Section D

Section D

SECTION G FUNCTIONAL STATUS JANUARY 14, 2016 1-3PM Objectives Understand the importance of this section is to provide the necessary assistance and promote independence Understand how to correctly code Section G Understand what needs to be on the care plan so all staff provides the same

assistance 10-1-2015 Changes 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 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-weightbearing, 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. Page G-20 G0110 Activities of Daily Living Assistance Self Performance

Staff Support 10 ADLs plus Bathing G0110: Activities of Daily Living G0110: ADL Assistance 7 day look-back period Assistance Only what took place in nursing home Only provided by direct staff and facility contracted staff not outside agencies or students

Assessment Process Observe activity Review medical record Interview staff from each shift: Frequency of ADL Resident does for self during each ADL Type and level of staff assistance ADL A. Bed Mobility Moves: to and from lying position to sitting position in bed or to edge of bed to head of bed

turns from side to side Positions body while in bed or other furniture sleeps on instead of bed Moving to sitting position before transferring into chair or w/c ADL B. Transfer Moves between surfaces to/from bed, chair, wheelchair, standing position Assumes standing position Moving from sitting position to standing

position before transferring into chair or w/c When lift used includes application of sling Exclude: movement to and from bath or toilet, covered under Toilet Use and Bathing ADL Walking C. In Room: Walks between locations in his/her room

(only) D. In Corridor: Walks in corridor on unit (only) ADL - Locomotion E. On Unit: Moves between locations in his/her room and adjacent corridor on same floor If uses w/c, self-sufficiency once in w/c F. Off Unit:

Moves to and returns from off unit locations (areas set aside for dining, activities, treatments) If facility only one floor, how moves to and from distant areas on floor If uses w/c, self-sufficiency once in w/c ADL G. Dressing Puts on, fastens, takes off all items of clothing including: donning/removing prosthesis or TED hose

putting on and changing pajamas and house dresses ADL H. Eating Eats and drinks, regardless of skill Includes nourishment by any means: orally, tube feeding, TPN, IV fluids administered for hydration/nutrition Do not include: eating/drinking during medication administration general supervision in DR

ADL I. Toilet Use Uses toilet room, commode, bedpan, or urinal Transfers on/off toilet, cleanses self, changes pad, manages ostomy or catheter, and adjusts clothing. Do not include staff emptying of bedpan, urinal, bedside commode, catheter bag or ostomy bag ADL J. Personal Hygiene Combs hair, brushes teeth

Shaves, applies makeup Washes and dries face, hands Do not include: washing and drying of face and hands during bath & shower, covered in Bathing ADL G0110: Activities of Daily Living

G0110(1): Self-Performance Goal to promote highest level of functioning Number of times ADL occurred Identify what resident actually did for self When assistance received Type of assistance received & Number of times each type of assistance provided May use assistive devices Code actual self-performance, not potential or what is care planned

G0110(1): Self-Performance Code 0. Independent Completed ADL with no help or oversight for every episode Bed Mobility Mrs. D. can easily turn herself in bed and is able to sit up without any staff assistance at any time in the 7 day look back period. She requires use of a single side rail that staff places in the up position when she is in bed.

G0110(1): Self-Performance Code 1. Supervision Oversight, encouragement, or cueing provided 3 or more times Bed Mobility Mrs. E. favors lying on her right side. Because she has a history of skin breakdown, staff must verbally remind her when she rests in bed to reposition off her right side throughout 7 day look back period.

G0110(1): Self-Performance Code 2. Limited Assistance Resident highly involved in activity and receives physical help in guided maneuvering of limb(s) or other non-weight-bearing assistance three or more times during the last 7 days. Staff not lifting or carrying Guided maneuvering vs. weight-bearing -- who is supporting weight of residents extremity or body Bed Mobility Mr. F. favors lying on his right side. Because he has a history of skin breakdown, staff need to cue him and guide

him to place his hands on the side rail and encourage him to change his position daily when in bed throughout 7 day look back period. G0110(1): Self-Performance Code 3. Extensive Assistance Resident performed part of the activity over the last 7 days, help of the following type(s) provided three or more times: Weight-bearing support provided three or more times. Staff performs all of activity or a

component of activity during part but not every time Combination of full staff performance and weight-bearing assistance G0110(1): Self-Performance Code 3. Extensive Assistance Examples: Support hand to help resident eat Lift arm to allow to resident to brush hair Lift foot to assist resident to put on their socks Bed Mobility Mr. Q. slid to the foot 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 his legs when reminded by staff. G0110(1): Self-Performance Code 4. Total Dependence Staff performs entire ADL every time Resident does not participate in any aspect of ADL

Resident unwilling or unable to perform any part of activity for entire look-back period Bed Mobility Mrs. S. is unable to physically turn, sit up, or lie down in bed. Two staff members must physically turn her without any participation at any time from her during the entire 7 day look back period. She must be physically assisted to a seated position in bed when reading. G0110(1): Self-Performance Code 7. Activity occurred only once or twice. Activity occurred but less than three times.

Example: Walk in Corridor: Resident ambulated in hallway for weekly bath but otherwise did not leave room Code 8. Activity did not occur. Activity did not occur or family and/or non-facility staff provided care 100% of time for that activity over entire 7-day period Examples: Locomotion On bed rest & did not get out of bed, & no locomotion via bed Toileting Had no elimination Eating Received no nourishment by any route

Self Performance - Rule of 3 1. When an activity occurs three times at any one given level of assistance, Code that level. Limited Assistance Limited Assistance Limited Assistance Limited

Assistance Rule of 3 2. When an activity occurs 3 or more times at multiple levels, code the most dependent level that occurred 3 or more times. Limited Extensive

Limited Limited ExtensiveExtensive ` Extensive Rule of 3 3. 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, as long as full staff performance did not occur every time. Full Staff Performance (Not every time) Weight Bearing Assistance + Extensive

(Weight Bearing Assistance) Extensive (Weight Bearing Assistance) = Extensive Rule of 3

3. When an activity occurs 3 or more times and at multiple levels, but not 3 times at any one level apply the following: b. When there is a combination of full staff performance and weight bearing assistance that total three or more times code extensive Total Dependence (Full Staff Performance)

Extensive + (Full Staff Performance) Extensive = Extensive Rule of 3

3. When an activity occurs three or more times and at multiple levels, but not three times at any one level apply the following: c. When there is a combination or full staff performance/weight bearing assistance, and/or non-weight bearing assistance that total 3 or more times code limited assistance (2) Total (Full Staff performance ) Extensive

Limited (Weight(Non-weight bearing bearing assistance) assistance) = Limited Rule of 3 If none of the above (previous

situations) are met Code Supervision Limited Extensive Self Performance Algorithm Start at top of algorithm. Work down until coding option in algorithm matches level of self performance. Page G-8 Scenario A resident experiences a severe case of flu during look-back period

Observations indicate resident required following support for transferring: 1 time of full assistance 2 times with extensive assistance 2 times with limited assistance (= Extensive) G0110: Activities of Daily Living G0110(2): ADL Support Provided Highest level of staff support provided even if only one time for each ADL over 7 day lookback period Code separately from ADL Self-Performance

assessment G0110(2): Support Provided Coding Code 0. No set up or physical help from staff. Code 1. Setup help only. Provided materials or devices necessary to perform ADL independently. Include giving or holding out item that resident takes from care giver Bed mobility - handing trapeze bar or raising rails Transfer - locking brakes on w/c for safe transfer

Walking - handing walker or cane Locomotion - unlocking w/c brakes prior to moving or adjust foot pedals Dressing - retrieving clothes from closet, laying clothes on bed, handing shirt Eating - opening containers, cutting meat, giving one food item at time Personal hygiene - providing washbasin and grooming articles G0110(2): ADL Support Provided Coding

Code 2. One staff physical assist Code 3. Two or more staff physical assist Code 8. ADL activity itself 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 G0110(1)(2) - Scenario #1 Mr. J is able to transfer himself from the wheelchair to bed by himself. Once on the bed, however, he is not able to lie down without help from staff. Each

afternoon and at bedtime during the 7-day lookback period one nursing staff assistant assists Mr. J by lifting his legs onto the bed. After that, Mr. J is able to turn and reposition himself independently. How would you code Bed Mobility? 3/2 Extensive Assist, Physical Assist of One Staff G0110(1)(2) - Scenario #2 Mrs. R requires extensive assistance with all ADLs and assistance of 2 staff. She spends all of her time in bed with the exception of a weekly outing to a music program in the activity room. During the

MDS observation period, two staff transferred the resident from her bed to a wheelchair and then back to bed when the activity was over. How would you code Transfer? 7/3 Took Place only 2 times Physical assistance of 2 G0110(1)(2) - Scenario #3 Mr. K. is reminded by one staff person to toilet frequently during the day. When in BR staff person reminds resident to unzip and zip his pants

and to wash his hands when toileting is complete. The resident required this same process several times daily throughout the entire 7-day look-back period. How would you code Toilet Use? 1/0 Supervision but not set up or physical help G0120: Bathing Takes full body bath, shower, or sponge bath. Includes transfer in and out of tub or shower Does not include washing back or hair

G0120: Bathing Coding Code for most dependent in self-performance and support G0120: Bathing Coding Self Performance Code 0. Independent. Requires no help from staff. Code 1. Supervision. Oversight help only. Code 2. Physical Help Limited to Transfer Only. Able to perform bathing activity, but required help with transfer only. Code 3. Physical Help in Part of Bathing Activity. Assistance

with some aspect of bathing. Code 4. Total Dependence. Unable to participate in any of bathing activity. Code 8. Activity Itself Did Not Occur If activity did not occur or family and/or non-facility staff provided care 100% of the time for that activity over entire 7-day period Support Provided - Codes same as G0110 (2) ADL Support Provided G0120 - Bathing Scenario 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. Clue: Code for maximum amount of assistance How would you code Bathing? 4/2 Total Dependence, Assisted by 1 Staff G0300: Balance During Transition and Walking

G0300: Balance During Transition & Walking Throughout 7 day look-back period, observe and document observations of balance during each transition: A. Sitting to Standing B. Walking C. Turning around D. Transferring on and off toilet E. Transferring from chair or wheelchair to bed & vice versa If no systematically documentation of stability in

these activities at least once during 7-day look-back period, conduct test for balance G0300: Balance During Transition & Walking Test Start with resident sitting up on edge of bed, in a chair, or in a wheelchair (if generally uses) Ask resident to: Stand up and stand still for 3-5 seconds G0300A. Sit to Stand

Walk approximately 15 feet using assistive device normally uses G0300B. Walking Turn around G0300C. Turning Around G0300: Balance, Transition & Walking - Test Ask resident to: Walk or wheel from starting point in room into

bathroom Prepare for toileting as normal, taking down pants or other clothing (not underclothes) Sit on toilet G0300D. Move on & off Toilet Ask resident who is not ambulatory and uses a wheelchair for mobility: to transfer from seated position in chair or wheelchair to seated position on bed G0300E. Surface to Surface Transfer

G0300: Balance, Transition & Walking - Coding For each transition code least steady episode, using assistive device if applicable Unsteady - unbalanced, move with sway, uncoordinated or jerking movements; abnormally slow gaits with small shuffling steps; wide-based gaits with halting, tentative steps G0300 A,B,C,D,E, - Coding Balance During Transitions & Walking

Code 0. Steady at all times. All steady transitions or walking, with or without assistive device If normally uses assistive device, plans or integrates its use in transition activity or walking May have abnormal gait Not Fall Risk Code 1. Not steady but able to stabilize without staff assistance Unsteady transitions or walking but able to stabilize w/o staff assistance Increased Fall Risk

G0300 A,B,C,D,E, - Coding Balance During Transitions & Walking Code 2. Not steady, only able to stabilize with staff assistance Unsteady transition or walking cannot stabilize w/o staff assistance. Had fall during transition or walking during lookback period High Fall Risk during transitions or walking Mechanical lift used (A,D,E) Code 8. Activity did not occur

G0300A - Scenario Mr. C. 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. How should G0300A be coded? Code 1. Not steady, but able to stabilize without staff assistance. Even though the second attempt at standing was steady, the first attempt suggests he is unsteady and at risk for falling during this transition.

G0400 Functional Limitation in Range of Motion G0400: Functional Limitation in ROM Limited ability to move joint: interferes with daily functioning or place at risk of injury Assess ROM at shoulder, elbow, wrist, hand, hip, knee, ankle, foot and other joints unless contraindicated (both sides of body) Ask to move each joint using verbal directions and

demonstration. G0400: Functional Limitation in ROM - Coding Code 0. No impairment. Full functional ROM on both sides, upper and lower extremities Code 1. Impairment on one side. Upper and/or lower extremity impairment on one side of body that interferes with daily functioning or places resident at risk of injury Code 2. Impairment on both sides.

Upper and/or lower extremity impairment on both sides of body that interferes with daily functioning or places resident at risk of injury G0600: Mobility Device G0600: Mobility Devices Coding A. Cane/crutch. Including single prong, tripod, quad cane, etc. B. Walker (or hemi-walker) Including enclosed frame-wheeled walker with/without posterior seat & lap cushion

Pushes wheelchair for support while walking. C. Wheelchair (manual or electric). Sits in wheelchair when moving about. Handpropelled, motorized, or pushed by another person. D. Limb Prosthesis. Z. None of the above. Used none of mobility devices listed in G0600 or locomotion did not occur during look-back period. G0900: Functional Rehabilitation Potential OBRA Admission A. Resident Believes Capable of

Increased Independence in at Least Some ADLs Code 0. No. Will probably stay same and continue with current needs for assistance. Code 1. Yes. Thinks can improve. Code even if expectation appears unrealistic. Code 9. Unable to Determine. Resident cannot indicate any beliefs about functional rehabilitation potential.

B. Direct Care Staff Believe Resident Is Capable of Increased Independence in at Least Some ADLs Code 0. No. Will probably stay same and continue with current needs for assistance. Likely to experience decrease in capacity for ADL care performance. Code 1. Yes. Can gain greater independence in ADLs. Not sure about potential for improvement.

Care Plan Considerations This needs to be very detailed. Staff needs to know exactly what help the elder needs for each ADL This is also where you include the elders preferred routine, i.e. when they get up, when they go to bed, when they bathe, how often they bathe, etc. Include mobile devices they require, i.e. cane, walker, wheelchair, prosthesis. Be specific about when they use the device.

Find out what their routine was prior to coming to the NH Questions? Ill take the next few minutes to answer any questions you might have Thank you!! Please feel free to contact me Shirley L. Boltz, RN RAI/Education Coordinator

785-296-1282 [email protected]

Recently Viewed Presentations

  • Anatomy Test Review - Mrs. Melino

    Anatomy Test Review - Mrs. Melino

    The digestive system of most birds includes a structure called the gizzard. The gizzard crushes and grinds food, often with the help of small stones that the bird has swallowed. Which of the following structures in the human digestive system...
  • OPLEMENJIVANJE DOMAĆIH ŽIVOTINJA - eu.me

    OPLEMENJIVANJE DOMAĆIH ŽIVOTINJA - eu.me

    Main features of Montenegrin agriculture . Agricultural policy: legal and strategic frame. EU accession: challenges, tasks and duties . Chapter 11. Agriculture and rural development. M O N T E N E G R O. Negotiating Team for the Accession...
  • DO THE BENEFITS OF CALIFORNIAS PROPOSITION 65 LAW

    DO THE BENEFITS OF CALIFORNIAS PROPOSITION 65 LAW

    : Presentation draws partially on work based on funded studies. Affiliated Scholar of the Center for the Study of Economic Liberty at Arizona State University, 2016- . Grant to write "Nutritional Label Nudges Are Unlikely to Improve Public Health," working...
  • Waves - Tenafly Public Schools

    Waves - Tenafly Public Schools

    Symbol Arial Verdana Wingdings 2 Wingdings Aspect 1_Aspect 2_Aspect 3_Aspect 4_Aspect 5_Aspect MathType 5.0 Equation -Simple Pendulum -Physical Pendulum -Torsional Pendulum The Simple Pendulum Slide 3 Period of the Simple Pendulum Slide 5 Physical Pendulum Period of the Physical Pendulum...
  • Public Health Implications of Global Warming

    Public Health Implications of Global Warming

    Creation of refugees with attendant health and mental health effects. Heat stress. Urban centers and the elderly. Northern areas that are unprepared. Forest fires. Peat fires. Ecosystem Effects and Disease. ... Public Health Implications of Global Warming
  • Trigonometric Functions

    Trigonometric Functions

    Unit Circle Rationale. Recall that when using the unit circle to evaluate the value of a trig function, cos θ = x and sin θ = y.What we didn't point out is that since the radius (hypotenuse) is 1, the...
  • Desiree's Baby & Irony

    Desiree's Baby & Irony

    Desiree's Baby & Irony . Bell Work. Complete the anticipation guide on "Desiree's Baby". In your journals, explain your rankings (why one factor is most/least important). ... The blues became a dialogue between a human being and his guitar.
  • Chapter 19 The Growth of Industry - PC\|MAC

    Chapter 19 The Growth of Industry - PC\|MAC

    Carnegie donated $350 million to various organizations. He built Carnegie Hall in New York City and more than 2000 libraries around the world. 9. A merger is the combining of companies into a corporation. 19.4 Industrial Workers. 1. Garment workers...