ADL'S and MDS

Perhaps monthly quizzes with prizes for correct answers...

I tell staff:

0--- Independent like you & me

1--- Eyeballing/Verbal cues only, No Touch

2--- Touch, No Weight Bearing at all

3--- Weight Bearing assistance, no matter how much or just a little bit

4--- Total Staff Care, resident did nothing at all to assist :)

wow that helps....what kinds of gifts!!! i was thinking maybe a bath and body works basket.....suggestions would be great!!!

I carry a salt packet in my pocket to demonstrate weight bearing, and explain that "extensive" doesn't mean you are dead tired after you do it. I also ask, "If you have this many patients that are zero's, how on earth can you say you are overworked?" and "So, if the people that work your days off are not as good as you, why on earth do you just copy whatever they charted?" Shocking but standard fare.

I know this thread is old, but Maybe someone will still see this.

With the new 3.0- and their new definition of weight-bearing.

If you had a resident that was able to use the handrails in the bathroom (he/she pulled them selves up with the rails) but was unable to pull up their pants safely and required staff to wipe them and pull up their pants.. what would you consider their Support level at this time?

I know this thread is old, but Maybe someone will still see this.

With the new 3.0- and their new definition of weight-bearing.

If you had a resident that was able to use the handrails in the bathroom (he/she pulled them selves up with the rails) but was unable to pull up their pants safely and required staff to wipe them and pull up their pants.. what would you consider their Support level at this time?

3--Extensive assistance :)

Its extensive? When there was no weight-bearing in the activity.. Just non-weightbearing of the pants and wiping.

When they taught the CNAs to code everyday,they were teaching them:Limited: non weight bearing, resident highly involved in activity. OrExtensive: resident participated in activity, weight-bearing assistance required. The cnas see on their kiosk- only that. So if a person was on the toilet- transfered themselves with oversight only to the toilet and from the toilet- however required assistance with wiping and pulling up pants- that it was limitedx1 due to the fact that there was no weight bearing.But it seems that our PPS coordinator says if u performed most if the task (no matter if it was only wiping with toilet paper and pulling down/up the pants) that it is extensive.. I just dont get it.

Toileting encompasses multiple tasks to complete the activity from start to end. In your case - transfers, cleansing, and adjusts clothes.

In order to code Toileting as independent, resident must perform ALL 3 tasks on his own. Since staff provided full staff performance in one or more of the tasks, the resident is correctly coded as Extensive Assistance.

Even if resident is independent in transfers and in pulling his pants back on, if he requires full staff performance in cleansing (because he constantly neglects to), he will still be coded as Extensive assistance.

Another ADL w/ multiple tasks involved is Personal hygiene -

A resident independently combs hair, brushes teeth, wash/dry face and hands, and apply deodorant. However, a staff member has to shave him every day. Again, the ADL will still be coded as Extensive Assistance.

Ok! Thank you! I got the realization if you perform a majority of the subtask you code extensive.

But why would you code extensive if they did a 3 out 4 subtask and you did only ONE with limited assist? How does that make it extensive?

Or if they performed 2 out 3

• Independent transfers in 7 days = 7
  
• Independent pulling pants up in 7 days = 7
  
• Total dependence cleansing = 7
  

• Number of times Independent = 14
  
• Number of times Total Dependence = 7
  

Instructions for RULE of 3

When an activity occurs 3 times at multiple levels, code the most dependent. Exception is Total Dependence since full assist must be required at all times.

Therefore, if you follow the algorithm you will end with? see RAI pG-6

Im not talking about the coding in the mds- but for CNAs to document on a individual basis day to day.