cane daily to walk in the room and on the unit The resident uses a standard push wheelchair that she self propels when leaving the unit due to her issues with endurance Coding G0G600A use of cane crutch and GO600C wheelchair would be checked Rationale The resident uses a quad cane in her room and on the unit and a wheelchair of
55. p on furniture other than a bed for example a recliner Consider assistance received in this alternative bed when coding bed mobility Do NOT include the emptying of bedpan urinal bedside commode catheter bag or ostomy bag in G0110 I Differentiating between guided maneuvering and weight bearing assistance determine who is supporting the weight of the resident s extremity or body For example if the staff member supports some of the weight of the resident s hand while helping the resident to eat e g lifting a spoon or a cup to mouth or performs part of the activity for the resident this is weight bearing assistance for this activity If the resident can lift the utensil or cup but staff assistance is needed to guide the resident s hand to his or her mouth this is guided maneuvering Do NOT record the staff s assessment of the resident s potential capability to perform the ADL activity The assessment of potential capability is covered in ADL Functional Rehabilitation Potential Item G0900 Do NOT record the type and level of assistance that the resident should be receiving according to the written plan of care The level of assistance actually provided might be very different from what is indicated in the plan Record what actually happened Do NOT include assistance provided by family or other visitors Some examples for coding for ADL Support Setup Help when the activity involves the following
56. refer LIMITATION IN RANGE back to item G0110 and view the limitation in ROM taking OF MOTION into account activities that the resident is able to perform Limited ability to move a joint that interferes with daily Item Rationale functioning particularly with activities of daily living or Health related Quality of Life places the resident at risk of l i injury e Functional impairment could place the resident at risk Jury of injury or interfere with performance of activities of daily living Planning for Care e Individualized care plans should address possible reversible causes such as de conditioning and adverse side effects of medications or other treatments October 2014 Page G 35 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0400 Functional Limitation in Range of Motion cont Steps for Assessment ie nA Review the medical record for references to functional range of motion limitation during the 7 day look back period Talk with staff members who work with the resident as well as family significant others about any impairment in functional ROM Coding for functional ROM limitations is a 3 step process e Test the resident s upper and lower extremity ROM See 6 below for examples e If the resident is noted to have limitation of upper and or lower extremity ROM review G0110 and or directly observe the resident to determine if the limitation interferes with function or places the resident at ris
57. resident s performance of an ADL activity bed mobility locomotion transfer etc ask probing questions beginning with the general and proceeding to the more specific See page G 10 for an example of using probes when talking to staff Activities of Daily Living Definitions A Bed mobility how resident moves to and from lying position turns side or side and positions body while in bed or alternate sleep furniture Transfer how resident moves between surfaces including to or from bed chair wheelchair standing position excludes to from bath toilet Walk in room how resident walks between locations in his her room D Walk in corridor how resident walks in corridor on unit Locomotion on unit how resident moves between locations in his her room and adjacent corridor on same floor If in wheelchair self sufficiency once in chair Locomotion off unit how resident moves to and returns from off unit locations e g areas set aside for dining activities or treatments If facility has only one floor how resident moves to and from distant areas on the floor If in wheelchair self sufficiency once in chair October 2014 Page G 3 CMS s RAI Version 3 0 Manual CH 3 MDS Items G GO0110 Activities of Daily Living ADL Assistance cont G Dressing how resident puts on fastens and takes off all items of clothing including donning removing a prosthesis or TED hose Dressing includes putting on and chang
58. return of function depending on resident specific goals e Assessment should identify all related risk factors in order to develop effective care plans to maintain current abilities slow decline and or promote improvement in the resident s functional ability Steps for Assessment 1 Complete this assessment for all residents 2 Throughout the 7 day look back period interdisciplinary team members should carefully observe and document observations of the resident during transitions from sitting to standing walking turning transferring on and off toilet and transferring from wheelchair to bed and bed to wheelchair for residents who use a wheelchair October 2014 Page G 26 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0300 Balance During Transitions and Walking cont 3 If staff have not systematically documented the resident s stability in these activities at least once during the 7 day look back period use the following process to code these items a Before beginning the activity explain what the task is and what you are observing for Have assistive devices the resident normally uses available c Start with the resident sitting up on the edge of his or her bed in a chair or in a wheelchair if he or she generally uses one d Ask the resident to stand up and stay still for 3 5 seconds Moving from seated to standing position G0300A should be rated at this time e Ask the resident to walk approximately
59. rio either The assessor continued to apply the coding instructions looking at the Rule of 3 The first Rule of 3 does not apply because even though the ADL activity occurred three or more times the non weight bearing assistance occurred only twice The second Rule of 3 does not apply because even though the ADL occurred three or more times it did not occur three times at multiple levels and the third Rule of 3 does not apply because even though the ADL occurred three or more times it did not occur at multiple levels or three times at any one level Since the third Rule of 3 did not apply the assessor knew not to apply any of the sub items However there is one final instruction to the provider that when none of the ADL Self Performance coding level definitions and the Rule of 3 do not apply the appropriate code to enter in Column 1 ADL Self Performance is Supervision 1 therefore in GO110I Toilet use the code Supervision 1 was entered October 2014 Page G 23 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0120 Bathing GO120 Bathing How resident takes full body bath shower sponge bath and transfers in out of tub shower excludes washing of back and hair Code for most performance and support A Self performance Independent no help provided Supervision oversight help only Physical help limited to transfer only Physical help in part of bathing activity Total dependence Activity itself did not occ
60. side NA She can help turn herself by grabbing onto her side rail I tell her what to do But she needs me to lift her bottom and guide her legs into a good position RN Do you lift her by yourself or does someone help you NA I do it by myself RN How many times during the last 7 days did you give this type of help NA Every day probably 3 times each day In this example the assessor inquired specifically how Mrs L moves to and from a lying position how she turns from side to side and how the resident positions herself while in bed A resident can be independent in one aspect of bed mobility yet require extensive assistance in another aspect so be sure to consider each activity definition fully If the RN did not probe further he or she would not have received enough information to make an accurate assessment of the actual assistance Mrs L received This information is important to know and document because accurate coding and supportive documentation provides the basis for reporting on the type and amount of care provided Coding Bed Mobility ADL assistance would be coded 3 self performance and 2 support provided extensive assistance with a one person assist Examples for G0110A Bed Mobility 1 Mrs D can easily turn and position herself in bed and is able to sit up and lie down without any staff assistance at any time during the 7 day look back period She requires use of a single sid
61. sion The three times that the staff had to physically support Mrs C during a portion of the transfer are considered weight bearing assistance This ADL occurred 21 times over the 7 day look back period There were three or more times where supervision was required and three times where weight bearing assistance was required therefore the appropriate code to enter on the MDS is Extensive assistance 3 Rationale The ADL activity occurred 21 times over the 7 day look back period Mrs C required supervision four times and weight bearing assistance was provided three times during the 7 day look back period The ADL activity also occurred three or more times at multiple levels four times with supervision three times with weight bearing assistance and 14 times without assistance Weight bearing assistance 1s also the highest level of dependence identified that occurred three or more times The first Rule of 3 does not apply because the ADL activity occurred three or more times at multiple levels not three or more times at any one level Because the ADL activity occurred three or more times at multiple levels the scenario meets the second Rule of 3 and the assessor will apply the most dependent level that occurred three or more times Note that this scenario does meet the definition of Extensive assistance as well since the activity occurred at least three times and there was weight bearing support provided three times The final code that should
62. ssistance If any transitions on or off the toilet during the 7 day look back period are not steady and the resident cannot stabilize without assistance from a staff If the resident fell when moving on or off the toilet during the look back period Residents coded in this category appear at high risk for falling during transitions If lift device is used Code 8 activity did not occur If the resident did not transition on and off the toilet during the 7 day look back period October 2014 Page G 32 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0300 Balance During Transitions and Walking cont Examples for GO0300D Moving on and off Toilet ie A resident sits up in bed stands up pivots and grabs her walker She then steadily walks to the bathroom where she pivots pulls down her underwear uses the grab bar and smoothly sits on the commode using the grab bar to guide her After finishing she stands and pivots using the grab bar and smoothly ambulates out of her room with her walker Coding G0300D would be coded O steady at all times Rationale This resident s use of the grab bar was not to prevent a fall after being unsteady but to maintain steadiness during her transitions The resident was able to smoothly and steadily transfer onto the toilet using a grab bar A resident wheels her wheelchair into the bathroom stands up begins to lift her dress sways and grabs onto the grab bar to st
63. t of the bed four times during the 7 day look back period Two staff members had to physically lift and reposition him toward the head of the bed Mr Q was able to assist by bending his knees and pushing with legs when reminded by staff Coding G0110A1 would be coded 3 extensive assistance GO110A2 would be coded 3 two t persons physical assist Rationale Resident required weight bearing assistance of two staff members on four occasions during the 7 day look back period with bed mobility 5 Mrs S is unable to physically turn sit up or lie down in bed Two staff members must physically turn her every 2 hours without any participation at any time from her at any time during the 7 day look back period She must be physically assisted to a seated position in bed when reading Coding G01 10A1 would be coded 4 total dependence GO110A2 would be coded 3 two persons physical assist Rationale Resident did not participate at any time during the 7 day look back period and required two staff to position her in bed Examples for G0110B Transfer 1 When transferring from bed to chair or chair back to bed the resident is able to stand up from a seated position without requiring any physical or verbal help and walk from the bed to chair and chair back to the bed every day during the 7 day look back period October 2014 Page G 12 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0110 Activities of Daily Living ADL Assistance cont
64. t only how the evaluating clinician sees the resident but how the resident performs on other shifts as well e In order to be able to promote the highest level of functioning among residents clinical staff must first identify what the resident actually does for himself or herself noting when assistance 1s received and clarifying the type weight bearing non weight bearing verbal cueing guided maneuvering etc and level of assistance supervision limited assistance etc provided by all disciplines e Ifa resident uses special adaptive devices such as a walker device to assist with donning socks dressing stick long handled reacher or adaptive eating utensils code ADL Self Performance and ADL Support Provided based on the level of assistance the resident requires when using such items October 2014 Page G 4 CMS s RAI Version 3 0 Manual CH 3 MDS Items G GO0110 Activities of Daily Living ADL Assistance cont For the purposes of completing Section G facility staff pertains to direct employees and facility contracted employees e g rehabilitation staff nursing agency staff Thus does not include individuals hired compensated or not by individuals outside of the facility s management and administration Therefore facility staff does not include for example hospice staff nursing CNA students etc Not including these individuals as facility staff supports the idea that the facility retains the primary responsibili
65. ties occurred how many times each ADL activity occurred what type and what level of support was required for each ADL activity over the entire 7 day look back period The following ADL Self Performance coding levels are exceptions to the Rule of 3 Code 0 Independent Coded only if the resident completed the ADL activity with no help or oversight every time the ADL activity occurred during the 7 day look back period and the activity occurred at least three times Code 4 Total dependence Coded only if the resident required full staff performance of the ADL activity every time the ADL activity occurred during the 7 day look back period and the activity occurred three or more times Code 7 Activity occurred only once or twice Coded if the ADL activity occurred fewer than three times in the 7 day look back period Code 8 Activity did not occur Coded only if the ADL activity did not occur or family and or non facility staff provided care 100 of the time for that activity over the entire 7 day look back period October 2014 Page G 6 CMS s RAI Version 3 0 Manual CH 3 MDS Items G GO0110 Activities of Daily Living ADL Assistance cont Instructions for the Rule of 3 When an ADL activity has occurred three or more times apply the steps of the Rule of 3 below Keeping the ADL coding level definitions and the above exceptions in mind to determine the code to enter in Column 1 ADL Self Performance
66. ty for the care of the resident outside of the arranged services another agency may provide to facility residents The ADL Self Performance coding level definitions are intended to reflect real world situations where slight variations in level of ADL self performance are common To assist in coding ADL Self Performance items facilities may augment the instructions with the algorithm on page G 7 This section involves a two part ADL evaluation Self Performance which measures how much of the ADL activity the resident can do for himself or herself and Support Provided which measures how much facility staff support is needed for the resident to complete the ADL Each of these sections uses its own scale therefore it is recommended that the ADL Self Performance evaluation Column 1 be completed for all ADL activities before beginning the ADL Support evaluation Column 2 Coding Instructions for G0110 Column 1 ADL Self Performance Code 0 independent if resident completed activity with no help or oversight every time during the 7 day look back period and the activity occurred at least three times Code 1 supervision if oversight encouragement or cueing was provided three or more times during the last 7 days Code 2 limited assistance if resident was highly involved in activity and received physical help in guided maneuvering of limb s or other non weight bearing assistance on three or more times during the last 7 days Code 3
67. ur or family and or non facility staff provided care 100 of the time for that activity over the entire 7 day period Support provided Bathing support codes are as defined in item GO110 column 2 ADL Support Provided above Item Rationale DEFINITION Health related Quality of Life BATHING The resident s choices regarding his or her bathing How the resident takes a full schedule should be accommodated when possible so that facility routine does not conflict with resident s desired routine body bath shower or sponge bath including transfers in and out of the tub or shower lt does not include the Planning for Care washing of back or hair The care plan should include interventions to address the resident s unique needs for bathing These interventions should be periodically evaluated and if objectives were not met alternative approaches developed to encourage maintenance of bathing abilities Coding Instructions for G0120A Self Performance Code for the maximum amount of assistance the resident received during the bathing episodes Code O independent if the resident required no help from staff Code 1 supervision if the resident required oversight help only Code 2 physical help limited to transfer only if the resident is able to perform the bathing activity but required help with the transfer only Code 3 physical help in part of bathing activity if the resident required assistance with some aspect of
68. vel The third Rule of 3 sub item a instructs providers to convert episodes of full staff performance to weight bearing assistance Therefore there are now two weight bearing episodes and October 2014 Page G 22 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0110 Activities of Daily Living ADL Assistance cont one non weight bearing episode The third Rule of 3 sub item b does not apply because even though there are two episodes of weight bearing assistance there are not enough weight bearing episodes to consider it Extensive assistance There is one episode of non weight bearing assistance that can be accounted for The third sub item c under the third Rule of 3 applies because there is a combination of full staff performance weight bearing assistance and or non weight bearing assistance that together total three times two episodes of weight bearing assistance and one episode of non weight bearing assistance Therefore the appropriate code is Limited assistance 2 which is the correct code to enter in Column 1 ADL Self Performance GO110G Dressing Note that none of the ADL Self Performance coding level definitions apply directly to this scenario It is only through the application of the third Rule of 3 working through all of the sub items that the facility is able to code this item as Limited assistance 5 Scenario During the look back period Mr S was able to toilet independently without assistan
69. vice and is steady while walking with it Residents in this category do not appear at risk for falls Residents who walk with an abnormal gait and or with an assistive device can be steady and if they are they should be coded in this category e Code 1 not steady but able to stabilize without staff assistance If during the 7 day look back period the resident appears unsteady while walking with assistive devices if used but does not require staff assistance to stabilize Residents coded in this category appear at risk for falling while walking October 2014 Page G 29 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0300 Balance During Transitions and Walking cont e Code 2 not steady only able to stabilize with staff assistance If during the 7 day look back period the resident at any time appeared unsteady and required staff assistance to be stable and safe while walking If the resident fell when walking during the look back period Residents coded in this category appear at high risk for falling while walking e Code 8 activity did not occur If the resident did not walk during the 7 day look back period Examples for G0300B Walking with Assistive Device if Used 1 A resident with a recent stroke walks using a hemi walker in her right hand because of left sided weakness Her gait is slow and short stepped and slightly unsteady as she walks she leans to the left and drags her left
70. who uses her wheelchair for mobility stands up from the edge of her bed pivots and sits in her locked wheelchair in a steady fashion Coding GO300E would be coded O steady at all times Rationale The resident was steady when transferring from bed to wheelchair A resident who needs assistance ambulating transfers to his chair from the bed He is observed to stand halfway up and then sit back down on the bed On a second attempt a nursing assistant helps him stand up straight pivot and sit down in his chair Coding GO300E would be coded 2 not steady only able to stabilize with staff assistance Rationale The resident was unsteady when transferring from bed to chair and required staff assistance to make a steady transfer A resident with an above the knee amputation sits on the edge of the bed and using his locked wheelchair due to unsteadiness and the nightstand for leverage stands and transfers to his wheelchair rapidly and almost misses the seat He is able to steady himself using the nightstand and sit down into the wheelchair without falling to the floor Coding GO300E would be coded 1 not steady but able to stabilize without staff assistance October 2014 Page G 34 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0300 Balance During Transitions and Walking cont Rationale The resident was unsteady when transferring from bed to wheelchair but did not require staff assistance to complete the activity 4 A
71. wice weekly showers Once staff walked resident to bathroom he bathed himself with periodic oversight Coding G0120A would be coded 1 supervision G0120B would be coded O no setup or physical help from staff Rationale Resident needed only supervision to perform the bathing activity with no setup or physical help from staff 2 For one bath the resident received physical help of one person to position self in bathtub However because of her fluctuating moods she received total help for her other bath from one staff member Coding G0120A would be coded 4 total dependence G0120B would be coded 2 one person physical assist Rationale Coding directions for bathing state code for most dependent in self performance and support Resident s most dependent episode during the 7 day look back period was total help with the bathing activity with assist from one staff person 3 On Monday one staff member helped transfer resident to tub and washed his legs On Thursday the resident had physical help of one person to get into tub but washed himself completely Coding G0120A would be coded 3 physical help in part of bathing activity G0120B would be coded 2 one person physical assist Rationale Resident s most dependent episode during the 7 day look back period was assistance with part of the bathing activity from one staff person October 2014 Page G 25 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0300 Balanc
72. y Residents coded 0 should not appear to be at risk of a fall during a transition October 2014 Page G 33 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0300 Balance During Transitions and Walking cont Code 1 not steady but able to stabilize without staff assistance If any transfers during the look back period are not steady but the resident stabilizes without assistance from a staff If the resident is unstable with an assistive device but does not require staff assistance Residents coded in this category appear at increased risk for falling during transitions Code 2 not steady only able to stabilize with staff assistance If any transfers during the 7 day look back period are not steady and the resident can only stabilize with assistance from a staff If the resident fell during a surface to surface transfer during the look back period Residents coded in this category appear at high risk for falling during transitions If a lift device a mechanical device that is completely operated by another person is used and this mechanical device is being used because the resident requires staff assistance to stabilize code 2 Code 8 activity did not occur lf the resident did not transfer between bed and chair or wheelchair during the 7 day look back period Examples for GO300E Surface to Surface Transfer Transfer Between Is Bed and Chair or Wheelchair A resident
73. y Coding G0300B would be coded 0 steady at all times Rationale Resident walks steadily with or without a normal gait and or the use of an assistive device at all times during the observation period October 2014 Page G 30 CMS s RAI Version 3 0 Manual CH 3 MDS Items G G0300 Balance During Transitions and Walking cont Coding Instructions G0300C Turning Around and Facing the Opposite Direction while Walking Code for the least steady episode using an assistive device if applicable Code O steady at all times If all observed turns to face the opposite direction are steady without assistance of a staff during the 7 day look back period If the resident is stable making these turns when using an assistive device If an assistive device or equipment is used the resident appropriately plans and integrates the use of the device into the transition activity Residents coded as 0 should not appear to be at risk of a fall during a transition Code 1 not steady but able to stabilize without staff assistance If any transition that involves turning around to face the opposite direction is not steady but the resident stabilizes without assistance from a staff If the resident is unstable with an assistive device but does not require staff assistance Residents coded in this category appear at increased risk for falling during transitions Code 2 not steady only able to stabilize with st
74. y into the chair Coding G0300C would be coded 2 not steady only able to stabilize with staff assistance Rationale The resident was unsteady when turning around and would have fallen without staff assistance Coding for G0300D Moving on and off Toilet Code for the least steady episode of moving on and off a toilet or portable commode using an assistive device if applicable Include stability while manipulating clothing to allow toileting to occur in this rating Code O steady at all times If all of the observed transitions on and off the toilet during the 7 day look back period are steady without assistance of a staff If the resident is stable when transferring using an assistive device or object identified for this purpose lf an assistive device is used e g grab bar the resident appropriately plans and integrates the use of the device into the transition activity Residents coded as 0 should not appear to be at risk of a fall during a transition Code 1 not steady but able to stabilize without staff assistance If any transitions on or off the toilet during the7 day look back period are not steady but the resident stabilizes without assistance from a staff If resident is unstable with an assistive device but does not require staff assistance Residents coded in this category appear at increased risk for falling during transitions Code 2 not steady only able to stabilize with staff a

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