OASIS Mandatory Questions

Implementation of Section GG Functional Abilities and Goals on OASIS

The Improving Medicare Post-Acute Care Transformation Act or IMPACT Act was signed into Law in 2014. The IMPACT Act requires assessment data to be standardized and interoperable to allow for exchange of data among various post-acute care providers.  The providers covered under the act include home health agencies (HHA), skilled nursing facilities (SNF), in-patient rehabilitation facilities (IRF) and long-term care hospitals (LTCH). The intent of the act was to change Medicare’s post-acute care services, improve outcomes and their reporting through shared decision making, care coordination, and enhanced discharge planning. To accomplish this goal, standardized data are to be collected by all the post-acute care providers using common assessment tools.

Section GG on the musculoskeletal part of OASIS was introduced to meet this intent of IMPACT act. Section GG deals with collection of some quality data regarding patient’s current functional status on various tasks and the clinician’s established reasonable discharge goals on performance of the same, considering all the limitations that patient currently has and the room for improvement. This quality data is aimed at helping better assessment of an individual’s current functional status and measurement of progress made with the service provided. Though there seems to be overlap between the M and GG sections on the musculoskeletal portion of the OASIS, they must be considered separately and answered using the guidance offered on the respective questions. Correlation between the choices selected for same or similar tasks on these two sections of OASIS is not expected.

GG0100 on Section GG of OASIS-E

This question discusses the patient’s ability to perform on the tasks listed here, prior to the current illness or exacerbation or injury that prompted a home health referral. While answering these questions on OASIS, clinician can consider the input provided by the patient and/or caregiver regarding their prior performance. At the same time, clinician should also consider patient’s health history and all the various co-morbidities one has to be able to judge an individual’s safe prior performance on the tasks listed. The term assistance denotes human assistance. An individual able to safely perform with the aid of an assistive device is still considered independent.

Patient’s prior functioning in 4 areas is answered on this question

• Self-care activities involving activities of daily living such as, bathing, dressing, toileting & personal hygiene, and ability to self-feed.
• Indoor mobility involving ability to walk around in the house from one room to the other.
• Accessing stairs involving getting up and down the stairs. The stairs could be inside or outside the house
• Functional cognition involving some instrumental activities of daily living, such as, ability to plan the daily life, do shopping for needed personal supplies, and self-administer medications.

Patient’s prior performance in these 4 areas is rated on a scale with 6 choices. The following discussion on these choices applies to all the 4 areas addressed under this question.

Answers for GG0100

• Choice 3 indicates patient was totally independent on performance for the activity under consideration. For example, while evaluating one’s prior performance on self-care tasks, an individual is rated 3 only if he or she was totally independent on all the activities grouped under self-care tasks, such as, bathing, dressing, toileting & personal hygiene, and ability to self-feed. One with history of receiving any assistance from caregivers, even reminders, would not qualify them for a rating of 3.
• As we move from choices 3 to 1, caregiver dependence for activity performance progressively increases, with choice 2 indicating history of patient needing some help and choice 1 indicating history of patient’s total caregiver dependence.
• If an individual was totally independent performing one activity listed under the task and needed partial assistance with another, he or she could qualify for a rating of 2. For example, an individual who was independent with the dressing activity but needed assistance with bathing activity, both grouped under the same task – Self-care activities.
• Individuals with history of complete caregiver dependence for all the activities listed under the task qualify for a rating of 1. For example, an individual who needed assistance on bathing, dressing, toileting & personal hygiene, and ability to self-feed, basically all the activities listed under the task Self-care activities.
• Choice 9 indicates – not applicable. Clinician can pick this response, if the patient was unable to perform the activity before this current illness or exacerbation or injury that prompted a home health referral. For example, if a patient is chronically wheelchair bound and was not accessing stairs for a long time before the current illness or exacerbation happened, picking choice 9 for this patient as a response for accessing stairs can be appropriate.
• Apart from these 4 choices, we have two other choices on this question. Choice 8 indicating unknown and the last choice being – Not assessed/No information. If patient’s prior performance on activities was not evaluated at start of care or resumption of care, these choices can be coded. Clinicians must try minimizing picking these choices, as they provide no information on patient’s prior functioning. Having poor or no information on patient’s prior functional status can make it difficult to establish a reasonable patient discharge goal.

This question M1830 on OASIS-E  discusses patient’s current ability on safely taking shower and washing entire body. Evaluating clinician must pay close attention to the tasks included for evaluation. Tasks considered under this question M1830 include:

• Ability to access the site of washing – shower or a tub and ability to safely transfer in and out of the shower or tub.
• Ability to safely wash entire body once the needed supplies are within reach, excluding shampooing of hair and washing face and hands. The tasks of washing face and hands, shampooing of hair are explicitly excluded on this question, as they were already considered as part of grooming.
• Also, ability to prepare water for shower in the tub, accessing bathing supplies, towels, and other implements are also excluded while assessing an individual’s ability on safe performance of bathing.
• Use of shower assistive devices, such as, shower seat, rotating transfer tub bench, bath lift, grab bars, safety rails, adaptive bathing sponge, foot brush, handheld shower, and long-handled bathing wand and back scrubber can be considered by the patient independently or with caregiver supervision and/or assistance.

Answers for Question M1830 on OASIS-E

• This is a single response question for which choices are provided indicating patient’s independence and a varying range of caregiver dependence.
• Choice zero on the question indicates patient to be totally and safely independent on all the tasks included. This patient does not need any assistive devices or caregiver assistance for safe shower performance.
• Choice 1 indicates ability of the patient to safely access the site of washing – shower or tub and independently able to wash the entire body, but with the use of assistive devices. The individual must be safely independent at accessing and using all the shower assistive devices employed for the task to be rated 1 on the performance. Individuals needing caregiver cues and reminders for safe access and use of assistive devices would not qualify for a rating of 1. This patient needs assistive devices but does not need caregiver assistance at any point of task performance.
• Choices 2 to 6 indicate a patient needing caregiver assistance during task performance, with the level of dependence progressively increasing as we go from choices 2 to 6.
• Choice 2 indicates a patient able to use the shower or tub for bathing, but with caregiver intervention only intermittently during task performance. Intermittent caregiver intervention could involve offering assistance with getting in and out of shower or tub, merely offering cues, or offering manual assistance during the actual performance of shower. This patient could need shower assistive devices for improved independence and safe task performance and could also require caregiver assistance at accessing and using them safely. This patient, able to use the shower or tub, needs only intermittent caregiver involvement but not for the entire duration of shower.
• Choice 3 indicates a patient able to use the shower or tub for bathing, but only with caregiver intervention throughout the duration of task performance continuously. Continuous caregiver intervention could involve offering assistance with significant portion of the tasks included under taking a shower. This patient could also need shower assistive devices for improved independence and safe task performance and require caregiver assistance at accessing and using them safely. This patient, able to use the shower or tub, needs continuous caregiver involvement throughout the duration of shower for safe task performance.
• Choice 4 indicates a patient unable to use the shower or tub due to medical restrictions or safety concerns. This patient is able to safely and independently complete the task of bathing self in bed or access and bathe self at the sink or sitting in a bedside chair or on the commode. This patient may need shower assistive devices for independent task performance but is safely independent at accessing and using all the devices employed for the task. This patient, unable to use the shower or tub, but is safely independent with washing self in the bed or sink or on the commode with or without use of assistive devices and does not need caregiver assistance in any form and at any point of task performance.
• Choice 5 indicates a patient unable to use the shower or tub due to medical restrictions or safety concerns. This patient is able to safely participate in the task of bathing self in bed or accessing and bathing self at the sink or sitting in a bedside chair or on the commode. This patient needs caregiver assistance in the form of either supervision, offering cues and reminders, or manual assistance with having the patient sit up in bed or chair or reaching the sink or transferring over to the commode or bedside chair or washing difficult to reach areas of the body like lower extremities and back. This patient, unable to use the shower or tub, definitely needs caregiver involvement but also participates in the task performance.
• The last choice on the question, choice 6, indicates patient to be completely dependent on caregiver assistance and is totally bathed by another person, regardless of where the bathing happens. This patient practically has no active participation during task performance and thus is hundred percent caregiver dependent.