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Q: I am confused about how to code ADLs that require weight-bearing support. How can I determine the difference between weight-bearing support and guided maneuvering?

Julia's PPS Chat, September 28, 2005

Welcome once again to our PPS chat!

Coding activities of daily living (ADL) continues to be a very difficult part of the MDS. Small differences in the amount of assistance provided to residents can change your coding dramatically.

Read on to find out the answer to a question about the amount of support and maneuvering provided.

Q: I am confused about how to code ADLs that require weight-bearing support. How can I determine the difference between weight-bearing support and guided maneuvering?

A: Your question refers to the coding of ADLs in Section G of the MDS, Physical functioning and structural problems. This section is one of the more complex portions of the MDS and can be difficult to complete without a full understanding of the various terms used for coding descriptions.

Let's turn to the revised Resident Assessment Instrument (RAI) User's Manual to answer your question. This revised manual contains clarifications and many examples to help you understand how to correctly code Section G. Pages 3-92 and 3-93 address guided maneuvering and weight-bearing support.

Using the example of eating, the manual states, "The key to the differentiation between guided maneuvering and weight-bearing assistance is determining who is supporting the weight of the resident's hand. If the staff member supports some of the weight of the resident's hand while helping the resident to eat (e.g., lifting a spoon or a cup to mouth), this is 'weight-bearing' assistance for this activity. If the resident can lift the utensil or cup, but staff assistance is needed to guide the resident's hand to his/her mouth, this is guided maneuvering."

You can apply this example to the other ADLs by determining whether, during the ADL activity, the staff are actually bearing weight for the resident or only helping a resident to maneuver. Read the coding descriptions in item G1A, ADL self-performance, carefully when completing this section.

Note that limited assistance, a code of 2, refers to guided maneuvering of limbs and extensive assistance; a code of 3 refers to weight-bearing support. Remember to count the number of times each type of assistance was provided during your seven-day assessment period and code exactly according to the MDS directions.

My suggestion for ensuring accuracy when coding ADLs is to be sure that you read the revised RAI USer's Manual definitions extremely closely and also study the examples that are given. Be sure that you have all the updates to the manual. By doing this, you can become an expert at ADL coding!

We'll be chatting again soon-