MDS Alert

Answer: This resident would not meet the MDS definition of bedfast. As stated in the question, the RAI manual definition of bedfast is a resident who is in his/her bed or chair 22 hours or more, in his/her own room. The concept of disregarding level of function is referring to level of ADL ability. In other words, a person who is able to get up and walk, but chooses to stay in bed 22 hours or more for four out of the seven days in the lookback would be coded as bedfast, even though she was able to get out of bed. The manual goes on to explain that "immobility, whether innate or self-inflicted, places residents at risk for a myriad of clinical problems. For example, being bedfast may also be an indicator that a resident is withdrawn from others and suffers from depression" (updated December 2002, RAI user's manual). For this resident, your assessment would focus on sections E, F and N of the MDS. These items assist in screening for indications of depression, and the potential impact on the resident's well-being from the possible social isolation experienced.

Expert advice provided by Cheryl Field, MSN, RN, CRRN, director of clinical and reimbursement services with LTCQ Inc. in Lexington, MA (www.ltcq.com).