Re: ADL Self-Performance - Here's an answer, I understand your question

[RRS2000]

If she had a three-day stay in the hospital within 30 days of admission and if she received care related to the tube feeding while in the hospital (although it doesn't have to be her primary reason for being in the hospital), then, yes, she would be coverable for 100 days as long as she receives enough tube feeding to meet the criteria for skilled level of care:  When the enteral feeding accounts for at least 51% of daily calories OR when the enteral feeding accounts for 26% of daily calories AND 501cc daily intake.

Rena

Rena R. Shephard, MHA, RN, FACDONA, RAC-C
Chair, American Association of Nurse Assessment Coordinators
[EMAIL PROTECTED]

Subj: RE: ADL Self-Performance - Here's an answer, I understand your question
Date: 4/8/04 4:53:32 PM Pacific Standard Time
From: [EMAIL PROTECTED]
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To: [EMAIL PROTECTED]
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Medicare question:
A resident admitted with a GT which was inserted in 2001.  She was @ home and therefore not skilled for the new GT.
Upon admission to our facility would she be covered for new GT -- 100 days?

-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]
Sent: Thursday, April 08, 2004 7:34 PM
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Subject: Re: ADL Self-Performance - Here's an answer, I understand your question


Thanks so much.  It is something I knew but never saw in writing or was explained anywhere...in manual or at seminars.  I appreciate it.

In a message dated 4/8/04 6:53:28 PM Eastern Daylight Time, [EMAIL PROTECTED] writes:

Page 3-99 has example.
Here's briefly why:

eating independently = 0
Spoon feed = 4
4 + 0 = 3 in MDS land
You take all the elements of the task in eating, (and personal hygiene may surprise you, too, if you read those examples on 3-100)

This is an exception to the "weight bearing" rule.   It is surprising and seems to be an exception that is not clearly stated.
You total elements of certain activities, like eating, personal hygiene, locomotion, and can come up with a "3" if you have elements of the same episode with some lesser numbers and an element that is total assist.
The shaving example on 3-100 is pretty clear.  The resident does all his personal hygiene, but a barber shaves him x3 that week...They code that as a "3" overall.

It's just another odd MDS manual thing that is only alluded to in the examples.  There is no language to explicitly spell this out.  There is some help on page 3-81 in the two definitions of Extensive assist, but even that second definition does not apply to one of the ADLs that have several elements that could have different levels of assistance in the same episode.


Hope this helps

Judy Wilhide, RN, BA, RAC-C
RAI Manager
Virginia