• Age 90 or older • Cognitive decision making:severely impaired • Delirium: Periods of lethargy • Ability to understand: sometimes or rarely • Transfer (extensive assistance or total dependence or did not occur) • Locomotion (extensive, total, did not occur) • Eating (extensive, total, did not occur) • Personal hygiene (total, did not occur) • Sad mood (daily repetitive verbalizations and/or something terrible about to happen) • Acute episode • Unstable • Change in care needs (has deteriorated) • End stage disease • Bowel (occasional, frequent incontinence) • Weight loss • Pressure or stasis ulcers The above items are on the quarterly and full MDS. Additional items on the full MDS: • Shortness of breath • Oxygen therapy • Problem swallowing • Time awake afternoon (zero) • Cardiac dysrhythmia • Congestive heart failure • Skin tears or cuts