OASIS Accuracy-The Three Home Health Gold (HHG) Mobility Items
By Terry Dancewicz, MS PT, MMHS, COS-C, Patient Care Manager
Home Health Compare includes three publically reported Mobility Items: Ambulation, Bathing, and Transferring. Over the past few months we have taken a look at Ambulation and its relationship to the other ADL/IADL items (QI articles in the VNACNF Connector on 8/25/14 and 9/29/14), Bathing (on 10/25/14), and M1850 Transferring (on 12/22/14). Staff has indicated an interest in specific patient examples. Please review the following patient scenarios that address these three mobility items along with the related Oasis guidance.
SCENARIO 1-M1830 Bathing:
At Start of Care the discharge information indicates that your patient requires assistance while taking a shower. You observe the patient's mobility and note that she cannot reach her feet to remove her socks and shoes and would need help with bathing. She does not have any ADL equipment and is not sure if she has an old shower chair or not. During the Oasis walk you note that the shower is on the second floor and the patient cannot safely get up the stairs.
How would you score your patient for M1830 Bathing?
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 (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.
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 self in bed, at the sink, in bedside chair, or on commode, with the assistance or supervision of another person. (Note: Oasis C1-Wording change for Response 5 - 'throughout the bath' has been removed.)
6 -Unable to participate effectively in bathing and is bathed totally by another person.
.......... Please make a selection, then continue reading for the correct response ..........
ANSWER Scenario 1 - M1830 Bathing: Response 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.
Rationale Scenario 1: The stairs represent an environmental barrier since the patient is unable to safely ascend the stairs where the shower is located; thus, the patient cannot safely access the shower and you would advise sponge bathing at SOC. In addition if the patient does not have appropriate (working) shower safety equipment/DME in place, then you cannot assume the patient would be safe with equipment they do not already have. Remember that since the patient needs intermittent assistance for washing difficult to reach areas (her feet), the patient cannot be scored "independent" for sponge bathing; a patient must also be able to independently, safely, obtain the items needed to sponge bathe in ordered to be scored independent for this task. Thus, the correct response is 5; the patient requires assistance to safely sponge bath. The patient in this scenario of course would benefit from a referral to both PT and OT at SOC.
SCENARIO 2- M1850 Transferring: A patient's family refused to let her be admitted to rehab after a long hospital stay, stating they could take care of her at home. She is severely deconditioned and needs considerable assistance to come to a sitting position at the side of the bed and then again to stand. Once standing, she requires someone to support the majority of her weight as she pivots to sit on the chair at the bedside. She only tolerates sitting up for 10 minutes before she requests to return to bed, again requiring the same level of assistance to safely transfer. How would you score M1850 Transferring?
0 -Able to independently transfer.
1 -Able to transfer with minimal human assistance or with use of an assistive device.
2 -Able to bear weight and pivot during the transfer process but unable to transfer self.
3 -Unable to transfer self and is unable to bear weight or pivot when transferred by another person.
4- Bedfast, unable to transfer but is able to turn and position self in bed.
5- Bedfast, unable to transfer and is unable to turn and position self.
.......... Please make a selection, then continue reading for the correct response ..........
ANSWER Scenario 2 - M1850 Transferring: Response 3- Unable to transfer self and is unable to bear weight or pivot when transferred by another person.
Rationale Scenario 2: "Able to bear weight" refers to the patient's ability to support the majority of his/her weight through any combination of weight-bearing extremities. The patient must be able to both bear weight and pivot for Response 2 to apply. If the patient is unable to do one or the other and is not bedfast, select Response 3.
SCENARIO 3-M1860 Ambulation: During your assessment, you observe your patient ambulates with a single point cane. You initially observe that he is safe walking 20' at which point you note that his right knee buckles, and the patient grimaces from knee pain. He reports he has osteoarthritis and that his knee always does that, but "it is no big deal and that is why he uses his cane". He does admit he likes to have someone close by when he negotiates the two steps into his sunken family room as his knee always hurts when doing stairs and he tends to lose his balance during this activity. How would you score M1860 Ambulation/Locomotion?
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.
2 -Requires use of a two-handed device (e.g., walker or crutches) to walk alone on a level surface and/or requires 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.
4 - Chairfast, unable to ambulate and is unable to wheel self.
5 -Bedfast, unable to ambulate or be up in a chair.
.......... Please make a selection, then continue reading for the correct response ..........
ANSWER Scenario 3 - M1860 Ambulation: Response 3- Able to walk only with the supervision or assistance of another person at all times.
Rationale- Although the patient demonstrates that he can ambulate with a cane, he is NOT SAFE as he has knee pain and his knee is intermittently buckling even on level surfaces in his home. Remember that Oasis is asking about SAFE ABILITY and not necessarily performance. The scenario identifies the patient's performance, ambulating in his home without assistance using a straight cane, but he is NOT SAFE with his current device and requires a referral to Physical Therapy.*
*Please remember to obtain an MD order for a referral to Rehab at SOC, if not already on the initial referral, when you observe a patient is unsafe or may need equipment.
THANK YOU for your hard work and your dedication to excellent patient care.
Questions? Contact Terry Dancewicz at 888-663-3688 X1341 or tdancewicz@vnacarenetwork.org or the Patient Care Manager in your office:
- Braintree: Carol Morris 781-535-5380
- Charlestown: Elaine Gardner 617-886-6464
- Danvers: Marilyn Bowden 888-663-3688 X1271
- Leominster: Terry Dancewicz 888-663-3688 X1341
- Needham: Maura Vitello 888-663-3688 X4536
- Southborough: Maria Dunn 888-663-3688 X1317
| 
