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. A decline in Activities of Daily Living (ADLs) can also have a negative impact during a State Survey.
The percentage of long-stay residents whose need for help with ADLs has increased is a measure which compares status from the prior assessment. It is triggered if a resident experiences:
· Increased need for help in 2 or more coding points with 1 late loss ADL; OR
· 1 point increase in coding points in 2 or more late-loss ADLs compared to the prior assessment.
This is the numerator. The look-back scan is 7 days. The denominator for this measure is all residents with one or more prior assessments, except those with exclusions.
Exclusions for this measure include:
· All 4 late-loss ADL items indicate dependence or activity was not attempted on the prior assessment
· 3 of the late-loss ADLs indicate dependence or activity was not attempted on the prior assessment, as in exclusion 1, AND the 4th late-loss ADL indicates substantial/maximal assistance on the prior assessment
· Comatose is coded or data is missing for comatose on the target assessment
· Prognosis of life expectancy is coded as less than 6 months on the target assessment
· Hospice care is being provided per the target assessment
· Resident is not in the numerator and one of the late-loss ADLs has a dash on the target assessment
· No prior assessment is available
On the MDS, the following items impact this measure
Obviously, poor performance or a high percentage can lead to financial repercussions for providers in states incorporating QMs into their Medicaid reimbursement through quality incentive payments. The reputational impact of this measure on Five Star and public reporting on Care Compare can lead to further detrimental effects.
State Surveyors use the Activities of Daily Living Critical Element Pathway when reviewing ADL performance. Aspects reviewed include comprehensive assessments focused on Section C, E, F, GG, J, and O of the MDS, Physician orders, pertinent diagnoses, and care planning. ADL care is observed across shifts, and interviews are conducted across shifts with residents, their representatives, and family and with staff including OT, PT, SLP, and RNP. Failure to comply can lead to various F-tags and potential Immediate Jeopardy (IJ).
Stay tuned for next month's edition where we will discuss ways to improve performance for this quality measure…