OASIS Alert

Just because a patient can't get her clothes from the closet without assistance doesn't mean she can't dress independently.

The answers you put in M0650/M0660 are based on what your patients are able to do more than 50 percent of the time. For instance, if your patient can dress herself without any problems, you should score her with a 0 (Independent -- no assistance or supervision required). How-ever, if she is usually completely dependent on others to obtain clothes and put them on, you should score her as 3 (Totally dependent on another person to dress/don clothing) -- even if she sometimes feels well enough to dress herself. But a patient's ability to dress and undress herself without help more than half of the time may not be as cut and dried as you think. You can improve your outcomes -- and patients' quality of life -- by evaluating whether a few simple changes will allow your patients more independence, says Debbie Dawson, RN, HCS-D, COS-C, a consultant with HealthCare Strategies.

Typical situations: Usually, a patient has kept her clothes in the same location for a long time, such as always hanging her shirts in the closet. Then the patient has surgery that limits her ability to reach up for the shirts. Now the patient is a 1 (Requires clothes to be laid out -- removed from closet/drawers and set-up or requires a device for dressing). Or, the patient also cannot dress herself and is a 2 (Needs some assistance to don clothing/shoes).

Most situations are temporary setbacks that will improve as the patient's wounds heal, Dawson notes. Therefore, you may start the episode at a 2, or 3, but the patient will be back at 0 or 1 by the end of the episode.

Short-term: You can improve even these temporary situations so that patients can dress independently. For instance, you might suggest that your patient's caregiver move all of her shirts to a chair next to the bed where she can reach them by herself. When the patient is able to reach up again, the caregiver can put the clothes back in their permanent location. Because the patient doesn't intend to make this a permanent solution, the patient's status can move from a 2 or 3 to a 1 -- but not a 0, according to the Center for Medicare & Medi-caid Services' October 2008 clarification on the OASIS Certificate and Competency Board's (OCCB) website.