Virginia Administrative Code
Title 12 - HEALTH
Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES
Chapter 60 - STANDARDS ESTABLISHED AND METHODS USED TO ASSURE HIGH QUALITY CARE
Section 12VAC30-60-318 - Definitions to be applied when completing the MDS
Universal Citation: 2 VA Admin Code 30-60-318
Current through Register Vol. 41, No. 3, September 23, 2024
A. Activities of Daily Living (ADLs):
1. Transfer (§E(1)(b)). In order to meet
this ADL, the individual must score a 1, 2, 3, 4, or 8 as described below:
a. (0) Independent -- No help or oversight --
OR -- help/oversight provided only 1 or 2 times during last seven days
b. (1) Supervision -- Oversight,
encouragement or cueing provided 3+ times during last seven days -- OR --
supervision plus physical assistance provided on 1 or 2 times during last seven
days
c. (2) Limited assistance --
Resident highly involved in activity; received physical help in guided
maneuvering of limbs or other nonweight bearing assistance 3+ times -- OR --
more help provided only 1 or 2 times during last seven days
d. (3) Extensive assistance -- While resident
performed part of activity, over last seven-day period, help of following type
or types was provided 3 or more times: weight-bearing support or full staff
performance during part (but not all) of last seven days
e. (4) Total dependence -- Full staff
performance of activity during entire seven days
f. (8) Activity did not occur during the
entire seven-day period. Use of this code is limited to situations where the
ADL activity was not performed and is primarily applicable to fully bed-bound
residents who neither transferred from bed nor moved between locations over the
entire seven-day period.
2. Dressing (§E(1)(d)). In order to meet
this ADL, the individual must score a 1, 2, 3, 4, or 8 as described below:
a.
(0) Independent -- No help or
oversight -- OR -- help/oversight provided only 1 or 2 times during last seven
days
b.
(1)
Supervision -- Oversight, encouragement or cueing provided 3+ times during last
seven days -- OR -supervision plus physical assistance provided on 1 or 2 times
during last seven days
c.
(2) Limited assistance --
Resident highly involved in activity; received physical help in guided
maneuvering of limbs or other nonweight bearing assistance 3+ times -- OR --
more help provided only 1 or 2 times during last seven days
d.
(3) Extensive
assistance -- While resident performed part of activity, over last seven-day
period, help of following type or types was provided 3 or more times:
weight-bearing support or full staff performance during part (but not all) of
last seven days
e.
(4) Total dependence -- Full staff performance of activity during
entire seven days
f.
(8) Activity did not occur during the entire seven-day period. Use of
this code is limited to situations where the ADL activity was not performed and
is primarily applicable to fully bed-bound residents who neither transferred
from bed nor moved between locations over the entire seven-day period.
3. Eating
(§E(1)(e)). In order to meet this ADL, the individual must score a 1, 2,
3, 4, or 8 as described below:
a.
(0) Independent -- No help or oversight -- OR -- help/oversight
provided only 1 or 2 times during last seven days
b.
(1) Supervision -- Oversight,
encouragement or cueing provided 3+ times during seven days -- OR --
supervision plus physical assistance provided on 1 or 2 times during last seven
days
c.
(2)
Limited assistance -- Resident highly involved in activity; received physical
help in guided maneuvering of limbs or other nonweight bearing assistance 3+
times -- OR -- more help provided only 1 or 2 times during last seven
days
d.
(3)
Extensive assistance -- While resident performed part of activity, over last
seven-day period, help of following type or types was provided 3 or more times:
weight-bearing support or full staff performance during part (but not all) of
last seven days
e.
(4) Total dependence -- Full staff performance of activity during
entire seven days
f.
(8) Activity did not occur during the entire seven-day period. Use of
this code is limited to situations where the ADL activity was not performed and
is primarily applicable to fully bed-bound residents who neither transferred
from bed nor moved between locations over the entire seven-day period,
or
g. To meet this ADL,
one of the following is checked:
(1) §L(4)(a) Parenteral or
intravenous
(2) §L(4)(b) Feeding tube
(3) §L(4)(d) Syringe (oral feeding)
4. Toilet Use
§E(1)(f)). In order to meet this ADL, the individual must score a 1, 2, 3,
4, or 8 as described below:
a.
(0)
Independent -- No help or oversight -- OR -help/oversight provided only 1 or 2
times during last seven days
b.
(1) Supervision -- Oversight,
encouragement or cueing provided 3+ times during last 7 days -- OR --
supervision plus physical assistance provided on 1 or 2 times during last 7
days
c.
(2)
Limited assistance -- Resident highly involved in activity; received physical
help in guided maneuvering of limbs or other nonweight bearing assistance 3+
times -- OR -- more help provided only 1 or 2 times during last seven
days
d.
(3)
Extensive assistance -- While resident performed part of activity, over last
seven-day period, help of following type or types was provided 3 or more times:
weight-bearing support or full staff performance during part (but not all) of
last seven days
e.
(4) Total dependence -- Full staff performance of activity during
entire seven days
f.
(8) Activity did not occur during the entire seven-day period. Use of
this code is limited to situations where the ADL activity was not performed and
is primarily applicable to fully bed-bound residents who neither transferred
from bed nor moved between locations over the entire seven-day period.
5. Bathing
(§E(3)(a)). To meet this ADL, the individual must score a 1, 2, 3, 4, or 8
as described below:
a.
(0)
Independent -- no help provided.
b.
(1) Supervision -- oversight help
only
c.
(2)
Physical help limited to transfer only
d.
(3) Physical help in part of
bathing activity
e.
(4) Total dependence
f.
(8) Activity did not occur during
the entire seven-day period. Use of this code is limited to situations where
the ADL activity was not performed and is primarily applicable to fully
bed-bound residents who neither transferred from bed nor moved between
locations over the entire seven-day period.
6. Bladder Continence (§F(1)(b)). In
order to meet this ADL, the individual must score a 2, 3, or 4 in this
category:
a.
(0) Continent --
Complete control
b.
(1) Usually continent -- incontinent episodes once a week or
less
c.
(2)
Occasionally incontinent -- 2+ times a week but not daily
d.
(3) Frequently incontinent --
tended to be incontinent daily, but some control present (e.g., on day
shift)
e.
(4)
Incontinent -- Had inadequate control; multiple daily episodes or
f. To meet this ADL, one of the
following is checked:
(1) §F(3)(b) external cathether
(2) §F(3)(c) indwelling catheter
7. Bowel Continence (§F(1)(a)). In order
to meet this ADL, the individual must score a 2, 3, or 4 in this category:
a.
(0) Continent -- Complete
control
b.
(1)
Usually continent -- control problems less than weekly
c.
(2) Occasionally incontinent --
once a week
d.
(3) Frequently incontinent -- 2-3 times a week
e.
(4) Incontinent -- Had inadequate
control all (or almost all) of the time, or
f. To meet this ADL, §F(3)(h) ostomy is
checked.
B. Joint Motion (§E(4)). In order to meet this category, at least one of the following must be checked:
1.
§E(4)(c)
Contracture to arms, legs, shoulders, or hands
2.
(d)
Hemiplegia/hemiparesis
3.
(e) Quadriplegia
4.
(f) Arm -- partial or
total loss of voluntary movement
5.
(g) Hand -- lack of dexterity
(e.g., problem using toothbrush or adjusting hearing aid)
6.
(h) Leg -- partial or total loss
of voluntary movement
7.
(i) Leg -- unsteady gait
8.
(j) Trunk -- partial or total
loss of ability to position, balance, or turn body
C. Locomotion (§E(1)(c)). In order to meet this ADL, the individual must score a 1, 2, 3, 4, or 8 in this category:
1.
(0) Independent -- No
help or oversight -- OR -- help/oversight provided only 1 or 2 times during
last seven days
2.
(1) Supervision -- Oversight, encouragement or cueing provided 3+
times during last seven days -- OR -- supervision plus physical assistance
provided on 1 or 2 times during last seven days
3.
(2) Limited assistance --
Resident highly involved in activity; received physical help in guided
maneuvering of limbs or other nonweight bearing assistance 3+ times -- OR --
more help provided only 1 or 2 times during last seven days
4.
(3) Extensive
assistance -- While resident performed part of activity, over last seven-day
period, help of following type or types was provided 3 or more times:
weight-bearing support or full staff performance during part (but not all) of
last seven days
5.
(4) Total dependence -- Full staff performance of activity during
entire seven days
6.
(8) Activity did not occur during the entire seven-day period. Use of
this code is limited to situations where the ADL activity was not performed and
is primarily applicable to fully bed-bound residents who neither transferred
from bed nor moved between locations over the entire seven-day period.
D. Nursing Observation. In order to meet this category, at least one of the following special treatments, procedures and skin conditions must be checked:
1.
§N(4)(a) Open lesions other than
stasis or pressure ulcers (e.g., cuts)
(f) Wound care or treatment
(e.g., pressure ulcer care, surgical wound)
(g) Other skin
care or treatment
2.
§P(1)(a) Chemotherapy
(b) Radiation
(c)
Dialysis
(d) Suctioning
(e) Tracheostomy
care
(f) Intravenous medications
(g)
Transfusions
(h) Oxygen
(i) Other special
treatment or procedure
E. Behavior and Orientation. In order to meet this category, the individual must meet at least one of the categories for both behavior AND orientation.
1. Behavior. To
meet the criteria for behavior, the individual must meet at least one of the
following:
a.
§H(1)(d) Failure to eat or
take medications, withdrawal from self-care or leisure activities (must be
checked); or
b. One of the
following is coded 1 (behavior of this type occurred less than daily) or 2
(behavior of this type occurred daily or more frequently):
(1)
§H(3)(a) Wandering (moved with no
rational purpose, seemingly oblivious to needs or safety)
(2)
§H(3)(b) Verbally abusive (others
were threatened, screamed at, cursed at)
(3)
§H(3)(c) Physically abusive (others
were hit, shoved, scratched, sexually abused)
(4)
§H(3)(d) Socially
inappropriate/disruptive behavior (made disrupting sounds, noisy, screams,
self-abusive acts, sexual behavior or disrobing in public, smeared/threw
food/feces, hoarding, rummaged through others' belongings)
2. Orientation: To meet this
category, the individual must meet at least one of the following:
a.
§B(3)(d) Awareness that individual is
in a nursing home -- is not checked;
b.
§B(3)(e) None of the memory/recall
ability items are recalled -must be checked; or
c.
§B(4) Cognitive skills for daily
decision-making -- must be coded with a 2 (moderately impaired -- decisions
poor; cues/supervision required) or 3 (severely impaired -never/rarely made
decisions).
Statutory Authority
§ 32.1-325 of the Code of Virginia.
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