MDS Alert

Scenario No. 1: Dr. B had been highly involved in self-care in most ADL activities. Seven weeks ago he slipped, fell, and bruised his right wrist. For several weeks he received more extensive assistance with dressing, grooming, and eating. However, in the last three weeks, he is functioning at the same level of involvement in ADLs as before the fall.

Scenario No. 2: Ms. A participated in a structured feeding group during the past six weeks. With lots of encouragement and supervision from the group leader, she has progressed from requiring extensive assistance to feeding herself under staff supervision. Her performance in other ADLs remains unchanged.

Scenario No. 3: Since fracturing her left hip three weeks ago, Mrs. Z receives more weight bearing help with transfers, locomotion, dressing, toileting, personal hygiene, and bathing. However, she has made strides in OT and PT. Her improvement in self-care has been steady although she still has a long way to go to reach her self-performance level of 90 days ago.

Ready, set, code: Code whether the resident's ADL status has changed compared to his or her status 90 days ago or since the last assessment if less than 90 days ago.

Code "0" if there has been no change. Code "1" if the resident's ADL function has improved. Code "2" if the resident's function has deteriorated.

Scenario No. 1: Code "0" for no change.

Scenario No. 2: Code "1" for improved.

Scenario No. 3: Code "2" for deteriorated.

Rationale: The intent for G9 is to document any changes occurring in the resident's overall ADL self-performance, as compared to their status 90 days ago or since the last assessment if less than 90 days ago. "This item asks for a snapshot of 'today' as compared to 90 days ago (i.e., a comparison of two points in time)," instructs the RAI user's manual. "These include, but are not limited to, changes in the resident's level of involvement in ADL activities as well as the amount and the type of support received by staff. If the resident is a new admission to the facility, this item includes changes during the period prior to admission.

Process: Review the record for indications of a change. Consult with the resident and direct care staff. Review Section G from the last assessment and compare these findings with current findings. For new residents, consult with the primary family caregiver. You may find that some ADLs have improved, some deteriorated, and others remain unchanged. You must weigh all of the information and make an overall clinical judgment (e.g., in general, the resident's ADL function has ...)."