Quality of Care and Quality of Life Indicator (QCLI) Dictionary

Transcription

1 Quality of Care and Quality of Life Indicator (QCLI) Dictionary This document contains the following information for each QCLI: Care Area, QCLI Name, Definition, Thresholds for Small and Not Small Samples (explained below), Sample, Data Source, and, Denominator and,, and. For QCLIs based on MDS 3.0 data, a description of MDS assessment selection and matching follows the threshold explanation below. An explanation of Small and Not Small Thresholds (implemented 11/01/2010) With the release of ASE-Q, Census and Admission sample QCLIs will have two separate sets of thresholds, one for small samples and one for not small samples. Small Census sample thresholds will apply when there are 35 or fewer residents in the Census sample and Not Small Census sample thresholds will apply when there are 36 or more residents in the Census sample. The exception to this rule is for Family Interview QCLIs. There is one threshold for Family Interview QCLIs, regardless of the Family Interview sample size. Small Admission sample thresholds will apply when there are 9 or fewer residents in the Admission Sample and Not Small thresholds will apply when there are 10 or more residents in the Admission sample. The applicable threshold is automatically applied by the software; surveyors do not have to choose which threshold to use. CMS (10/2011) Preface Page 1 of 7

2 MDS 3.0 Assessments Used in ASE-Q QCLI Calculations Most Recent MDS Assessment The Most Recent assessment can be any of the A0310A or A0310 B values listed below. The value for A0310F must be 99. A0310A=01 Admission or A0310A=02 Quarterly or A0310A=03 Annual or A0310A=04 Significant change in status or A0310A=05 Significant correction to prior comprehensive or A0310A=06 Significant correction to prior quarterly or A0310B=01 5-day or A0310B=02 14-day or A0310B=03 30-day or A0310B=04 60-day or A0310B=05 90-day or A0310B=06 Readmission/Return And A0310F=99 Not entry/discharge. ASE-Q uses a resident identifier and A2300-Assessment Reference Date (ARD) to select one assessment per resident the most recent assessment. The following is a list of MDS 3.0 QCLIs that are based on the Most Recent MDS assessment. QCLI # QCLI Name Care Area Time Point QP010 Prevalence of Indwelling Catheter Urinary Catheter Use MR QP012 Prevalence of Urinary Tract Infections Urinary Tract Infections MR QP013 Prevalence of Weight Loss Nutrition MR QP014 Prevalence of Tube Feeding Tube Feeding MR QP015 Prevalence of Dehydration Hydration MR QP020 Prevalence of Antianxiety/Hypnotic Use Psychoactive Medications MR QP022 Prevalence of Daily Physical Restraint Physical Restraints MR QP024_H Prevalence of Stage 1-4 Pressure Ulcers (High Risk) Pressure Ulcers MR QP024_L Prevalence of Stage 1-4 Pressure Ulcers (Low Risk) Pressure Ulcers MR QP061 Wound Infection Infections (non-uti related) MR QP084 Tube Fed and Losing Weight Tube Feeding MR (and CenRecord) CMS (10/2011) Preface Page 2 of 7

3 QCLI # QCLI Name Care Area Time Point QP213 Lack of Corrective Action for Visual Problems Vision MR QP214 Lack of Corrective Action for Auditory Problems Hearing MR Most Recent Full MDS Assessment The Most Recent FULL assessment can be any of the A0310A values listed below. The value for A0310F must be 99. A0310A=01 Admission or A0310A=03 Annual or A0310A=04 Significant change in status or A0310A=05 Significant correction to prior comprehensive And A0310F=99 Not entry/discharge. ASE-Q uses a resident identifier and the ARD (A2300) to select one assessment per resident the most recent assessment. The following MDS 3.0 QCLI is based on the Most Recent FULL MDS assessment. QCLI # QCLI Name Care Area Time Point QP217 Oral/Dental Problems Dental Status and Services MRFull Paired Assessments: 5- & 30-Day PPS Assessments The 5-day assessment must have A0310B=01 (5-day scheduled assessment) and A0310F must be 99. The 30-day assessment must have A0310B=03 (30-day scheduled assessment) and A0310F must be 99. ASE-Q uses a resident identifier to match all 5-day and 30-day assessments for a resident. ARDs (A2300) are used to select pairs of assessments where the 30-day assessment ARD is at least 13 days after the 5-day ARD but no more than 34 days after the 5-day ARD. If the remaining 5 & 30-day matched assessments contain more than one pair of assessments per resident, only the most recent is selected for QCLI calculations. The following MDS 3.0 QCLI is based on the matched 5 & 30-day assessments. QCLI # QCLI Name Care Area Time Point QP119 Lack of Transferring Rehabilitation Progress Rehabilitation 5- & 30-day CMS (10/2011) Preface Page 3 of 7

4 Paired Assessments: Previous & Most Recent (excluding Admission) Assessments The Previous assessment can be any of the A0310A or A0310B values listed below. The value for A0310F must be 99. A0310A=01 Admission or A0310A=02 Quarterly or A0310A=03 Annual or A0310A=04 Significant change in status or A0310A=05 Significant correction to prior comprehensive or A0310A=06 Significant correction to prior quarterly or A0310B=01 5-day or A0310B=02 14-day or A0310B=03 30-day or A0310B=04 60-day or A0310B=05 90-day or A0310B=06 Readmission/Return And A0310F=99 Not entry/discharge. The Most Recent (excluding Admission) assessment can be any of the A0310A or A0310B values listed below. The value for A0310F must be 99. A0310A=02 Quarterly or A0310A=03 Annual or A0310A=04 Significant change in status or A0310A=05 Significant correction to prior comprehensive or A0310A=06 Significant correction to prior quarterly or A0310B=02 14-day or A0310B=03 30-day or A0310B=04 60-day or A0310B=05 90-day And A0310F=99 Not entry/discharge. CMS (10/2011) Preface Page 4 of 7

5 ASE-Q uses a resident identifier to match all Previous and Most Recent (excluding Admission) assessments for a resident. ASE-Q uses the ARDs to select pairs where the Most Recent (excluding Admission) assessment ARD is at least 1 day after the Previous ARD but no more than 94 days after the Previous ARD. If the Previous & Most Recent (excluding Admission) matched assessments contain more than one pair of assessments per resident, only the most recent is selected for QCLI calculations. The following MDS 3.0 QCLI is based on the matched Previous & Most Recent (excluding Admission) assessments QCLI # QCLI Name Care Area Time Point QP017 Decline in Late Loss ADLs ADL, Cleanliness and Grooming Prev & Most Recent (excl. Adm.) QP018 Decline in ROM Range of Motion Prev & Most Recent (excl. Adm.) QP028b Dressing Severe Decline ADL, Cleanliness and Grooming Prev & Most Recent (excl. Adm.) QP039b Locomotion Severe Decline ADL, Cleanliness and Grooming Prev & Most Recent (excl. Adm.) QP106b Increase in Rejection of Care Behavior and Emotional Status Prev & Most Recent (excl. Adm.) Paired Assessments: Admission & 90-Day Assessments The Admission assessment can be any of the A0310A or A0310B values listed below. The value for A0310F must be 99. A0310A=01 Admission or A0310B=01 5-day or A0310B=06 Readmission/Return And A0310F=99 Not entry/discharge. The 90-day assessment can be any of the A0310A or A0310B values listed below. The value for A0310F must be 99. A0310A=02 Quarterly or A0310A=04 Significant change in status or A0310A=06 Significant correction to prior quarterly or A0310B=05 90-day And A0310F=99 Not entry/discharge. CMS (10/2011) Preface Page 5 of 7

6 ASE-Q uses a resident identifier to match all Admission and 90-day assessments for a resident. ARDs (A2300) are used to select pairs where the 90-day assessment ARD is at least 66 days after the Admission ARD but no more than 94 days after the Admission ARD for quarterly and 90-day assessments. For assessment pairs involving a significant change or correction, the change/correction ARD must occur at least one day after the Admission ARD but no more than 94 days after the Admission ARD. If the Admission & 90-day matched assessments contain more than one pair of assessments per resident, only the most recent is selected for QCLI calculations. The following MDS 3.0 QCLI is based on the matched Admission & 90-day assessments. QCLI # QCLI Name Care Area Time Point QP027 Dressing Decline Since Admission ADL, Cleanliness and Grooming Admission & 90-day QP028a* Dressing Severe Decline ADL, Cleanliness and Grooming Admission & 90-day QP031 Eating Decline Since Admission ADL, Cleanliness and Grooming Admission & 90-day QP034 Toileting Decline Since Admission ADL, Cleanliness and Grooming Admission & 90-day QP038 Locomotion Decline Since Admission ADL, Cleanliness and Grooming Admission & 90-day QP039a** Locomotion Severe Decline ADL, Cleanliness and Grooming Admission & 90-day QP043a Increase in Physical Abuse Behavior and Emotional Status Admission & 90-day QP047 Continence Decline Since Admission Urinary Incontinence Admission & 90-day QP106a*** Increase in Rejection of Care Behavior and Emotional Status Admission & 90-day * If the resident is included in QP028b (Prev & Most Recent (excl. Adm.)), the resident is excluded from this QCLI. ** If the resident is included in QP039b (Prev & Most Recent (excl. Adm.)), the resident is excluded from this QCLI. *** If the resident is included in QP106b (Prev & Most Recent (excl. Adm.)), the resident is excluded from this QCLI. CMS (10/2011) Preface Page 6 of 7

7 Summary of MDS Assessments and Time Points for ASE-Q QCLIs Time Point Name A0310A (OBRA RFA) A0310B (OMRA RFA) A0310F (Entry/Discharge) 1. Most Recent 01,02,03,04,05,06 01,02,03,04,05, Most Recent Full 01,03,04, Day Medicare Day Medicare Acceptable date range between 5-day and 30-day assessments is days. 5. Previous 01,02,03,04,05,06 01,02,03,04,05, Most Recent (Excl. Adm.) 02,03,04,05,06 02,03,04,05 99 Acceptable date range between assessments is 1-94 days. 7. Admission 01 01, Day 02,04, Acceptable date range between assessments is days for 90-day and quarterly assessments and 1-94 days for significant change or correction assessments. CMS (10/2011) Preface Page 7 of 7

8 QUALITY OF CARE QUALITY OF LIFE INDICATS (QCLI) DICTIONARY - BY CARE AREA Table of Contents Theshold Threshold Page# QCLI# QCLI Name (Data Source) Sample Small Not Small Abuse 1 QP205 Abuse (Resident Observation) Census >0.0% >0.0% 2 QP236 Abuse (Family Interview) Census >0.0% >0.0% 3 QP253 Abuse (Resident Interview) Census >0.0% >0.0% Abuse Prohibition Review 4 QP205 Abuse Prohibition (Resident Observation) Census >0.0% >0.0% 5 QP236 Abuse Prohibition (Family Interview) Census >0.0% >0.0% 6 QP253 Abuse Prohibition (Resident Interview) Census >0.0% >0.0% Accidents 7 QP092 Dangerous Device Use (Resident Observation) Census >1.0% >1.0% 8 QP218 Potential Accident Hazards / Bed Side Rails (Resident Observation) Census >2.4% >2.4% 9 QP265 Fall and/or Fracture in Last 30 Days (Staff Interview) Census >1.0% >1.0% Activities 10 QP096 Structured Activities for Cognitively Impaired (Resident Observation) Census >51.0% >51.0% 11 QP208 Activities (Resident Interview) Census >40.0% >30.0% 12 QP239 Activities (Family Interview) Census >1.0% >1.0% CMS (10/2011) TOC Page 1 of 6

9 QUALITY OF CARE QUALITY OF LIFE INDICATS (QCLI) DICTIONARY - BY CARE AREA Table of Contents Theshold Threshold Page# QCLI# QCLI Name (Data Source) Sample Small Not Small Activities of Daily Living, Cleanliness and Grooming ADL 13 QP017 Incidence of Decline in Late Loss ADLs (Previous & Most Recent (excl.adm.) MDS) MDS >30.5% >30.5% 15 QP027 Dressing Decline Since Admission (Admission & 90-Day MDS) MDS >40.0% >40.0% 16 QP028a Dressing Severe Decline (Admission & 90-Day MDS) MDS >14.0% >14.0% 17 QP028b Dressing Severe Decline (Previous & Most Recent (excl.adm.) MDS) MDS >7.0% >7.0% 18 QP031 Eating Decline Since Admission (Admission & 90-Day MDS) MDS >49.0% >49.0% 19 QP034 Toileting Decline Since Admission (Admission & 90-Day MDS) MDS >33.3% >33.3% 20 QP038 Locomotion Decline Since Admission (Admission & 90-Day MDS) MDS >99.0% >99.0% 21 QP039a Locomotion Severe Decline (Admission & 90-Day MDS) MDS >1.0% >1.0% 22 QP039b Locomotion Severe Decline (Previous & Most Recent (excl.adm.) MDS) MDS >20.0% >20.0% 23 QP238 ADL Assistance (Family Interview) Census >1.0% >1.0% Cleanliness and Grooming 24 QP074 Dressing [Not Dressed] (Resident Observation/CenRecord/Most Recent MDS) Census >3.0% >2.0% 25 QP075 Cleanliness/Grooming/Oral (Resident Observation) Census >14.0% >12.0% 26 QP256 Cleanliness/Grooming/Oral (Resident Interview) Census >10.0% >9.0% Admission, Transfer, and Discharge Review 27 QP183 Admission Process (Family Interview) Census >1.0% >1.0% 28 QP250 Exercise of Rights (Resident Interview) Census >7.6% >1.0% 29 QP251 Exercise of Rights (Family Interview) Census >1.0% >1.0% Behavioral and Emotional Status 30 QP043a Increase in Physical Abuse (Admission & 90-Day MDS) MDS >4.0% >4.0% 31 QP106a Increase in Rejection of Care (Admission & 90-Day MDS) MDS >35.0% >35.0% 32 QP106b Increase in Rejection of Care (Previous & Most Recent (excl.adm.) MDS) MDS >21.0% >21.0% Choices 33 QP234 Choices (Resident Interview) Census >10.0% >10.0% 34 QP244 Choices (Family Interview) Census >1.0% >1.0% Community Discharge 35 QP071 Lack of Community Discharge (AdmRecord/Most Recent MDS) Admission >82.0% >82.0% CMS (10/2011) TOC Page 2 of 6

10 QUALITY OF CARE QUALITY OF LIFE INDICATS (QCLI) DICTIONARY - BY CARE AREA Table of Contents Theshold Threshold Page# QCLI# QCLI Name (Data Source) Sample Small Not Small Death 37 QP059 Death (AdmRecord/Most Recent MDS) Admission >1.0% >1.0% Dental Status and Services 38 QP216 Oral Health Status (Resident Observation) Census >1.0% >1.0% 39 QP217 Oral/Dental Problems (Most Recent Full MDS) MDS >74.0% >74.0% 40 QP245 Oral Health Status (Family Interview) Census >1.0% >1.0% 41 QP254 Oral Health Status (Resident Interview) Census >20.0% >20.0% Dignity 42 QP212 Dignity (Resident Interview) Census >6.0% >5.0% 43 QP240 Dignity (Family Interview) Census >1.0% >1.0% Environmental Observations Family Interview 44 QP248 Building and Environment (Family Interview) Census >66.6% >66.6% Resident Interview 45 QP201 Building and Environment (Resident Interview) Census >12.4% >12.4% Resident Room Review 46 QP140 Resident Care Equipment (Resident Observation) Census >7.5% >7.5% 47 QP147 Room Accommodations (Resident Observation) Census >2.5% >2.5% 48 QP151 Bedroom Privacy (Resident Observation) Census >5.0% >5.0% 49 QP152 Clean Linens Available (Resident Observation) Census >5.0% >5.0% 50 QP221 Room Odors (Resident Observation) Census >5.0% >5.0% 51 QP222 Room Furnishings (Resident Observation) Census >14.0% >14.0% 52 QP223 Lighting Levels (Resident Observation) Census >2.5% >2.5% 53 QP224 Comfortable Room Temperatures Maintained (Resident Observation) Census >1.0% >1.0% 54 QP225 Comfortable Sound Levels Maintained (Resident Observation) Census >2.5% >2.5% 55 QP226 Pest Control (Resident Observation) Census >1.0% >1.0% 56 QP228 Electric Cords and Outlets (Resident Observation) Census >1.0% >1.0% 57 QP229 Ambulation, Transfer, and Therapy Equipment [Resident Use] (Resident Observation) Census >1.0% >1.0% 58 QP230 Bathing Safety Equipment (Resident Observation) Census >1.0% >1.0% 59 QP231 Functioning Call System (Resident Observation) Census >1.0% >1.0% CMS (10/2011) TOC Page 3 of 6

11 QUALITY OF CARE QUALITY OF LIFE INDICATS (QCLI) DICTIONARY - BY CARE AREA Table of Contents Theshold Threshold Page# QCLI# QCLI Name (Data Source) Sample Small Not Small Food Quality 60 QP249 Food Quality [Resident Level] (Resident Interview) Census >33.3% >33.3% Hearing 61 QP214 Lack of Corrective Action for Auditory Problems (Most Recent MDS) MDS >90.0% >90.0% Hospitalization 62 QP058 Hospitalization Within 30 Days (AdmRecord) Admission >22.0% >15.0% Hydration 63 QP015 Prevalence of Dehydration (Most Recent MDS) MDS >1.0% >1.0% 64 QP182 Hydration (Resident Observation) Census >1.0% >1.0% 65 QP258 Hydration (Resident Interview) Census >9.0% >1.0% Infections (non-uti related) 66 QP061 Wound Infection (Most Recent MDS) MDS >6.7% >6.7% Notification of Change 67 QP252 Notification of Change (Family Interview) Census >1.0% >1.0% Nutrition 68 QP013 Prevalence of Weight Loss (Most Recent MDS) MDS >15.9% >15.9% 69 QP081 Significant Weight Loss (CenRecord/Most Recent MDS) Census >12.0% >12.0% 70 QP082 Underweight and No Supplements (Staff Interview/CenRecord/Most Recent MDS) Census >15.0% >15.0% 71 QP105 Weight Loss Since Admission (AdmRecord/Most Recent MDS) Admission >21.7% >21.7% Pain Recognition and Management 72 QP129 Pain (Resident Observation) Census >6.0% >6.0% 73 QP255 Pain (Resident Interview) Census >19.5% >15.8% Participation in Care Planning 74 QP210 Participation in Care Planning (Resident Interview) Census >11.7% >7.5% 75 QP242 Participation in Care Planning (Family Interview) Census >1.0% >1.0% CMS (10/2011) TOC Page 4 of 6

12 QUALITY OF CARE QUALITY OF LIFE INDICATS (QCLI) DICTIONARY - BY CARE AREA Table of Contents Theshold Threshold Page# QCLI# QCLI Name (Data Source) Sample Small Not Small Personal Funds Review 76 QP121a Personal Funds (Family Interview) Census >1.0% >1.0% 77 QP121b Medicaid Costs (Family Interview) Census >1.0% >1.0% 78 QP199 Personal Funds (Resident Interview) Census >25.0% >25.0% Personal Property 79 QP194 Personal Property (Resident Interview) Census >9.0% >9.0% 80 QP241 Personal Property (Family Interview) Census >1.0% >1.0% Physical Restraints 81 QP022 Prevalence of a Daily Physical Restraint (Most Recent MDS) MDS >11.3% >11.3% 82 QP089 Potential Restraints (Resident Observation) Census >15.7% >15.7% 83 QP093 Side Rails (Staff Interview) Census >19.0% >19.0% Positioning 84 QP233 Positioning (Resident Observation) Census >5.0% >5.0% Pressure Ulcers 86 QP024_H Prevalence of Stage I-IV Pressure Ulcers (High Risk) (Most Recent MDS) MDS >25.5% >25.5% 88 QP024_L Prevalence of Stage I-IV Pressure Ulcers (Low Risk) (Most Recent MDS) MDS >15.0% >15.0% 90 QP049 Presence of Pressure Ulcer (Staff Interview) Census >17.0% >17.0% 91 QP050 Presence of Stage III or IV Pressure Ulcer (Staff Interview) Census >1.0% >1.0% 92 QP109 Pressure Ulcer Incidence or Worsening (AdmRecord) Admission >5.0% >5.0% 93 QP262 Presence of Pressure Ulcer (CenRecord) Census >40.0% >15.9% 94 QP263 Presence of Stage III or IV Pressure Ulcer (CenRecord) Census >1.0% >1.0% Privacy 95 QP204 Privacy (Resident Interview) Census >34.9% >13.0% 96 QP243 Privacy (Family Interview) Census >1.0% >1.0% Psychoactive Medications 97 QP020 Prevalence of Antianxiety/Hypnotic Use (Most Recent MDS) MDS >34.0% >34.0% 98 QP063 Antipsychotic Use Without a Supporting Diagnosis (CenRecord) Census >40.0% >40.0% 99 QP066 Benzodiazepine Use (CenRecord) Census >15.0% >15.0% CMS (10/2011) TOC Page 5 of 6

13 QUALITY OF CARE QUALITY OF LIFE INDICATS (QCLI) DICTIONARY - BY CARE AREA Table of Contents Theshold Threshold Page# QCLI# QCLI Name (Data Source) Sample Small Not Small Range of Motion 100 QP018 Incidence of Decline in Range of Motion (Previous & Most Recent (excl.adm.) MDS) MDS >18.1% >18.1% 101 QP076 Contracture - Presence of (Resident Observation) Census >17.0% >17.0% 102 QP077 Contracture Without a Splint Device (Resident Observation) Census >12.0% >9.5% 103 QP264 Contracture Without ROM or Splint Device (Staff Interview) Census >1.0% >1.0% Rehabilitation 104 QP119 Lack of Transferring Rehabilitation Progress (5- & 30-Day MDS) MDS >70.0% >70.0% Skin Conditions (non-pressure related) 105 QP261 Other Skin Conditions (Resident Observation) Census >8.8% >7.5% Social Services 106 QP246 Interaction With Others (Resident Interview) Census >17.0% >17.0% 107 QP247 Interaction With Others (Family Interview) Census >33.6% >33.6% Sufficient Nursing Staff Review 108 QP232 Sufficient Staff (Resident Interview) Census >30.0% >30.0% 109 QP237 Sufficient Staff (Family Interview) Census >1.0% >1.0% Tube Feeding 110 QP014 Prevalence of Tube Feeding (Most Recent MDS) MDS >35.0% >35.0% 111 QP084 Tube Fed and Losing Weight (CenRecord/Most Recent MDS) Census >2.6% >2.6% Urinary Catheter Use 113 QP010 Prevalence of Indwelling Catheter (Most Recent MDS) MDS >14.8% >14.8% 114 QP079 Unjustified Use of a Catheter (Staff Interview) Census >4.0% >4.0% Urinary Incontinence 115 QP047 Continence Decline Since Admission (Admission & 90-Day MDS) MDS >20.0% >20.0% 116 QP260 Presence of Incontinence (Resident Observation) Census >1.0% >1.0% Urinary Tract Infections 117 QP012 Prevalence of Urinary Tract Infections (Most Recent MDS) MDS >25.0% >25.0% Vision 118 QP213 Lack of Corrective Action for Visual Problems (Most Recent MDS) MDS >17.0% >17.0% CMS (10/2011) TOC Page 6 of 6

14 Care Area: Abuse QCLI Name: Abuse (Resident Observation) Threshold-Small Facilities: >0.0% Threshold-Not Small Facilities: >0.0% QP205 Definition: Resident abused by staff. Residents in the Census Sample Data Source: Resident Observation Denominator Updated: 10/18/2010 Residents in the Census Sample with a valid response to the abuse item. "Are staff treating the resident in a manner that may indicate abuse (yelling at resident, striking resident, treating resident in a rough manner, etc.)? " =1-Yes. Census=1 L1o38_1=1 Missing data for L1o38_1 Census=1 (L1038_1=0 or 1) CMS (10/2011) Dictionary Page 1 of 118

15 Care Area: Abuse QCLI Name: Abuse (Family Interview) Threshold-Small Facilities: >0.0% Threshold-Not Small Facilities: >0.0% QP236 Definition: Resident abused by staff. Family Interview residents "Have you ever noticed any staff member being rough with, talking in a demeaning way or yelling at [resident's name] or any other resident?"=1-yes "Did you report it?"=1-yes "Did facility staff act promptly to investigate and correct the situation?"=0-no L1dscrn=1 L1d3802=1 L1d3803=1 L1d3804=0 Data Source: Family Interview Denominator Updated: 10/18/2010 Family Interview residents with a valid response to the "notice staff member being rough with a resident" item. L1dscrn=1 (L1d3802=0 or 1) Residents who are interviewable, residents who refuse to be interviewed, and residents who are unavailable for an interview. [L1R2607=1, 2, or 3] Missing data for L1d3802 CMS (10/2011) Dictionary Page 2 of 118

16 Care Area: Abuse QCLI Name: Abuse (Resident Interview) Threshold-Small Facilities: >0.0% Threshold-Not Small Facilities: >0.0% QP253 Definition: Resident abused by staff. Data Source: Resident Interview Denominator Updated: 10/18/2010 Residents in the Census Sample Residents in the Census Sample with a valid response to at least one of the three abuse items. ("Have you ever been treated roughly by staff?"=1-yes "Has staff yelled or been rude to you?"=1-yes "Do you ever feel afraid because of the way you or some other resident is treated?"=1-yes) Census=1 Census=1 (L1r3801=1 or L1r3802=1 or L1r2714=1) (L1r3801=0 or 1 or L1r3802=0 or 1 or L1r2714=0 or 1) Residents who are not interviewable, residents who refuse to be interviewed, and residents who are unavailable for an interview [L1R2607=0, 2, or 3] Missing data on L1r3801, L1r3802, and L1r2714 CMS (10/2011) Dictionary Page 3 of 118

17 Care Area: Abuse Prohibition Review QCLI Name: Abuse Prohibition (Resident Observation) Threshold-Small Facilities: >0.0% Threshold-Not Small Facilities: >0.0% QP205 Definition: Use the Abuse Prohibition investigative protocol to complete this task on every QIS on which the Abuse care area is investigated. Data Source: Resident Observation Denominator Updated: 10/18/2010 Residents in the Census Sample Residents in the Census Sample with a valid response to the abuse item. "Are staff treating the resident in a manner that may indicate abuse (yelling at resident, striking resident, treating resident in a rough manner, etc.)? " =1-Yes Census=1 L1o38_1=1 Missing data for L1o38_1 Census=1 (L1o38_1=0 or 1) CMS (10/2011) Dictionary Page 4 of 118

18 Care Area: Abuse Prohibition Review QCLI Name: Abuse Prohibition (Family Interview) Threshold-Small Facilities: >0.0% Threshold-Not Small Facilities: >0.0% QP236 Definition: Use the Abuse Prohibition investigative protocol to complete this task on every QIS on which the Abuse care area is investigated. Family Interview residents "Have you ever noticed any staff member being rough with, talking in a demeaning way or yelling at [resident's name] or any other resident?"=1-yes "Did you report it?"=1-yes "Did facility staff act promptly to investigate and correct the situation?"=0-no L1dscrn=1 L1d3802=1 L1d3803=1 L1d3804=0 Data Source: Family Interview Denominator Updated: 10/18/2010 Family Interview residents with a valid response to the "notice staff member being rough with a resident" item. L1dscrn=1 (L1d3802=0 or 1) Residents who are interviewable, residents who refuse to be interviewed, and residents who are unavailable for an interview. [L1R2607=1, 2, or 3] Missing data for L1d3802 CMS (10/2011) Dictionary Page 5 of 118

19 Care Area: Abuse Prohibition Review QCLI Name: Abuse Prohibition (Resident Interview) Threshold-Small Facilities: >0.0% Threshold-Not Small Facilities: >0.0% QP253 Definition: Use the Abuse Prohibition investigative protocol to complete this task on every QIS on which the Abuse care area is investigated. Data Source: Resident Interview Denominator Updated: 10/18/2010 Residents in the Census Sample Residents in the Census Sample with a valid response to at least one of the three abuse items. ("Have you ever been treated roughly by staff?"=1-yes "Has staff yelled or been rude to you?"=1-yes "Do you ever feel afraid because of the way you or some other resident is treated?"=1-yes) Census=1 Census=1 (L1r3801=1 or L1r3802=1 or L1r2714=1) (L1r3801=0 or 1 or L1r3802=0 or 1 or L1r2714=0 or 1) Residents who are not interviewable, residents who refuse to be interviewed, and residents who are unavailable for an interview [L1R2607=0, 2, or 3] Missing data on L1r3801, L1r3802, and L1r2714 CMS (10/2011) Dictionary Page 6 of 118

20 Care Area: Accidents QCLI Name: Dangerous Device Use (Resident Observation) Threshold-Small Facilities: >1.0% Threshold-Not Small Facilities: >1.0% QP092 Definition: Resident with a device incorrectly applied. Residents in the Census Sample Data Source: Resident Observation Denominator Updated: 10/18/2010 Residents in the Census Sample with a valid response for the potential restraints item. "Does the resident have a potential restraint in place? (physical device or equipment that may potentially restrict a resident s movement and/or access to her/his body)"=1 Yes "Is the device correctly applied? (Such as potential trunk and limb restraints) "=0-No Census=1 L1o0901=1 L1o0913=0 Missing data for L1o0901 Census=1 (L1o0901=0 or 1) CMS (10/2011) Dictionary Page 7 of 118

21 Care Area: Accidents QCLI Name: Potential Accident Hazards / Bed Side Rails (Resident Observation) Threshold-Small Facilities: >2.4% Threshold-Not Small Facilities: >2.4% QP218 Definition: Side rails do not fit the bed properly. Residents in the Census Sample "If the bed side rails are in the up position, do the bed side rails fit the bed properly to prevent the resident from being caught between the side rails and mattress?"=0-no Census=1 L1o1403=0 L1o1403=2-NA, side rails are not observed in the up position Missing data for L1o1403 Data Source: Resident Observation Denominator Updated: 10/18/2010 Residents in the Census Sample and a valid response to the "bed rails fitting properly" item. Census=1 (L1o1403=0 or 1) CMS (10/2011) Dictionary Page 8 of 118

22 Care Area: Accidents QCLI Name: Fall and/or Fracture in Last 30 Days (Staff Interview) Threshold-Small Facilities: >1.0% Threshold-Not Small Facilities: >1.0% QP265 Definition: Resident had a fall and/or sustained a fracture within the last 30 days. Residents in the Census Sample Data Source: Staff Interview Denominator Updated: 10/18/2010 Residents in the Census Sample with a valid response to the fall/fracture item. "Has the resident had a fall and/or sustained a fracture within the last 30 days?"=yes Census=1 L1s5401=1 Missing data for L1s5401 Census=1 (L1s5401=0 or 1) CMS (10/2011) Dictionary Page 9 of 118

23 Care Area: Activities QCLI Name: Structured Activities for Cognitively Impaired (Resident Observation) Threshold-Small Facilities: >51.0% Threshold-Not Small Facilities: >51.0% QP096 Definition: Appropriately structured activities for cognitively impaired residents are not available. Residents in the Census Sample ("Did you observe the resident in activities during the two days of Stage 1 (This is not limited to group activities or scheduled activities)?"=0-no "Is the resident actively participating in the activities or does staff encourage the resident to participate?"=0-no) Census=1 (L1o2001=0 or L1o2002=0) Data Source: Resident Observation Denominator Updated: 10/18/2010 Residents in the Census Sample with a valid response to the activities item. Census=1 (L1o2001= 0 or 1) Residents who are interviewable, residents who refuse to be interviewed, and residents who are unavailable for an interview [L1R2607=1,2, or 3] Missing data for L1o2001 CMS (10/2011) Dictionary Page 10 of 118

24 Care Area: Activities QCLI Name: Activities (Resident Interview) Threshold-Small Facilities: >40.0% Threshold-Not Small Facilities: >30.0% QP208 Definition: Facility fails to provide appropriate activities. Data Source: Resident Interview Denominator Updated: 10/18/2010 Residents in the Census Sample ("Do you participate in any of the activity programs here? "=0-No "Do the organized activities meet your interests?"=0-no "Do you receive assistance for things you like to do, such as supplies, batteries, books? (Facility should have items available for residents to use)."=0-no "Are there activities offered on the weekends, including religious events?"=0-no "Are there activities available in the evenings?"=0-no) Census=1 (L1r3007=0 or L1r3008=0 or L1r3009=0 or L1r3001=0 or L1r3010=0) Residents in the Census Sample with a valid response to at least one of the activities item. Census=1 ((L1r3007=0, 1, or 2) or (L1r3008=0 or 1) or (L1r3009=0 or 1) or (L1r3001=0 or 1) or (L1r3010=0 or 1)) Residents who are not interviewable, residents who refuse to be interviewed, and residents who are unavailable for an interview [L1R2607=0, 2, or 3] Missing data for all activity items (L1r3007, L1r3008, L1r3009, L1r3001, and L1r3010) CMS (10/2011) Dictionary Page 11 of 118

25 Care Area: Activities QCLI Name: Activities (Family Interview) Threshold-Small Facilities: >1.0% Threshold-Not Small Facilities: >1.0% QP239 Definition: Facility fails to encourage appropriate activities and provide assistance to attend. Family Interview residents "Does staff encourage [resident's name] to attend activities and provide assistance to attend them?"=0-no Data Source: Family Interview Denominator Updated: 10/18/2010 Family Interview residents with a valid response to the "activities" item. L1dscrn=1 L1d3004=0 L1dscrn=1-Yes (L1d3004=0 or 1) Residents who are interviewable, residents who refuse to be interviewed, and residents who are unavailable for an interview. [L1R2607=1, 2, or 3] Missing data for L1d3004 CMS (10/2011) Dictionary Page 12 of 118

26 Care Area: Activities of Daily Living, Cleanliness and Grooming QCLI Name: Incidence of Decline in Late Loss ADLs (Previous & Most Recent (excl.adm.) MDS) Threshold-Small Facilities: >30.5% Threshold-Not Small Facilities: >30.5% QP017 Definition: Resident showing a one level decline in at least two late-loss ADLs, or a two level decline in at least one late-loss ADL. Residents with Previous and Most Recent (excl.adm.) MDS assessments valid responses at both time points for at least one of the following items: bed mobility, transfer, eating, toilet use. ((One level decline in TWO or more of the following four late loss ADLs: #1: "Bed mobility, self-performance" on the Previous MDS is 1 or more levels less than on the MR (excl.adm.) MDS #2: "Transfer, self-performance" on the Prev MDS is 1 or more levels less than on the MR (excl.adm.) MDS #3: "Eating, self-performance" on the Prev MDS is 1 or more levels less than on the MR (excl.adm.) MDS #4: "Toilet use, self-performance" on the Prev MDS is 1 or more levels less than on the MR (excl.adm.) MDS) (Two level decline in ONE or more of the following four late loss ADLs: #1: "Bed mobility, self-performance" on the Prev MDS is 2 or more levels less than on the MR (excl.adm.) MDS #2: "Transfer, self-performance" on the Prev MDS is 2 or more levels less than on the MR (excl.adm.) MDS #3: "Eating, self-performance" on the Prev MDS is 2 or more levels less than on the MR (excl.adm.) MDS #4: "Toilet use, self-performance" on the Prev MDS is 2 or more levels less than on the MR (excl.adm.) MDS)). TWO or more of the following: ([PrevMDS] G0110A1 - [MR (excl.adm.) MDS] G0110A1 le -1) ([PrevMDS] G0110B1 - [MR (excl.adm.) MDS] G0110B1 le -1) ([PrevMDS] G0110H1 - [MR (excl.adm.) MDS] G0110H1 le -1) ([PrevMDS] G0110I1 - [MR (excl.adm.) MDS] G0110I1 le -1). ONE or more of the following: ([PrevMDS] G0110A1 - [MR (excl.adm.) MDS] G0110A1 le -2) ([PrevMDS] G0110B1 - [MR (excl.adm.) MDS] G0110B1 le -2) ([PrevMDS] G0110H1 - [MR (excl.adm.) MDS] G0110H1 le -2) ([PrevMDS] G0110I1 - [MR (excl.adm.) MDS] G0110I1 le -2). Valid responses on the Previous assessment are 0, 1, 2, and 3. Valid responses on the Most Recent (excl.adm.) assessment are 0, 1, 2, 3, and 4. Sample: MDS Data Source: MDS MDS Timepoint: Prev & Most Recent (excl.adm.) Denominator Updated: 08/30/2011 Residents with a Previous and Most Recent (excl.adm.) MDS assessment with valid responses at both time points for at least one of the following items: bed mobility, transfer, eating, toilet use. Valid response for at least one of the following pairs: ([PrevMDS] G0110A1 and [MR (excl.adm.) MDS] G0110A1) ([PrevMDS] G0110B1 and [MR (excl.adm.) MDS] G0110B1) ([PrevMDS] G0110H1 and [MR (excl.adm.) MDS] G0110H1) ([PrevMDS] G0110I1 and [MR (excl.adm.) MDS] G0110I1) Valid responses on the Previous assessment are 0, 1, 2, and 3. Valid responses on the Most Recent-(excl.Adm.) assessment are 0, 1, 2, 3, and 4. CMS (10/2011) Dictionary Page 13 of 118

27 QP017 (cont'd) [PrevMDS] ("Bed mobilit y"=4,7, or 8-Total dependence, Activity occurred only once or twice, Activity did not occur [G0110A1] "Transfer"=4,7,or 8 [G0110B1] "Eating"=4,7,8 [G0110H1] "Toilet use"=4,7,8 [G0110I1]) or "Comatose=1-Yes [B0100]" (Residents who cannot decline because they are already totally depende nt or who are comatose on the earlier assessment.) MDS assessments selected are: MR (excluding Admission) where ((A0310A=02,03,04,05, or 06 or A0310B=02,03,04, or 05) and A0310F=99) the second most recent [Prev] where ((A0310A=01,02,03,04,05, or 06 or A0310B=01,02,03,04,05, or 06) and A0310F=99). The difference between the Prev and the MR (excl. Adm.) Assessment Reference Dates (ARD) (A2300) must be a t MR (excl. Adm.) ARD. Prev=Previous and MR(excl. Adm.)=Most Recent Excluding Admission. least 1 day but no more than 94 days (with the Prev ARD occurring before the CMS (10/2011) Dictionary Page 14 of 118

28 Care Area: Activities of Daily Living, Cleanliness and Grooming QCLI Name: Dressing Decline Since Admission (Admission & 90-Day MDS) Threshold-Small Facilities: >40.0% Threshold-Not Small Facilities: >40.0% QP027 Definition: Resident has declined one or more levels in dressing since admission. Sample: MDS Data Source: MDS MDS Timepoint: Admission & 90-Day Denominator Updated: 08/30/2011 Residents with Admission and 90-day MDS assessments "Dressing, self-performance" on the Admission MDS is 1 or more levels less than on the 90-day MDS. Residents with Admission and 90-day MDS assessments with valid responses at both time points for the "dressing-self performance" item. [AdmissionMDS] G0110G1 - [90dayMDS] G0110G1 le -1 ([AdmissionMDS] G0110G1=0,1,2, or 3) ([90dayMDS] G0110G1=0,1,2, 3 or 4) [Admission or 90-day MDS] "Prognosis: Does the resident have a condition or chronic disease that may result in a life expectancy of less than 6 months?" = 1 - Yes [J1400] [AdmissionMDS] "Dressing, self-performance"=4,7,8 - Total dependence, Activity occurred only once or twice, Activity did not occur [G0110G1] Missing data on G0110G1 at either time point MDS assessments selected are: a 90-day ((A0310A=02,04, or 06 or A0310B=05 and A0310F=99) the Admission ( A0310A=01 or A0310B=01 or 06) and A0310F=99) that precedes the 90-day assessment. If the 90-day assessment is a significant change or correction assessment (A0310A=4 or 6), the difference between the admission and 90-day Assessment Reference Dates (ARD) (A2300) must be at least 1 day but no more than 94 days (with the Admission ARD occurring before the 90-day ARD). If the 90-day assessment is a quarterly assessment (A0310A=2) or 90-day (A0310B=5), the difference between the admission and 90-day ARD must be between 66 and 94 days (inclusive), with the Admission ARD occurring before the 90-day ARD. CMS (10/2011) Dictionary Page 15 of 118

29 Care Area: Activities of Daily Living, Cleanliness and Grooming QCLI Name: Dressing Severe Decline (Admission & 90-Day MDS) Threshold-Small Facilities: >14.0% Threshold-Not Small Facilities: >14.0% QP028a Definition: Resident has declined two or more levels in dressing in 90 days. Sample: MDS Data Source: MDS MDS Timepoint: Admission & 90-Day Denominator Updated: 08/30/2011 Residents with Admission and 90-day MDS assessments "Dressing, self-performance" on the Admission MDS is 2 or more levels less than on the 90-day MDS. [AdmissionMDS] G0110G1 - [90dayMDS] G0110G1 le -2 Residents with Admission and 90 day MDS assessments with valid responses at both time points for the "dressing-self performance" item. ([AdmissionMDS] G0110G1=0,1, or 2) ([90dayMDS] G0110G1=0,1,2, 3 or 4) [Admission or 90-day MDS] "Prognosis: Does the resident have a condition or chronic disease that may result in a life expectancy of less than 6 months?" = 1 - Yes [J1400] [AdmissionMDS] "Dressing, self-performance"=3,4,7,8 - Extensive assistance, Total dependence, Activity occurred only once or twice, Activity did not occur [G0110G1] If the resident is in the numerator or denominator of QP028b (Dressing Severe Decline (Previous-Most Recent (excl. Adm.) Missing data on G0110G1 at either time point MDS assessments selected are: a 90-day ((A0310A=02,04, or 06 or A0310B=05 and A0310F=99) the Admission ( A0310A=01 or A0310B=01 or 06) and A0310F=99) that precedes the 90-day assessment. If the 90-day assessment is a significant change or correction assessment (A0310A=4 or 6), the difference between the admission and 90-day Assessment Reference Dates (ARD) (A2300) must be at least 1 day but no more than 94 days (with the Admission ARD occurring before the 90-day ARD). If the 90-day assessment is a quarterly assessment (A0310A=2) or 90-day (A0310B=5), the difference between the admission and 90-day ARD must be between 66 and 94 days (inclusive), with the Admission ARD occurring before the 90-day ARD. CMS (10/2011) Dictionary Page 16 of 118

30 Care Area: Activities of Daily Living, Cleanliness and Grooming QCLI Name: Dressing Severe Decline (Previous & Most Recent (excl.adm.) MDS) Threshold-Small Facilities: >7.0% Threshold-Not Small Facilities: >7.0% QP028b Definition: Resident has declined two or more levels in dressing in 90 days. Residents with Previous and Most Recent (excl.adm.) MDS assessments "Dressing, self-performance" on the Previous MDS is 2 or more levels less than on the Most Recent (excl.adm.) MDS. Sample: MDS Data Source: MDS MDS Timepoint: Prev & Most Recent (excl.adm.) Denominator Updated: 08/30/2011 Residents with Previous and Most Recent (excl.adm.) MDS assessments with valid responses at both time points to the "dressing self-performance" item. ([PrevMDS] G0110G1 - [MR (excl.adm.) MDS] G0110G1) le -2 [PrevMDS] G0110G1=0,1, or 2 [MR (excl.adm.) MDS] G0110G1=0,1,2,3, or 4 [Prev or MR (excl.adm.) MDS] "Prognosis: Does the resident have a condition or chronic disease that may result in a life expectancy of less than 6 months?" = 1 - Yes [J1400] [Prev MDS] "Dressing, self-performance" = 3,4,7,8 - Extensive assistance, Total dependence, Activity occurred only once or twice, Activity did not occur [G0110G1] Missing data on G0110G1 at either time point MDS assessments selected are: MR (excluding Admission) where ((A0310A=02,03,04,05, or 06 or A0310B=02,03,04, or 05) and A0310F=99) the second most recent [Prev] where ((A0310A=01,02,03,04,05, or 06 or A0310B=01,02,03,04,05, or 06) and A0310F=99). The difference between the Prev and the MR (excl. Adm.) Assessment Reference Dates (ARD) (A2300) must be at least 1 day but no more than 94 days (with the Prev ARD occurring before the MR (excl. Adm.) ARD. Prev=Previous and MR(excl. Adm.)=Most Recent Excluding Admission. CMS (10/2011) Dictionary Page 17 of 118

31 Care Area: Activities of Daily Living, Cleanliness and Grooming QCLI Name: Eating Decline Since Admission (Admission & 90-Day MDS) Threshold-Small Facilities: >49.0% Threshold-Not Small Facilities: >49.0% QP031 Definition: Resident has declined in eating in 90 days. Sample: MDS Data Source: MDS MDS Timepoint: Admission & 90-Day Denominator Updated: 08/30/2011 Residents with Admission and 90-day MDS assessments Residents with Admission and 90 day MDS assessments with valid responses at both time points for the "eating-self performance" item. "Eating, self-performance" on the Admission MDS is 1 or more levels less than on the 90-day MDS. [AdmissionMDS] G0110H1 - [90dayMDS] G0010H1 le -1 ([AdmissionMDS] G0110H1=0,1,2, or 3) and ([90dayMDS] G0110H1=0,1,2,3, or 4) [Admission or 90-day MDS] "Prognosis: Does the resident have a condition or chronic disease that may result in a life expectancy of less than 6 months?" = 1 - Yes [J1400] [AdmissionMDS] "Eating, self-performance"=4,7,8-total dependence, Activity occurred only once or twice, Activity did not occur [G0110H1] Missing data on G0110H1 at either time point MDS assessments selected are: a 90-day ((A0310A=02,04, or 06 or A0310B=05 and A0310F=99) the Admission ( A0310A=01 or A0310B=01 or 06) and A0310F=99) that precedes the 90-day assessment. If the 90-day assessment is a significant change or correction assessment (A0310A=4 or 6), the difference between the admission and 90-day Assessment Reference Dates (ARD) (A2300) must be at least 1 day but no more than 94 days (with the Admission ARD occurring before the 90-day ARD). If the 90-day assessment is a quarterly assessment (A0310A=2) or 90-day (A0310B=5), the difference between the admission and 90-day ARD must be between 66 and 94 days (inclusive), with the Admission ARD occurring before the 90-day ARD. CMS (10/2011) Dictionary Page 18 of 118

32 Care Area: Activities of Daily Living, Cleanliness and Grooming QCLI Name: Toileting Decline Since Admission (Admission & 90-Day MDS) Threshold-Small Facilities: >33.3% Threshold-Not Small Facilities: >33.3% QP034 Definition: Resident has declined one or more levels in toileting since admission. Sample: MDS Data Source: MDS MDS Timepoint: Admission & 90-Day Denominator Updated: 08/30/2011 Residents with Admission and 90-day MDS assessments "Toilet use, self-performance" on the Admission MDS is 1 or more levels less than on the 90-day MDS. Residents with Admission and 90-day MDS assessments with valid responses at both time points for the "toilet use-self performance" item. [AdmissionMDS] G0110I1 - [90dayMDS] G0110I1 le -1 ([AdmissionMDS] G0110I1=0,1,2, or 3) and([90daymds] G0110I1=0,1,2,3, or 4) [Admission or 90-day MDS] "Prognosis: Does the resident have a condition or chronic disease that may result in a life expectancy of less than 6 months?" = 1 - Yes [J1400] [AdmissionMDS] "Toilet use, self-performance"=4,7,8-total dependence, Activity occurred only once or twice, Activity did not occur [G0110I1] Missing data on G0110I1 at either time point MDS assessments selected are: a 90-day ((A0310A=02,04, or 06 or A0310B=05 and A0310F=99) the Admission ( A0310A=01 or A0310B=01 or 06) and A0310F=99) that precedes the 90-day assessment. If the 90-day assessment is a significant change or correction assessment (A0310A=4 or 6), the difference between the admission and 90-day Assessment Reference Dates (ARD) (A2300) must be at least 1 day but no more than 94 days (with the Admission ARD occurring before the 90-day ARD). If the 90-day assessment is a quarterly assessment (A0310A=2) or 90-day (A0310B=5), the difference between the admission and 90-day ARD must be between 66 and 94 days (inclusive), with the Admission ARD occurring before the 90-day ARD. CMS (10/2011) Dictionary Page 19 of 118

33 Care Area: Activities of Daily Living, Cleanliness and Grooming QCLI Name: Locomotion Decline Since Admission (Admission & 90-Day MDS) Threshold-Small Facilities: >99.0% Threshold-Not Small Facilities: >99.0% QP038 Definition: Resident has declined one or more levels in locomotion since admission. Residents with Admission and 90-day MDS assessments "Locomotion on unit, self-performance" on the Admission MDS is 1 or more levels less than on the 90-day MDS. Sample: MDS Data Source: MDS MDS Timepoint: Admission & 90-Day Denominator Updated: 08/30/2011 Residents with Admission and 90-day MDS assessments and valid responses at both time points for the "locomotion on unit-self performance" item. [AdmissionMDS] G0110E1 - [90dayMDS] G0110E1 le -1 ([AdmissionMDS] G001E1=0,1,2, or 3) and ([90dayMDS] G001E1=0,1,2,3, or 4) [Admission or 90-day MDS] "Prognosis: Does the resident have a condition or chronic disease that may result in a life expectancy of less than 6 months?" = 1 - Yes [J1400] [AdmissionMDS] "Locomotion on unit, self-performance" =4,7,8-Total dependence, Activity occurred only once or twice, Activity did not occur [G0110E1] Missing data on G0110E1at either time point MDS assessments selected are: a 90-day ((A0310A=02,04, or 06 or A0310B=05 and A0310F=99) the Admission ( A0310A=01 or A0310B=01 or 06) and A0310F=99) that precedes the 90-day assessment. If the 90-day assessment is a significant change or correction assessment (A0310A=4 or 6), the difference between the admission and 90-day Assessment Reference Dates (ARD) (A2300) must be at least 1 day but no more than 94 days (with the Admission ARD occurring before the 90-day ARD). If the 90-day assessment is a quarterly assessment (A0310A=2) or 90-day (A0310B=5), the difference between the admission and 90-day ARD must be between 66 and 94 days (inclusive), with the Admission ARD occurring before the 90-day ARD. CMS (10/2011) Dictionary Page 20 of 118

34 Care Area: Activities of Daily Living, Cleanliness and Grooming QCLI Name: Locomotion Severe Decline (Admission & 90-Day MDS) Threshold-Small Facilities: >1.0% Threshold-Not Small Facilities: >1.0% QP039a Definition: Resident has declined two or more levels in locomotion in 90 days. Sample: MDS Data Source: MDS MDS Timepoint: Admission & 90-Day Denominator Updated: 08/30/2011 Residents with Admission and 90-day MDS assessments Residents with Admission and 90 day MDS assessments and valid responses at both time points for the "locomotion on unit-self performance" item. "Locomotion on unit, self performance" on the Admission MDS is 2 or more levels less than on the 90-day MDS [AdmissionMDS] G0110E1 - [90dayMDS] G001E1 le -2 [(AdmissionMDS] G0110E1=0,1, or 2) and ([90dayMDS] G0110E1=0,1,2,3, or 4) [Admission or 90-day MDS] "Prognosis: Does the resident have a condition or chronic disease that may result in a life expectancy of less than 6 months?" = 1 - Yes [J1400] [AdmissionMDS] "Locomotion on unit, self-performance"=3,4,7,8-extensive assistance, Total dependence, Activity occurred only once or twice, Activity did not occur [G0110E1] If the resident is in the numerator or denominator of QP039b (Locomotion Severe Decline (Previous-Most Recent (excl. Adm.) Missing data on G0110E1 at either time point MDS assessments selected are: a 90-day ((A0310A=02,04, or 06 or A0310B=05 and A0310F=99) the Admission ( A0310A=01 or A0310B=01 or 06) and A0310F=99) that precedes the 90-day assessment. If the 90-day assessment is a significant change or correction assessment (A0310A=4 or 6), the difference between the admission and 90-day Assessment Reference Dates (ARD) (A2300) must be at least 1 day but no more than 94 days (with the Admission ARD occurring before the 90-day ARD). If the 90-day assessment is a quarterly assessment (A0310A=2) or 90-day (A0310B=5), the difference between the admission and 90-day ARD must be between 66 and 94 days (inclusive), with the Admission ARD occurring before the 90-day ARD. CMS (10/2011) Dictionary Page 21 of 118

35 Care Area: Activities of Daily Living, Cleanliness and Grooming QCLI Name: Locomotion Severe Decline (Previous & Most Recent (excl.adm.) MDS) Threshold-Small Facilities: >20.0% Threshold-Not Small Facilities: >20.0% QP039b Definition: Resident has declined two or more levels in locomotion within 90 days. Residents with Previous and Most Recent (excl.adm.) MDS assessments "Locomotion on unit, self performance" on the Previous MDS is 2 or more levels less than on the Most Recent (excl.adm.) MDS. Sample: MDS Data Source: MDS MDS Timepoint: Prev & Most Recent (excl.adm.) Denominator Updated: 08/30/2011 Residents with Previous and Most Recent (excl.adm.) MDS assessments with valid responses at both time points for the "locomotion" item. ([PrevMDS] G0110E1 - [MR (excl.adm.) MDS] G0110E1 le -2) [(PrevMDS] G0110E1=0,1, or 2) and ([MR (excl.adm.) MDS] G0110E1=0,1,2,3, or 4) [Previous or Most Recent (excl.adm.) MDS] "Prognosis: Does the resident have a condition or chronic disease that may result in a life expectancy of less than 6 months?" = 1 - Yes [J1400] [Previous MDS] "Locomotion on unit, self-performance"=3,4,7,8-extensive assistance, Total dependence, Activity occurred only once or twice, Activity did not occur [G0010E1] Missing data for G0110E1 at either time point MDS assessments selected are: MR (excluding Admission) where ((A0310A=02,03,04,05, or 06 or A0310B=02,03,04, or 05) and A0310F=99) the second most recent [Prev] where ((A0310A=01,02,03,04,05, or 06 or A0310B=01,02,03,04,05, or 06) and A0310F=99). The difference between the Prev and the MR (excl. Adm.) Assessment Reference Dates (ARD) (A2300) must be at least 1 day but no more than 94 days (with the Prev ARD occurring before the MR (excl. Adm.) ARD. Prev=Previous and MR(excl. Adm.)=Most Recent Excluding Admission. CMS (10/2011) Dictionary Page 22 of 118