Quality Measure Improvement Guide for Aids to Daily Living

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1 Quality Measure Improvement Guide for Aids to Daily Living Problem: Maintaining or improving residents daily living is important to attracting and retaining nursing home residents. It also is one of ten quality measures (QMs) in the Centers for Medicaid & Medicare Services (CMS) Five-Star Rating. Your facility s quality performance in ADLs is evaluated based on three CMS regulations: F310 A resident s abilities in activities of daily living do not diminish unless circumstances of the individual s clinical condition demonstrate that diminution was unavoidable. This includes the resident s ability to: (i) Bathe, dress, and groom; (ii) Transfer and ambulate; (iii) Toilet; (iv) Eat; and (v) Use speech, language, or other functional communication systems. Intent (a): The intent of this regulation is that the facility must ensure that aresident s abilities in ADLs do not deteriorate unless the deterioration was unavoidable. F311 A resident is given the appropriate treatment and services to maintain or improve his or her abilities specified in paragraph (a)(1)* of this section; intrepretive guidelines. Intent (a)(2): The intent of this regulation is to stress that the facility is responsible for providing maintenance and restorative programs that will not only maintain, but improve, as indicated by the resident s comprehensive assessment to achieve and maintain the highest practicable outcome. F312 A resident who is unable to carry out activities of daily living receives the necessary services to maintain good nutrition, grooming, and personal and oral hygiene. Intent (a)(3): The intent of this regulation is that the resident receives the care and services needed because he/she is unable to do their own ADL care independently. Solution: To help you improve your nursing home s ADL quality outcomes and its CMS Five-Star quality rating Briggs has assembled the specific documentation, charting, education and training, and medical supplies you ll need. Remember, every Briggs form integrates industry best practices, and has been recognized by customers as best-of-class. * interpretive guidelines Get the Right Solutions Now! The sooner you implement the right solutions, the sooner you can see your Five-Star quality ratings improve.

2 DOCUMENTATION Packaging List Price* Qty. Assessments CFS6-1HH ADL Functional/Restorative Assessment and Progress 100/pad CFS6-1HF ADL Functional/Restorative Assessment and Progress 100/pad CFS6-12HH Range of Motion Assessment 100/pad CFS6-12HF Range of Motion Assessment 100/pad Rehabilitation & Therapy CFS10-1HH Rehabilitation Screen 100/pad CFS10-1HF Rehabilitation Screen 100/pad HH Rehabilitation Evaluation 100/pk HH Rehabilitation Treatment Plan 100/pad Resident Functional Assessment 100/pad 9.54 CFS6-12HH Range of Motion Assessment 100/pad CFS6-12HF Range of Motion Assessment 100/pad Rehabilitation Nursing Program Evaluation 100/pad 9.54 CFS10-6HH Therapy Treatment Progress Notes 100/pad CFS10-6HF Therapy Treatment Progress Notes 100/pad CFS10-5/4P Therapy Progress Notes 100/pk Therapy Notes 100/pad P Occupational Therapy Daily Service and Treatment Grid 100/pk CFS10-3HH Occupational Therapy Evaluation and Treatment Plan 100/pad P Occupational Therapy Progress Status 100/pad B Physical Therapy Progress Record 100/pad Month Physical Therapy Record 100/pad /2 Physical Therapy Requisition and Charge 100/pk P Physical Therapy Progress Status 100/pad P Physical Therapy Daily Service and Treatment Grid 100/pk CFS10-2HH Physical Therapy Evaluation and Treatment Plan 100/pad P Tinetti Assessment tool:balance and Gait 100/pad Restorative Nursing 3715HH Restorative Nursing Program Needs Identification 100/pad HH Functional Restorative Progress Comparison 100/pad 12.28

3 3722HH Functional Restorative Progress Comparison Addendum 100/pad Restorative Program Tracking Form 100/pk HH Restorative Nursing Care Plan and Progress Notes 100/pad CAN Care Plan Reference Sheet 100/pad HH Restorative Care Flow Record SC 100/pad Restorative Meeting Summary 100/pad Restorative Aide Notes 100/pad HH Restorative Nursing Transfer Form 100/pad HH Restorative Nurse's Progress Notes 100/pad P Restorative Nurse's Progress Notes 100/pad CFS6-33HH Rehabiltiaion/Restorative Service Delivery Record 100/pad CFS6-33HF Rehabiltiaion/Restorative Service Delivery Record 100/pad HH 5-Week Restorative care Flow Record 100/pad HF 5-Week Restorative care Flow Record 100/pad HH 1-month Restorative Care Flow Record 100/pad HF 1-month Restorative Care Flow Record 100/pad CFS6-13HH Restorative Care Flow Record 100/pad CFS6-13HF Restorative Care Flow Record 100/pad Late Loss ADL Flow Sheet 100/pad Education and training Packaging List Price* Qty F315 Simplified 1 each Restorative Simplified 1 each DV Techniques in Toileting/Incontinence Care 1 each Charting Packaging List Price* Qty Chart Divider - ADL Tracking - Poly - Lavender - Side each Chart Divider - ADL Tracking - Poly - Lavender - Bottom each G Chart Divider - Nurse Assistant - Paper - Orange - Side 25/pk G Chart Divider - Nurse Assistant - Paper - Orange - Bottom 25/pk Chart Divider - Restorative - Paper - Orange - Side 25/pk Chart Divider - Restorative - Paper - Orange - Bottom 25/pk 11.50

4 676 Chart Divider - Restorative - Tyvek - Orange - Side 25/pk Chart Divider - Restorative - Tyvek - Orange - Bottom 25/pk Chart Divider - Restorative - Poly - Orange - Side each Chart Divider - Restorative - Poly - Orange - Bottom each 1.35 Medical Supplies Packaging List Price* Qty. Gait Belts Heelbo Johnny Grait Belt 12/bx Heelbo Grait Gait Belt, 63" 12/bx Heelbo Chair Belt 6/bx Mobility Wheelchairs DMI 18" Wheelchair with Fixed Armrests 1 each DMI 18" Wheelchair with Removable Desk Arms 1 each Transport Chairs DMI 19" Folding Steel Transport Chair with Hand Brakes, Chrome Frame, Black Seat DMI 19" Folding Steel Transport Chair with Hand Brakes, Burgundy Frame, Black Seat DMI 19" Ultra Lightweight Aluminum Transport Chair, Royal Blue Frame, Black Seat DMI 19" Ultra Lightweight Aluminum Transport Chair, Titanium Frame, Black Seat Walkers DMI Single Release Aluminum Folding Walker with 5" Non-Swivel Wheels, Silver DMI Bariatric Two-Button Release Aluminum Folding Walker with Rubber Tips, Silver Rollators DMI Aluminum Rollator with Weight-Activated Brakes, Burgundy 1 each each each each each each each DMI Lightweight Aluminum Rollator, Burgundy 1 each DMI Lightweight Aluminum Rollator, Royal Blue 1 each DMI Lightweight Aluminum Rollator, Titanium 1 each Canes DMI Adjustable Aluminum Cane, Standard Handle, Black 1 each DMI Adjustable Quad Cane, Small base, Black 1 each 13.59

5 ADL's Eating Carrycup 12 oz Blue White Lid 1 each DMI Comfort Grip Cutlery, Teaspoon 1 each DMI Comfort Grip Cutlery, Fork 1 each DMI Comfort Grip Cutlery, Soup Spoon 1 each DMI Comfort Grip Cutlery, Knife 1 each DMI Universal Beverage Holder 1 each Reaching DMI Suction Cup Reacher, 33" 1 each DMI Folding Aluminum Reacher with Magnetic Tip, 32" 1 each DMI Aluminum Reacher with Magnetic Tip, 32" 1 each DMI Aluminum Reacher with Magnetic Tip, 26" 1 each 8.60 Dressing Dressing, reaching kit 1 each Misc Packaging List Price* Qty DMI Long Handle Bell 1 each 3.79 ORDERING INFORMATION: Fill out the information below and fax to 1. or call 1.. Name Title Facility Address City State Zip Account Number Phone Address *If you belong to an ownership or group purchasing organization you may be eligible for additional discounts.

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