MDS Alert

Question: What's an exception to "three strikes and you code" where you code the highest level of support required by the resident three times when completing column A for activities of daily living?

Answer: "Total Dependence," which the 2002 RAI user's manual defines as "full staff performance of the activity during entire seven-day period" (see page 3-81). If staff performed an activity for the resident during the entire observation period, but the resident performed part of the activity himself/herself, you would not code a "4" (Total Dependence).
 
Thus, a resident would not necessarily be coded as "total dependence" in self-performance using the three-strike concept. In order [for you] to code "total dependence," the resident's nonparticipation in all aspects of the ADL would have to occur "every time" during the seven-day look-back period.

If you're not sure exactly what self-performance score to use for ADL tasks listed in MDS Section G1, refer to the ADL Self-Performance Tree found in the 2002 RAI User's manual (page 3-90) as your guide.

Expert advice provided by Andrea Platt, RN, MDS consultant with Thomas Health Care Consulting in Fishers, IN.