1. Home Health Solutions, LLC
ADL/IADL OASIS Items
The C2 Version
Presented by:
Home Health Solutions, LLC

2. List 3 conventions of ADL/IADL items of oasis
Define what is “minimal assistance” as it relates to OASIS items
Understand the intent behind new OASIS item GG0170C and what it measures
Explain how cognitive abilities play a role in safe ambulation

3. OASIS Conventions for ADL/IADL Items
All questions assess the patient’s SAFE ABILITY, not necessarily the actual performance
The ability can be temporary or permanent
The clinician must consider what the patient is able to do on the day of the assessment
If ability varies over time, choose the response describing the patient’s ability more than 50% of the time period under consideration.

4. Conventions cont.
While the presence or absence of a caregiver may impact actual performance of activities, it does not impact the patient’s ability to perform the task.
Willingness and compliance are not a focus of these items
“Assistance of another person” includes those patients, actively participating in a task, but needing assistance of another one or more person(s) to safely complete included tasks.

5. M1810/M1820

6. DRESSING
Must take into account if a patient modifies the clothing they wear due to a physical impairment. If the modified clothing selection is considered routine when there is no reasonable expectation that the patient could return to their previous style of dressing.
Look at the patient’s spinal flexion, joint range of motion, shoulder and upper arm strength, and manual dexterity.
If the patient uses some type of orthotic, prosthetic, brace, sling, etc. This would be considered part of dressing then assess the patient’s ability to donn/doff these items.

7. Continued:
The guidance in M1810 & M1820 states that you assess the patient's ability to obtain, put on and remove the clothing items usually worn. Other guidance states that items such as prosthetics, corsets, cervical collars, hand splints, Teds, etc. are considered dressing apparel.
If the MD has ordered for the patient to wear the particular device/sling/splint/AFO/etc. then consider this as part of dressing and scoring would include these items.
The time it takes for the patient to perform dressing is not considered in M1810/1820.

8. M1830

9. BATHING
If the patient requires standby assistance to bathe safely in the tub or shower or requires verbal cueing/reminders, then select Response 2 or Response 3, depending on whether the assistance needed is intermittent (“2”) or continuous (“3”).
Response 2—Intermittent
Patient's ability to transfer into/out of the tub or shower is the only bathing task requiring human assistance
Patient requires one, two, or all three of the types of assistance listed in Response 2 but not the continuous presence of another person

10. CONTINUED:
Response 3—Continuous—If a patient requires one, two, or all three of the types of assistance listed in Response 2 and the continuous presence of another person
Response 4—The patient must be able to safely and independently bathe outside the tub/shower, including independently accessing water at the sink, or setting up basin at the bedside, etc.
Response 5—The patient must be unable to bathe in the tub/shower, can participate in bathing self but needs assistance (even if just to wash his back).
Response 6—The patient is totally unable to participate in bathing and is totally bathed by another person, regardless of where bathing occurs or if patient has a functioning tub or shower.

11. Something else about M1830
If the patient does not have a shower/tub or unable to access the tub/shower or it is malfunctioning making it unsafe, then the clinician would choose the patient’s ability to bath outside of the shower/tub. (option 4 or 5)
Also the patient’s status should not be based on the assumption of the ability to perform a task with equipment that they do not currently have in the home.
Also, consider medical restrictions. If the MD orders a certain body part to not get wet or not immerse in water, then consider the amount of assistance needed for the bath/shower. If it prevents the patient from getting into the bath/shower then option 4 or 5 should be considered.

12. M1840

13. Toilet Transfers First assess the patient’s safe ability to:
get to and from the toilet/commode
AND transfer on and off the toilet or commode
Response 1—When reminded…
Patient needs assistance getting to/from the toilet, toileting transfer or both
Patient who can independently get to the toilet but needs assistance to get on and off the toilet
If the patient requires any degree of hands on/stand-by/verbal cueing for any part of this process

14. continued:
Response 2— this only refers to the patients using a BSC at all times. (Convenience does not count)
Response 3—
Patient who is unable to get to/from the toilet or BSC but is able to place and remove a bedpan/urinal independently
This is the best response wether or not the patient requires assistance to empty the urinal/bedpan
Response 4—
Pt either cannot assist or needs assist to get onto/off bedpan or assist with urinal (excluding emptying)

15. M1850

16. Transferring
Identified the patient’s ability to safely transfer from bed to chair (and chair to bed), or position self in the bed if bedfast
For most patients, the transfer between bed and chair will include transferring from a supine position in bed to a sitting position at the bedside, then some type of standing, stand-pivot or sliding board transfer to a chair at the bedside.

17. Sitting Surface not at Bedside
If the sleeping surface is in the bedroom and the sitting surface is down the hall in the bathroom and the patient is independent moving from the supine to sitting position, sitting to stand and then standing to sitting, but requires minimal human assistance or a device to ambulate from the bed to the sitting surface, the appropriate score would be a “1”.
If the patient requires more than minimal assistance or requires minimal assistance and an assistive device to ambulate then the score would be a “2”.

18. Minimal human assistance is defined in guidance an individual assisting the patient contributes less than 25% of the total effort required to perform the task.
Additionally, human assistance can come in the form of verbal cues, environmental set up and/or actual “hands on” assistance.

19. M1850 continued: Response 1—
Patient is able to transfer self from bed to chair, but requires standby assist to transfer safely, or requires verbal cueing/reminders.
If the patient transfers either with min human assistance (but not device), or with the use of a device (no human assistance)

20. M1850 continued: Response 2—
Patient requires both min human assistance and an assistive device to transfer safely
Patient can bear weight and pivot, but requires more than min human assist
Patient must be able to both bear weight and pivot
Response 3—
Patient unable to do 1 or the other and is not bedfast
Response 4 & 5—
Dependent on patients ability to turn/position in bed but is bedfast

21. GG0170c
Functional
Abilities &
Goals

22. What does this measure?
This item identifies the patient’s need for assistance with the mobility task of moving from lying on the back to sitting on the side of the bed with feet flat on the floor, and with no back support.

23. Steps for Assessment for Column 1
Assess patients(pts) functional status based on direct observation and/or on report by pt, caregiver(cg)/family.
Pts should be allowed to perform activities as independently as possible, as long as they are safe.
If cg assistance is required because pts performance is unsafe or of poor quality, enter the response according to amount of assistance required to be safe.
Activities may be completed with or without assistive devices. Use of assistive devices to complete an activity should not affect the scoring of the activity.
If the pts self-care performance varies during the assessment time frame, report the pts usual status, not the pts most independent status and not the pts most dependent status.

24. GG0170C Column 1 continued:
Enter 05- Pt only requires set up or clean up. This means that the cg only needs help removing cover from body or application of a garment/device before getting up.
Enter 04- Pt requires actual touching for safety to complete task or verbal cueing. It can be assistance throughout the task or intermittently.
Enter 03- Pt requires cg to provide less than half the effort. The cg has to lift, hold, or support truck &/or limbs and provides less than half the effort
Enter 02- Pt requires cg to provide more than half the effort. The cg has to lift, hold or support trunk &/or limbs and provide more than half the effort
Enter 01- Pt requires cg to provide all the effort. Pt is unable to contribute any of the effort to complete the task or the assist of 2 or more cg is required for the pt to complete the activity.

25. Column 2- Discharge Goal
The clinician will complete this column also when performing the SOC/ROC.
The clinician along with collaboration from the pt/cg decide at what level of ability that the pt will be able to reach at the time of discharge.
This level of ability to perform the task may be decided to be either stable, improved or declined based on the pts current disease process.

26. Examples
Pt has Multiple Sclerosis and the patient scored 02 for the current status but due to the decline of the disease, the pt/cg may decide that the goal is to avoid any further decline at the time of d/c but would not estimate that there will be an improvement so the discharge goal would also be 02 or maybe even a 01. (clinician will have to explain in narrative why a decline is anticipated)
Pt has had a total knee replacement. At admit, the pt needs assist to get the surgical leg off of the bed so would score a 03 but when talking to the pt, the expectation would be that the pt plans to be independent with this task at the time of discharge so the discharge goal would be 06.

27. M1860

28. Ambulation Response 1— 1 hand device and no human assistance
Response 2— two-handed device and/or intermittent human assistance
Response 3— Continuous human assistance or supervision at all times
Response 4 & 5— Refers to the patient that cannot ambulate even with a device and/or assistance

29. Things to consider…..
If a patient can only take a couple of steps with the assistance of another and use of a device then this patient is not considered ambulatory.
Cognitive function plays a role in the response. If a patient has poor judgement and insight then this must be considered when answering this item.

30. Take Aways…..
Always read the responses to the M1800 items from bottom to top.
Consider the level and amount of assistance for safe ability
The presence or absence of a caregiver has no bearing on the oasis item responses. It is the clinicians judgement that determines safe ability
THE CLINICIAN CANNOT ACCURATELY ASSESS THESE ITEMS SITTING ON THE COUCH!!!!

31. THANK YOU HOME HEALTH SOLUTIONS, LLC
Heather Calhoun RN, BSN, COS-C, HCS-D, HCS-H
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