Virginia Law

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).