HOMEWORK HCA 345

Compliments of ADL Data Systems, Inc.

ADL = 2 — 16 RUG-IV ADL Score End Splits LE2 LE1

15—16 15—16

Depression No Depression

LD2 LD1

11—14 11—14

Depression No Depression

LC2 LC1

6 —10 6 —10

Depression No Depression

LB2 LB1

2—5 2—5

Depression No Depression

RUG-IV ADL Score End Splits

BB2

BB1

2 — 5

2 — 5

≥ 2 restorative nursing

< 2 restorative nursing

ES3 ES2 ES1 B

BA2

BA1

0 — 1

0 — 1

≥ 2 Restorative nursing

< 2 restorative nursing

RUG-IV ADL Score End Splits

G0110 (1) Self Performance

G0110 (2) Staff Support

ADL Score

G0110 (1) Self

G0110 (2) Staff Support

ADL Score

Eating

____ ______

____ ______

0 1 2 3 4

any number = any number = -, 0, 1, or 2 = -, 0, 1, or 2 = 3 =

-, 0, 1, 2, 7 or 8 AND -, 0, 1, 8 = 0 -, 0, 1, 2, 7 or 8 AND 2 or 3 = 2 3 or 4 AND -, 0 or 1 = 2 3 AND 2 or 3 = 3 4 AND 2 or 3 = 4

-, 0, 1, 7, or 8 AND 2 AND 3 AND 4 AND 3 or 4 AND

Bed Mobility (G0110A) =

Transfer (G0110B) =

Toilet Use (G0110I) =

Eating (G0110H) =

K0700A is 51% or more of total calories OR K0700A is 26% to 50% of total calories AND K0700B is 501 cc or more per day fluids enteral intake in the last 7 days

• Pressure relieving chair/bed++ • Turning/Repositioning • Nutrition or hydration intervention • Ulcer Care • Application of Dressing (Not to feet) • Application of Ointment (Not to feet) ++ Count as one service if both are provided

• Surgical Wound Care • Application of Dressing (Not to feet) • Application of Ointment (Not to feet)

• Urinary toileting program and/or bowel toileting program ++ • Passive and/or active ROM ++ • Splint or brace assistance • Bed mobility and/or walking training++ • Transfer training • Dressing and/or grooming training • Eating and/or swallowing training • Amputation/prostheses care • Communication training ++ Count as one service even if both provided

15 — 16 15 — 16 11 — 14 11 — 14 6 — 10 6 — 10 2 — 5 2 — 5 0 — 1 0 — 1

RUG-IV Late Loss ADL Calculations (Enter ADL score for each item below)

Bed Mobility, Toilet and Transfer Use

PE2 PE1 PD2 PD1 PC2 PC1 PB2 PB1 PA2 PA1

HE2 HE1 HD2 HD1 HC2 HC1 HB2 HB1

15-16 15-16 11-14 11-14 6-10 6-10 2-5 2-5

≥ 2 restorative < 2 restorative ≥ 2 restorative < 2 restorative ≥ 2 restorative < 2 restorative ≥ 2 restorative < 2 restorative ≥ 2 restorative < 2 restorative

CATEGORY VIII- Reduced Physical Function ADL = 0 — 16

Depression No Depression Depression No Depression Depression No Depression Depression No Depression

• Residents who do not meet the conditions in any of the previous categories • Behavioral Symptom & Cognitive Performance with RUG-IV ADL score > 5 • Restorative Nursing Services used for end splits

• Comatose and completely ADL dependent or ADL did not occur • Septicemia •Diabetes with both Insulin injections for all 7 days and insulin order changes on 2 or more days • Quadriplegia and ADL score >= 5 • Chronic obstructive pulmonary disease (COPD) and shortness of breath when lying flat • Fever with one of the following: Pneumonia, Vomiting, Weight loss or Feeding tube • Parenteral/IV feedings • Respiratory therapy for 7 days

RUG-IV Cheat Sheet

CATEGORY VI- CLINICALLY COMPLEX

• Pneumonia • Hemiplegia and ADL score ≥ 5 • Surgical wounds or open lesions with treatment • Burns • Chemotherapy while a resident

Category V — Special Care Low

Ultra High Criteria 720 minutes or more (total) of therapy per week 1 Discipline for at least 5 days A second discipline for at least 3 days 144 minutes or more if MSSAI = YES Very High Criteria 500 minutes or more (total) of therapy per week At least 1 discipline for at least 5 days 100 to 143 minutes if MSSAI = YES High Criteria 325 minutes or more (total) of therapy per week At least 1 discipline for at least 5 days 65 to 99 minutes if MSSAI = YES Medium Criteria 150 minutes or more (total) of therapy per week At least 5 days of any combination of the 3 disciplines 30 to 64 minutes if MSSAI = YES Low Criteria 45 minutes or more (total) of therapy per week At least 3 days of any combination of 3 disciplines 2 or more Restorative Nursing Services received, each for 6 or more days for at least 15 minutes. 15 to 29 minutes if MSSAI = YES

AND AND

AND

AND

AND

AND AND

Includes calculations to determine resident late loss ADL Score. For specific info on RUG-IV, please refer to Chapter 6 in the LTC RAI User's Manual Version 3.0.

Rehabilitation Ultra High PLUS Extensive Service(s) Rehabilitation Very High PLUS Extensive Service(s)

Rehabilitation High PLUS Extensive Service(s)

Rehabilitation Medium PLUS Extensive Service(s)

Rehabilitation Low PLUS Extensive Service(s)

CE2 CE1 CD2 CD1 CC2 CC1 CB2 CB1 CA2 CA1

• Cerebral palsy with ADL score ≥ 5 • Multiple sclerosis with ADL score ≥ 5 • Parkinson’s disease with ADL score ≥ 5 • Respiratory failure and oxygen therapy while a resident • Feeding tube • 2 or more stage 2 pressure ulcers with 2 or more selected skin treatments • Any stage 3 or 4 pressure ulcer with two or more selected ulcer treatments • 2 or more venous/arterial ulcers with two or more selected ulcer treatments • 1 stage 2 pressure ulcer and 1 venous/arterial ulcer with 2 or more selected ulcer treatments • Foot infection, diabetic foot ulcer or other open lesion of foot with application of dressings to the feet • Radiation treatment while a resident • Dialysis treatment while a resident Signs of depression used for end splits: PHQ score ≥10

ADL = 0 — 16 • Residents with Extensive Services, Special Care High or Special Care Low

15 — 16 15 — 16 11 — 14 11 — 14 6 — 10 6 — 10 2 — 5 2 — 5 0 — 1 0 — 1

Depression No Depression

Depression No Depression

Depression No Depression

Depression No Depression

Depression No Depression

• Oxygen while a resident • IV medications while a resident • Transfusions while a resident Signs of depression used for end splits: PHQ

• Residents has a cognitive impairment BIMS score ≤ 9 or CPS ≥ 3 • Hallucinations • Delusions • Residents displaying one of the following symptoms: •• Physical or verbal behavioral symptoms toward others •• Other behavioral symptoms •• Rejection of care •• Wandering • Restorative Nursing Services used for end splits

RUX RUL RVX RVL RHX RHL RMX RML RLX

RUC RUB RUA

11 — 16 2 — 10

11 — 16 2 — 10

11 — 16 2 — 10

11 — 16 2 — 10 2 — 16

11 — 16 6 — 10 0 — 5

Tracheostomy care AND Ventilator or Respirator (while a resident) Tracheostomy care OR Ventilator or Respirator (while a resident) Infection Isolation (while a resident)

RVC RVB RVA

RHC RHB RHA

RMC RMB RMA

RLB RLA

11 — 16 6 — 10 0 — 5

11 — 16 6 — 10 0 — 5

11 — 16 6 — 10 0 — 5

11 — 16 0 — 10

CATEGORY VII- Behavioral Symptoms and Cognitive Performance

ADL = 0 — 5 RUG-IV ADL Score End Splits

ADL = 0 — 16 RUG-IV ADL Score

ADL = 2 — 16 RUG-IV

Category IV - Special Care High

ADL = 2 — 16 RUG-IV ADL Score End Splits

Category III - Extensive Services

Signs of depression used as end splits: PHQ score ≥10

1

Category II - Rehabilitation

1. Tube Feeding Classification Requirement 4. Restorative Nursing Services

2. Selected Ulcer Treatments

3. Selected Skin Treatments

2

2

2

2

4

4

Category I - Rehabilitation Plus Extensive Services

ADL = 2 — 16 RUG-IV ADL Score

See Rehab Criteria (Category II) and Extensive Services Criteria (Category III)

3

1

score ≥10

Total RUG-IV ADL Score:

4