OASIS Complete Webinar Series - Fazzi Associatesstart of the training. In order to participate in...

OASIS Complete Webinar Series

The Functional Activity Assessment from the Caregiver’s Perspective

Presented By: Rhonda Marie Will, RN, BS, HCS-D, COS-C

October 8, 2010

243 King Street, Suite 246 Northampton, MA 01060

413-584-5300 fax: 413-584-0220

e-mail: [email protected] www.fazzi.com

Instructions and Handouts for: The Functional Activity Assessment from the Caregiver’s Perspective

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Fazzi Associates, Inc. 1

Speaker Information Rhonda Will, RN, BS, COS-C, HCS-D is the Assistant Director of the OASIS Competency Institute for Fazzi Associates, Inc. As a registered nurse she has worked in home health care since 1979 in various clinical, administrative and management roles. Rhonda has extensive experience in staff and program development and as a consultant and trainer. Her areas of expertise include OASIS assessment and diagnosis selection and ICD-9-CM skill building, documentation, care planning and management, and regulatory compliance. With Fazzi Associates Rhonda has developed OASIS and clinical training programs, record audits for reimbursement and quality and ICD-9-CM Coding training. She presents educational programs on site and by audio/video conferencing for home health agencies, state and national home health associations and industry vendor sponsored meetings.. Rhonda provided clinical leadership for the 2003 3M National OASIS Integrity Project and the 2009 National Best Practices OASIS C Project with Fazzi Associates. Recognized as an industry expert, she gave feedback on data items in the CMS draft OASIS C Guidance Manual and The Handbook of Home Health Standards: Quality, Documentation and Reimbursement (5th ed.) by Tina Marelli. Rhonda served on the Editorial Board for “Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional” from 2008-2010 and conducts peer review for draft magazine articles.


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OASIS-Complete Webinar Series

The Functional Activity Assessment from the Caregiver’s Perspective

October 8, 2010

©2009

Rhonda Will, RN, BS, COS-C, HCS-DAssistant Director of OASIS Competency Institute

Fazzi Associates, Inc.

[email protected]

Objectives

Describe the convention for scoring OASISDescribe the convention for scoring OASIS ADL/IADL items when there is varying ability

Define “assistance”

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OASIS Conventions

Assessment strategiesInterview– Interview

– Observation – Patient demonstration

• OASIS Walk®

Use all available sources to complete OASIS

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Use all available sources to complete OASIS items– Physician, patient, referral information, caregivers

The OASIS WALK®

WatchWAL

atchssessisten

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LK

istennow


Ability: The OASIS WALK® in PACES

Physical conditionActivities permitted medical restrictionsActivities permitted, medical restrictionsCognitive condition, mental and emotional statusEnvironment and availability of EquipmentSensory condition

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Consider the criteria. Document what he/she has had the ability to do safely in this 24 hr period of assessment.

OASIS Think: Key Conventions

Assistance: In person any amount of verbal or physical– In person– any amount of verbal or physical intervention

– From supervision, verbal cues hands on

Assistive devices: CMS has not provided formal list

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– CMS has not provided formal list– Service animals are considered an “assistive

device” and not “in person/human” assistance.– Use clinical judgment


OASIS Think: Key Conventions

“Functional ability” may be different than:

Performance What was directly observed during the assessment process

and/orWillingness

What the patient may or may not choose to do on a regular basis

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Is not related to the presence or absence of a caregiver

OASIS Think: Varying Ability

Time: When ability varies over the time period under consideration (e g day of assessment)consideration (e.g., day of assessment)

Report what is true > 50% of the time

Tasks/Items: When ability varies among a group of items/tasks (e.g. M1800 Grooming, M1810/1820

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Dressing, M1900 Prior ADL, etc)

Report what is true for the majority of the items


Grooming and Dressing

Majority of TASKS

If varying ability on day of assessment…

select level of ability to perform the majorityand/or more frequently performed grooming

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Time Points

q y p g gtasks.

M1810 – Ability to Dress Upper BodyA patient is unable to manage zippers and buttons, but is able to safely gather the items and independently dress is clothing styles she has preferred for years – loose pullover tops, pull on pants and slip on shoes.

Consider prosthetic, orthotic or other supportive and protective devices.

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Time Points


M1830 Bathing(M1830) Bathing: Current ability to wash entire body safely. Excludes grooming

(washing face, washing hands, and shampooing hair).

(Able to transfer by some safe means/accessible/permitted on day of assessment)

0 - Able to bathe self in shower or tub independently, including getting in and out of tub/shower.

1 - With the use of devices, is able to bathe self in shower or tub independently, including getting in and out of the tub/shower.

2 - Able to bathe in shower or tub with the intermittent assistance of another person: (a) for intermittent supervision or encouragement or reminders OR

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(a) for intermittent supervision or encouragement or reminders, OR (b) to get in and out of the shower or tub, OR (c) for washing difficult to reach areas.

3 - Able to participate in bathing self in shower or tub, but requires presence of another person throughout the bath for assistance or supervision.

M1830 Bathing(M1830) Bathing: Current ability to wash entire body safely. Excludes grooming

(washing face, washing hands, and shampooing hair). Bathing and transfer

(Unable to transfer safely by some means/inaccessible/not permitted on day of assessment)

4 - Unable to use the shower or tub, but able to bathe self independently with or without the use of devices at the sink, in chair, or on commode.

5 - Unable to use the shower or tub, but able to participate in bathing

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5 Unable to use the shower or tub, but able to participate in bathing self in bed, at the sink, in bedside chair, or on commode, with the assistance or supervision of another person throughout the bath.

6 - Unable to participate effectively in bathing and is bathed totally by another person.


M1830 - BathingResponse Environment Assistance

0 In Shower/Tub None

1 In Shower/Tub Devices

2 In Shower/Tub Intermittent Assistance

3 In Shower/Tub Presence of Another Throughout

4 Sink/Chair/Commode No Human Assistance

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Time Points

5 Bed/Sink/Chair/Commode Presence of Another Throughout

6 Unspecified Totally Dependent

M1830 - BathingWith someone present throughout the bath to provide cues for safety and sequencing activities, the patient is able to perform all bathing tasks safely without any hands-on assistance.

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Time Points


M1840 – Toilet Transferring©2009

Time Points

M1845 – Toileting HygieneA patient is able to use a commode, can clean self independently and needs supervision for clothing management for safety reasons.

Hygiene and clothing management

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Time Points


M1850 - Transferring

Move from supine position on sleeping surface sitting position another

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Time Points

surface sitting position another sitting surface

M1860 - Ambulation(M1860) Ambulation/Locomotion: Current ability to walk safely, once in a

standing position, or use a wheelchair, once in a seated position, on a variety of surfaces.

0 - Able to independently walk on even and uneven surfaces and negotiate stairs with or without railings (i.e., needs no human assistance or assistive device).

1 - With the use of a one-handed device (e.g. cane, single crutch, hemi-walker), able to independently walk on even and uneven surfaces and negotiate stairs with or without railings.

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2 - Requires use of a two-handed device (e.g., walker or crutches) to walk alone on a level surface and/or requires human supervision or assistance to negotiate stairs or steps or uneven surfaces.

3 - Able to walk only with the supervision or assistance of another person at all times.


M1860 - Ambulation

4 - Chairfast, unable to ambulate but is able to wheel self independently.

5 - Chairfast, unable to ambulate and is unable to wheel self.

6 - Bedfast, unable to ambulate or be up in a chair.

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M1860 - AmbulationResponse Environment Assistance

0 Even/Uneven Surfaces None

M1860 - AmbulationResponse Environment Assistance

0 Even/Uneven Surfaces None0 e /U e e Su acesand Stairs

o e

1 Even/Uneven Surfaces and Stairs

One-handed device

2 Even/Uneven Surfaces and Stairs

Human Supervision/Assistance for Stairs, Steps, Uneven Surfaces

3 Unspecified Human Supervision/Assistance at All times

and Stairs1 Even/Uneven Surfaces

and StairsOne-handed device

2 Even Surfaces > But Uneven Surfaces/Stairs>

One or Two-handed device Human Supervision/Assistance

3 Unspecified Human Supervision/Assistance at All Times

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Time Points

4 Chairfast No Human Assistance

5 Chairfast Unable to Wheel Self

6 Bedfast NA

4 Chairfast Able to Wheel Self

5 Chairfast Unable to Wheel Self

6 Bedfast NA


M1860 - AmbulationA patient lives alone and is currently walking throughout two levels of the house with no assistive device. She is observed to frequently rely on the furniture and walls to support herself and when asked to walk unsupported, her gait is unsteady. Score on the fall risk assessment is high.

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Time Points

M1870 – Feeding and EatingThe patient has a feeding tube in place. Oral intake is good so the tube is not being used. He requires intermittent supervision while eating due to history of aspiration with certain consistencies.

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Time Points

The feeding tube is only considered if being used for nutritional intake.


M1880 – Ability to Plan and Prepare Light Meals

The patient reports making herself a sandwich for lunch but needed her husband to make her breakfast today because “my hands were sore.”

Any prescribed diet requirements should be considered

Don’t forget ability vs willingness

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Time Points

Don t forget ability vs. willingness

With enteral feedings, do not consider ability to set up, monitor and change the equipment.

M1890 – Ability to Use TelephoneThe patient’s daughter reports it is difficult to reach the patient by phone – “She forgets to answer sometimes and gets distracted. I have to repeat myself several times and occasionally she has hung up mid-conversation.”

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Time Points

Includes: ability to safely answer the phone, dial a number and effectively use the phone to communicate.


M1900 Prior Functioning ADL/IADL

Used for risk adjustment and in care planning (goal setting)

3 levels of human assistance to safely complete tasks

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Time Points

3 levels of human assistance to safely complete tasksIndependent: Required no human assistanceNeeded some help: Required some effort from anotherDependent: Required total effort of another, unable to contribute any physical or cognitive effort

If varying ability, reflect level of ability for the majority of the tasks

Fazzi Associates, Inc.243 Ki St t S it 246243 King Street, Suite 246Northampton, MA 01060

800-379-0361www.fazzi.com

©2009

[email protected]


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