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Q: I still get confused when completing item G1a, ADL self-performance. When the staff perform the majority of the ADL for the resident, how do I differentiate between extensive assistance and total dependence? Both options seem somewhat similar.

Julia's PPS Chat, January 18, 2006

A: This can be a very confusing area of the MDS to complete. Let's begin by looking at the definitions of extensive assistance and total dependence in the updated Resident Assessment Instrument (RAI) User's Manual. Page 3-81 defines extensive assistance as "while the resident performed part of activity over last seven days, help of following type(s) was provided three or more times:

  • Weight-bearing support provided three or more times;
  • Full staff performance of activity (three or more times) during part (but not all) of last seven days."

Total dependence is defined as "full staff performance of the activity during entire seven-day period. There is complete non-participation by the resident in all aspects of the ADL definition task."

Looking at these definitions, the deciding factor is whether the resident assisted during the ADL. If the resident did not participate at all every time the ADL was performed during your seven day assessment period, then you should code the resident as being totally dependent. For example, say you prepare to turn the resident in bed. If the staff must perform the entire activity and the resident does not assist in any way, you would consider this total dependence in bed mobility.

If the resident is able to reach for a side rail to assist but the staff perform all other aspects of turning the resident in bed, you would not consider this resident totally dependent.

Remember to closely watch for any participation from the resident. If the resident does participate, even to a small extent, do not code total dependence.

Always review the coding guidelines in the RAI User's Manual carefully. Be sure that you have all the recent updates to the manual so that your coding will be as accurate as possible. Also, talk with staff and review the medical record documentation for information about the ADL assistance required by your resident.

We'll be chatting again soon-