As discussed last month, the Quality Measure for Activities of Daily Living – Long Stay impacts Care Compare and Five Star. It may also impact Medicaid reimbursement dependent on the State. Adecline in late loss Activities of Daily Living (ADLs) can also have a negative impact during a State Survey.
This is a 7-day look-back scan measure.
How can we improve performance for this Quality Measure and prevent residents’ decline in ADLs?
Late loss ADLs, including sit to lying, sit to stand, eating, and toilet transfers, are considered late loss as they tend to be the functional areas residents retain the longest. These should be regularly and continually assessed to promote a resident’s highest level of function, and therefore an improved quality of life with less risk for further potential decline.
The first key is to analyze processes for screening and assessing ADLs. This includes nursing and therapy screening and assessment.
· Therapy screening – upon admission, quarterly, as needed
· Nursing screening and assessment – upon admission, quarterly, as needed
· Nursing and Therapy Communication
Some additional ideas for improving performance of this measure include:
1. Ensure all team members know the Assessment Reference Date (ARD).
2. Make sure team members understand the requirements for coding ADLs per the Resident Assessment Instrument (RAI).
3. Perform Utilization Review (UR) with the Interdisciplinary Team (IDT) prior to MDS completion and submission.
4. Audit clinical documentation to ensure it is clear, complete, precise, and timely.
5. Check the MDS software to determine if an alert has been triggered and correct the alert.
6. Treat and address health conditions and root causes impacting ADL performance.
7. Refer residents to therapy as appropriate.
8. Initiate Restorative Nursing Program(s) as appropriate.
9. Manage residents’ depression and/or pain.
10. Address residents’ refusals of treatment.
11. Ensure residents receive appropriate assistance from direct care staff.
12. Encourage residents to perform ADLs as independently as possible.
13. Encourage participation in activities.
14. Ensure residents have appropriate adaptive equipment to perform at their highest functional level.
Monitor success through chart audits. Review CASPER reports and Quality Measure data and provide continuing education and training to all staff involved in the residents’ care.
Check out our next blog on the Quality Measure for the Ability to Walk Independently Worsened.