QM 11 ADL Decline

[rdl2k9]

We are having an issue that I'm sure one of you can set us straight on. Our ADL Decline is through the roof. But we've found out why. We have 2 facliities, one will code let's say 8 of 52 residents for a 10-15% adl decline which is the norm. The other will code as 10 of 10 or 8 of 8. for 100% ADL decline which kills us on the 5 star/qm's.

So, my question is.. Very specifically what causes a person to be in the denominator group for ADL Decline? We have 60-65 long term residents and there seems to be something very simple that we're not coding on the MDS's because 40-50 of these residents aren't being included in the sample group. Any help would be very much appreciated.

[andy3k]

According to the MDS 3.0 QM Manual, below is the information about the nominator for "MDS 3.0 Measure (#0688): Percent of Residents Whose Need for Help with Activities of Daily Living Has Increased (Long Stay)".

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).

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.

Residents meet the definition of increased need of help with late-loss ADLs if either of the following are true

1. At least two of the following are true (note that in the notation below, [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],

2. At least one of the following is true:

1. Bed mobility: [Level at target assessment (G0110A1[t]] - [Level at prior assessment (G0110A1[t-1])] > [1], or

2. Transfer: [Level at target assessment (G0110B1[t]] - [Level at prior assessment (G0110B1[t-1])] > [1], or

3. Eating: [Level at target assessment (G0110H1[t]] - [Level at prior assessment (G0110H1[t-1])] > [1], or

4. Toileting: [Level at target assessment (G0110I1[t]] - [Level at prior assessment (G0110I1[t-1])] > [1].