The four late-loss ADL items are self-performance bed mobility (G0110A1), self-performance transfer. (G0110B1), self-per
Improving the Quality Measures: Percent of Residents Whose Need for Help with Activities of Daily Living Has Increased (Long Stay)
Measure Description This measure reports the percent of long-stay residents whose need for help with late-loss Activities of Daily Living (ADLs) has increased when compared to the prior assessment
1
Numerator •
•
Long-stay residents with selected target and prior assessment assessments that indicate the need for help with late-loss Activities of Daily Living (ADLs) has increased when the selected assessments are compared The four late-loss ADL items are self-performance bed mobility (G0110A1), self-performance transfer (G0110B1), self-performance eating (G0110H1), and self-performance toileting (G0110I1)
2
Numerator
3
Numerator •
•
An increase is defined as an increase in two or more coding points in one late-loss ADL item or one point increase in coding points in two or more late-loss ADL items Note that for each of these four ADL items, if the value is equal to [7, 8] on either the target or prior assessment, then recode the item to equal [4] to allow appropriate comparison
4
Numerator
5
Numerator
Residents meet the definition of increased need of help with late-loss ADLs if either of the following are true:
6
Numerator 1. At least two of the following are true ([t] refers to the target assessment, and [t-1] refers to the prior assessment): • 1. Bed mobility: [Level at target assessment (G0110A1[t])] [Level at prior assessment (G0110A1[t-1])] >[0], or • 2. Transfer: [Level at target assessment (G0110B1[t])] [Level at prior assessment (G0110B1[t-1])] >[0], or • 3. Eating: [Level at target assessment (G0110H1[t])] - [Level at prior assessment (G0110H1[t-1])] >[0], or • 4. Toileting: [Level at target assessment (G0110I1[t])] [Level at prior assessment (G0110I1[t-1])] >[0]
7
Numerator 2. At least one of the following is true: • • • •
Bed mobility: [Level at target assessment (G0110A1[t])] - [Level at prior assessment (G0110A1[t-1])] >[1], or Transfer: [Level at target assessment (G0110B1[t])] - [Level at prior assessment (G0110B1[t-1])] >[1], or Eating: [Level at target assessment (G0110H1[t])] - [Level at prior assessment (G0110H1[t-1])] >[1], or Toileting: [Level at target assessment (G0110I1[t])] - [Level at prior assessment (G0110I1[t-1])] >[1].
8
Denominator All long-stay residents with a selected target and prior assessment, except those with exclusions.
9
Exclusions 1. All four of the late-loss ADL items indicate total dependence on the prior assessment, as indicated by: • • • •
Bed Mobility (G0110A1) = [4, 7, 8] and Transferring (G0110B1) = [4, 7, 8] and Eating (G0110H1) = [4, 7, 8] and Toileting (G0110I1) = [4, 7, 8]
10
Exclusions 4,7,8
4,7,8
4,7,8
4,7,8
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Exclusions 2. Three of the late-loss ADLs indicate total dependence on the prior assessment, as in #1 AND the fourth late-loss ADL indicates extensive assistance (value 3) on the prior assessment
12
Exclusions 3. If resident is comatose (B0100 = [1, -]) on the target assessment.
4. Prognosis of life expectancy is less than 6 months (J1400 = [1, -]) on the target assessment.
1,-
13
Exclusions 5. Hospice care (O0100K2 = [checked, -]) on the target assessment.
X,-
14
Exclusions 6. The resident is not in the numerator and • • • •
Bed Mobility (G0110A1) = [-] on the prior or target assessment, or Transferring (G0110B1) = [-] on the prior or target assessment, or Eating (G0110H1) = [-] on the prior or target assessment, or Toileting (G0110I1) = [-] on the prior or target assessment]
-
15
How to Make Improvements 1. Refer to RAI Manual Appendix C: Care Area Assessments/Activities of Daily Living-Functional Status/Rehabilitation Potential and for residents who trigger evaluate: • Possible underlying problems that may affect function • Abnormal laboratory values • Medications that can contribute to functional decline
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How to Make Improvements • • •
Limiting factors resulting in the need for assistance with any of the ADLs Problems resident is at risk for because of functional decline Input from resident and/or family/representative
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How to Make Improvements 2. Analyze your findings for each resident and document: • • A description of the problem • • The causes and contributing factors • • The risk factors related to the care area 3. Develop and implement an individualized plan of care based on analysis
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The Change Package: Strategies of High-Performing Nursing Homes Provide exceptional compassionate clinical care that treats the whole person by striving to prevent problems: Attachment #3: Change Bundle: To Encourage Nursing Home Resident’s Mobility
Download the Change Package: https://www.lsqin.org/wpcontent/uploads/2015/03/NH-ChangePackage032615-Final-508.pdf
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Resources •
•
MDS 3.0 RAI Manual: https://www.cms.gov/Medicare/Quality-InitiativesPatient-AssessmentInstruments/NursingHomeQualityInits/MDS30RAI Manual.html MDS 3.0 QM User’s Manual: https://www.cms.gov/Medicare/Quality-InitiativesPatient-AssessmentInstruments/NursingHomeQualityInits/NHQIQualit yMeasures.html
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Resources •
•
Promoting Mobility https://www.youtube.com/watch?v=WHmv95Cm2M&feature=youtu.be Mobility: Promoting Physical Activity for People Living in Nursing Homes https://www.youtube.com/watch?v=txCex3NCGW U&feature=youtu.be
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Contact the Lake Superior Quality Innovation Network Michigan: MPRO Kathleen Lavich 248-465-7399
[email protected]
Minnesota: Stratis Health Kristi Wergin 952-853-8561
[email protected]
Wisconsin: MetaStar Liz Dominguez 608-441-8266
[email protected]
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This material was prepared by the Lake Superior Quality Innovation Network, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The materials do not necessarily reflect CMS policy. 11SOW-MI/MN/WI-C2-16-18 012216
