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. Evaluating Activities of Daily Living (ADLs) includes evaluating all the aspects of the ADL, defined on page G-2 of the RAIM3, as "ADL ASPECTS: Components of an ADL activity. These are listed next to the activity in the item set." The steps for assessment for all the ADLs included in item G0110 and listed on page G-3 of the RAIM3 include the following:
. 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, determine the level of assistance required for moving the resident to and from a lying position, for turning the resident from side to side, and/or for positioning the resident in bed.
. In another example, from either page G-1 or directly from the MDS Item Set for item G0110B, when evaluating transfer, staff would determine the level of assistance required for moving the resident "between surfaces including to or from bed, chair, wheelchair, standing position (excludes to/from bath/toilet)."
. Recently, CMS staff were asked to clarify the components of a transfer when a sling lift (or Hoyer lift, a brand name) is used. CMS staff responded: if the person is able to perform actions that are part of the transfer (e.g., sits on the edge of the bed and assists with sliding onto the transfer sling; partially weight-bear stands and sits on the transfer sling; or positions themselves in the sling), that would be considered assisting in ADL aspects that are part of the transfer activity. A person who simply folds their hands across their chest or puts their hand on a bar while in the sling lift is not performing actions that can be considered as assisting with a transfer.
. The coding instructions from page G-5 of the RAIM3 inform staff that extensive assistance is coded "if resident performed part of the activity over the last 7 days, help of the following type(s) was provided three or more times:
-- Weight-bearing support provided three or more times.
-- Full staff performance of activity during part but not all of the last 7 days."
. Continuing on page G-5, total dependence is coded "if there was full staff performance of an activity with no participation by resident for any aspect of the ADL activity. The resident must be unwilling or unable to perform any part of the activity over the entire 7-day look-back period."
. Therefore, if a resident folds their arms or places their hand on the bar once situated in the sling lift (an action that is not a component or aspect of the ADL activity of transfer), and if this same resident requires full staff performance of those components that are a part of the ADL activity of transfer every time transfer occurs during the 7-day look-back period, the correct code would be total dependence.
Source: The MDS Mentor
, September 2012, page 3