To assess the resident for functional limitation in joint motion, the resident has to do all or most of the work of moving the joint. (Staff can assist in getting the resident started, but if the staff performs the ROM for the resident, then it is the staff member's joint function that is being tested.) Bullet points 3, 4, and 5 on page 3-108 help with the question of what happens if the resident can't follow directions.
The dilemma is in where the physical problem leaves off and the cognitive problem takes over. If you have a resident who cannot follow directions, but who will attempt to put on a blouse or brush her hair, etc., if she is handed the equipment or materials, then observe the joint mobility and how well she is able to handle the task. You can only do your best to make a coding decision.
However, it would not be appropriate to code "no limitation" for the resident with severe arthritis of the hand if you can observe any activity at all that will give you a clue as to whether or not the hand is functional. For example, if that resident picks at her clothes, or wanders around and picks up food off of trays, etc. (you know what I mean, you all have this resident in your facility, too!), you can make a determination about the functionality of the hand. The question is not, "Does she complete her ADLs?" The question is, "Functionally, would she be able to complete her ADLs if should could do it cognitively?"
Rena
Rena R. Shephard, MHA, RN, FACDONA, RAC-C
Chair, American Association of Nurse Assessment Coordinators
[EMAIL PROTECTED]
Subj: Rena, could you read the threads on this and give us your input: Re: Contracture Question
Date: 3/10/04 2:20:30 PM Pacific Standard Time
From: [EMAIL PROTECTED]
Reply-to: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the Internet
Rena, could you read the discussion re surveyors citing for this, and give
us your advice please.
Kathy Archibald RN Living Center Supervisor
FAX 1-208-547-2790
Voice 1-208-547-2771
email [EMAIL PROTECTED]
Important Notice: This communication, including any attachments, may
contain information that may be confidential or privileged and is intended
solely for the entity or individual to whom it is addressed. If you are NOT
the intended recipient, you must delete this message and attachments and are
hereby notified that any disclosure, copying, or distribution of this
message is strictly prohibited. Nothing in this email, including any
attachment, is to be a legally binding signature.
----- Original Message -----
From: "dawn" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Tuesday, March 09, 2004 4:03 PM
Subject: Re: Contracture Question
>
> Kathy: we were cited for this as well. I was devastated. They cited
>"misinterpretation of the RAI definition". I too had the same resident
>situation.
>
> dawn P
>
> ----- Original Message -----
> From: "Carol O'Brien" <[EMAIL PROTECTED]>
> To: <[EMAIL PROTECTED]>
> Sent: Tuesday, March 09, 2004 11:17 AM
> Subject: RE: Contracture Question
>
>
> >Last year we got cited for that exact thing. Our logic was that the
> >contracture doesn't affect the self-care due to the dementia.
>Surveyor's
> >listened to the argument and read all of the material we could pull
off
>the
> >discussion group. They didn't agree and ultimately gave us an E level
> >citation for accuracy of coding.
> >
> >
> >>From: "Kathy Archibald" <[EMAIL PROTECTED]>
> >>Reply-To: [EMAIL PROTECTED]
> >>To: <[EMAIL PROTECTED]>
> >>Subject: Contracture Question
> >>Date: Tue, 9 Mar 2004 07:53:40 -0700
> >>
> >>On G4 we are to code limitations in ROM if it affects their selfcare;
>if a
> >>resident who is totally dependent for all cares due to Alzheimers has
a
> >>contracture to a hand, do we code this? Am curious what you guys
think
> >>because we were cited last year for not coding G4 accurately and
want
>to
> >>make sure we don't repeat. Thanks.
> >>Kathy Archibald RN Living Center Supervisor
> >>FAX 1-208-547-2790
> >>Voice 1-208-547-2771
> >>email [EMAIL PROTECTED]
