Home Health & Hospice

Complex Caregiving Data Elements Need Clarification

Homecare Insider, November 9, 2009

OASIS-C makes some drastic changes in questions addressing a patient’s living and caregiving arrangements.  There are three new data elements; two are charts.  At first glance, these charts look complex; however, they eliminate many of the confusing aspects of OASIS-B1 data elements, especially with regard to the primary caregiver.

The following is a description of the new data elements:
• M1100, patient living situation, presents three options for the patient’s living arrangements and four choices for availability of assistance.
• M2100, types and sources of assistance, is a complex chart.  The data element, which takes up almost one page, asks about the patient’s need for assistance and the type of assistance received in seven areas:  activities of daily living, instrumental activities of daily living, medication administration, medical procedures/treatments, management of equipment (including oxygen, IV/infusion, enteral/parenteral nutrition, ventilator therapy), supervision and safety, and advocacy or facilitation in medical care.  The levels of assistance address the role and abilities of the caregiver.
• M2110, how often does the patient receive ADL/IADL assistance from any caregiver other than agency staff, is similar to a data element in OASIS-B1 (M0370).  However, this new data element counts any caregiver’s involvement, not just that of the primary caregiver.

Clinicians must pay close attention to the item-by-item guidance to ensure appropriate answers.  A patient can have different needs and the caregiver can have different abilities in each of the seven activities in M2100.  According to the OASIS-C Guidance Manual, consider the response that represents the most need of the patient for assistance and the most need or greatest limitation of the caregiver.  Example:  The patient is independent in eating but needs help in the other six activities.  The caregiver cannot transfer the patient but is willing to learn and she can assist with the other activities.  Response 2, caregiver(s) needs training/supportive services to provide assistance.

Also be aware of consistency issues.  If these responses identify that a caregiver needs instruction, the clinical record should explain the agency’s action.  If a patient needs assistance with an activity but a caregiver is not likely to provide the care, what is plan?

The CD recording, “Analysis of Redesigned OASIS-C Data Elements,” discusses these data elements and more.  Check out this educational program for clinicians.