OASIS Complete Webinar Series The Functional Activity Assessment from the Caregiver s Perspective Presented By: Rhonda Marie Will, RN, BS, HCS-D, COS-C October 8, 2010 243 King Street, Suite 246 Northampton, MA 01060 413-584-5300 fax: 413-584-0220 e-mail: info@fazzi.com www.fazzi.com
Instructions and Handouts for: The Functional Activity Assessment from the Caregiver s Perspective 11 12 10 9 8 7 6 1 2 3 4 5 Eastern Standard Time 1:00 PM to 2:00 PM 11 12 10 9 8 7 6 1 2 3 4 5 Central Standard Time 12:00 PM to 1:00 PM 11 12 10 9 8 7 6 1 2 3 4 5 Mountain Standard Time 11:00 AM to 12:00 PM 11 12 10 9 8 7 6 1 2 3 4 5 Pacific Standard Time 10:00 AM to 11:00 AM It is very important that you have these materials printed and ready to use prior to the start of the training. In order to participate in this training you will need to do the following: Dial 1-877-615-4339 at least 10 minutes prior to the start of the webinar. 1. When asked, enter Conference ID 6529707# 2. Give your agency s name. 3. At this time you will be entered into the call and in listen mode. 4. If at any time you need assistance you may press *0 for the operator. 5. There will be a Q & A period toward the end of the session. Questions will be answered in the order in which they are received. To ask a question, press *1. You will have the opportunity to ask your question and then be returned to listen mode. Do not press *1 prior to this time. 6. To view the presentation online you must click on the link sent to you from GoToWebinar. Nurses Only: Directions to receive contact hours for the training. 1. Each participant must complete an evaluation in order to receive contact hours. Click on the following link in order to access the online evaluation form: https://www.surveymonkey.com/s/gndc3ls *Please allow four weeks for processing. Fazzi Associates, Inc. 1
Speaker Information Rhonda Will, RN, BS, COS-C, HCS-D is the Assistant Director of the OASIS Competency Institute for Fazzi Associates, Inc. As a registered nurse she has worked in home health care since 1979 in various clinical, administrative and management roles. Rhonda has extensive experience in staff and program development and as a consultant and trainer. Her areas of expertise include OASIS assessment and diagnosis selection and ICD-9-CM skill building, documentation, care planning and management, and regulatory compliance. With Fazzi Associates Rhonda has developed OASIS and clinical training programs, record audits for reimbursement and quality and ICD-9-CM Coding training. She presents educational programs on site and by audio/video conferencing for home health agencies, state and national home health associations and industry vendor sponsored meetings.. Rhonda provided clinical leadership for the 2003 3M National OASIS Integrity Project and the 2009 National Best Practices OASIS C Project with Fazzi Associates. Recognized as an industry expert, she gave feedback on data items in the CMS draft OASIS C Guidance Manual and The Handbook of Home Health Standards: Quality, Documentation and Reimbursement (5th ed.) by Tina Marelli. Rhonda served on the Editorial Board for Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional from 2008-2010 and conducts peer review for draft magazine articles. Fazzi Associates, Inc. 2
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OASIS-Complete Webinar Series The Functional Activity Assessment from the Caregiver s Perspective October 8, 2010 Rhonda Will, RN, BS, COS-C, HCS-D Assistant Director of OASIS Competency Institute Fazzi Associates, Inc. rwill@fazzi.com Objectives Describe the convention for scoring OASIS ADL/IADL items when there is varying ability Define assistance Fazzi Associates, Inc. 4
OASIS Conventions Assessment strategies Interview Observation Patient demonstration OASIS Walk Use all available sources to complete OASIS items Physician, patient, referral information, caregivers The OASIS WALK WatchW A L K ssess isten now Fazzi Associates, Inc. 5
Ability: The OASIS WALK in PACES Physical condition Activities permitted, medical restrictions Cognitive condition, mental and emotional status Environment and availability of Equipment Sensory condition Consider the criteria. Document what he/she has had the ability to do safely in this 24 hr period of assessment. OASIS Think: Key Conventions Assistance: In person any amount of verbal or physical intervention From supervision, verbal cues hands on Assistive devices: CMS has not provided formal list Service animals are considered an assistive device and not in person/human assistance. Use clinical judgment Fazzi Associates, Inc. 6
OASIS Think: Key Conventions Functional ability may be different than: Performance What was directly observed during the assessment process and/or Willingness What the patient may or may not choose to do on a regular basis Is not related to the presence or absence of a caregiver OASIS Think: Varying Ability Time: When ability varies over the time period under consideration (e.g., day of assessment) Report what is true > 50% of the time Tasks/Items: When ability varies among a group of items/tasks (e.g. M1800 Grooming, M1810/1820 Dressing, M1900 Prior ADL, etc) Report what is true for the majority of the items Fazzi Associates, Inc. 7
Grooming and Dressing Majority of TASKS If varying ability on day of assessment select level of ability to perform the majority and/or more frequently performed grooming g tasks. A patient is unable to manage zippers and buttons, but is able to safely gather the items and independently dress is clothing styles she has preferred for years loose pullover tops, pull on pants and slip on shoes. M1810 Ability to Dress Upper Body Consider prosthetic, orthotic or other supportive and protective devices. Fazzi Associates, Inc. 8
M1830 Bathing (M1830) Bathing: Current ability to wash entire body safely. Excludes grooming (washing face, washing hands, and shampooing hair). (Able to transfer by some safe means/accessible/permitted on day of assessment) 0 - Able to bathe self in shower or tub independently, including getting in and out of tub/shower. 1 - With the use of devices, is able to bathe self in shower or tub independently, including getting in and out of the tub/shower. 2 - Able to bathe in shower or tub with the intermittent assistance of another person: (a) for intermittent supervision or encouragement or reminders, OR (b) to get in and out of the shower or tub, OR (c) for washing difficult to reach areas. 3 - Able to participate in bathing self in shower or tub, but requires presence of another person throughout the bath for assistance or supervision. M1830 Bathing (M1830) Bathing: Current ability to wash entire body safely. Excludes grooming (washing face, washing hands, and shampooing hair). Bathing and transfer (Unable to transfer safely by some means/inaccessible/not permitted on day of assessment) 4 - Unable to use the shower or tub, but able to bathe self independently with or without the use of devices at the sink, in chair, or on commode. 5 - Unable to use the shower or tub, but able to participate in bathing self in bed, at the sink, in bedside chair, or on commode, with the assistance or supervision of another person throughout the bath. 6 - Unable to participate effectively in bathing and is bathed totally by another person. Fazzi Associates, Inc. 9
M1830 - Bathing Response Environment Assistance 0 In Shower/Tub None 1 In Shower/Tub Devices 2 In Shower/Tub Intermittent Assistance 3 In Shower/Tub Presence of Another Throughout 4 Sink/Chair/Commode No Human Assistance 5 Bed/Sink/Chair/Commode Presence of Another Throughout 6 Unspecified Totally Dependent With someone present throughout the bath to provide cues for safety and sequencing activities, the patient is able to perform all bathing tasks safely without any hands-on assistance. M1830 - Bathing Fazzi Associates, Inc. 10
M1840 Toilet Transferring A patient is able to use a commode, can clean self independently and needs supervision for clothing management for safety reasons. M1845 Toileting Hygiene Hygiene and clothing management Fazzi Associates, Inc. 11
M1850 - Transferring Move from supine position on sleeping surface sitting position another sitting surface M1860 - Ambulation (M1860) Ambulation/Locomotion: Current ability to walk safely, once in a standing position, or use a wheelchair, once in a seated position, on a variety of surfaces. 0 - Able to independently walk on even and uneven surfaces and negotiate stairs with or without railings (i.e., needs no human assistance or assistive device). 1 - With the use of a one-handed device (e.g. cane, single crutch, hemiwalker), able to independently walk on even and uneven surfaces and negotiate stairs with or without railings. 2 - Requires use of a two-handed device (e.g., walker or crutches) to walk alone on a level surface and/or requires human supervision or assistance to negotiate stairs or steps or uneven surfaces. 3 - Able to walk only with the supervision or assistance of another person at all times. Fazzi Associates, Inc. 12
M1860 - Ambulation 4 - Chairfast, unable to ambulate but is able to wheel self independently. 5 - Chairfast, unable to ambulate and is unable to wheel self. 6 - Bedfast, unable to ambulate or be up in a chair. M1860 - Ambulation Response Environment Assistance 0 Even/Uneven e e e Surfaces Noneo e and Stairs 1 Even/Uneven Surfaces One-handed device and Stairs 2 Even/Uneven Surfaces Surfaces > Human One or Two-handed Supervision/Assistance device for But and Uneven StairsSurfaces/Stairs> Stairs, Human Steps, Supervision/Assistance Uneven Surfaces 3 Unspecified Human Supervision/Assistance at All times Times 4 Chairfast No Able Human to Wheel Assistance Self 5 Chairfast Unable to Wheel Self 6 Bedfast NA Fazzi Associates, Inc. 13
A patient lives alone and is currently walking throughout two levels of the house with no assistive device. She is observed to frequently rely on the furniture and walls to support herself and when M1860 asked to walk - Ambulation unsupported, her gait is unsteady. Score on the fall risk assessment is high. The patient has a feeding tube in place. Oral intake is good so the tube is not being used. He requires intermittent supervision while eating due to history of aspiration with certain consistencies. M1870 Feeding and Eating The feeding tube is only considered if being used for nutritional intake. Fazzi Associates, Inc. 14
The patient reports making herself a sandwich for lunch but needed her husband to make her breakfast today because my hands were sore. M1880 Ability to Plan and Prepare Light Meals Any prescribed diet requirements should be considered Don t forget ability vs. willingness With enteral feedings, do not consider ability to set up, monitor and change the equipment. The patient s daughter reports it is difficult to reach the patient by phone She forgets to answer sometimes and gets M1890 Ability to Use Telephone distracted. I have to repeat myself several times and occasionally she has hung up mid-conversation. Includes: ability to safely answer the phone, dial a number and effectively use the phone to communicate. Fazzi Associates, Inc. 15
M1900 Prior Functioning ADL/IADL Used for risk adjustment and in care planning (goal setting) 3 levels of human assistance to safely complete tasks Independent: Required no human assistance Needed some help: Required some effort from another Dependent: Required total effort of another, unable to contribute any physical or cognitive effort If varying ability, reflect level of ability for the majority of the tasks Fazzi Associates, Inc. 243 King Street, t Suite 246 Northampton, MA 01060 800-379-0361 www.fazzi.com rwill@fazzi.com Fazzi Associates, Inc. 16