Long-Term Care

Upcoming ADL changes

MDS 3.0 Insider, July 13, 2009

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It can be difficult to keep track of all the changes facilities will face with the implementation of the MDS 3.0 and RUG-IV. Unfortunately, some important changes, such as those related to activities of daily living (ADL), have not received the attention they deserve. ADLs play a large role in the assessment process and RUG classification, and SNF staff members must be aware of the upcoming changes to ADL coding and the index scoring methodology.

The latest MDS 3.0 includes additional instructions to help simplify ADL coding. For example, when an ADL activity occurs three or more times at various levels of assistance, it instructs members of the MDS team to code for the most dependent episode. The draft also restores the two-column coding format for ADL self-performance and support provided included in the MDS 2.0, which was omitted from the previous draft.

The RUG-IV proposal includes changes to improve the ADL index scoring methodology. SNF staff must remember that these are proposed changes and we will not know the final RUG-IV specifications until later this year. Highlights of the proposed changes to the ADL index include the following:

  • Changing the 15-point scale (4-18) to a 17-point scale (0-16) to better capture functional status
  • The eating ADL no longer considers enteral and IV feeding in the calculation, but will include support codes for staff assistance
  • The point counts related to specific ADL function have been adjusted based on recent data analysis (e.g., If bed mobility is coded as extensive [G1Aa=3] with assist of 1 person [G1Ba=2], the score would be 4 of the 15 points under RUG-III, but under RUG-IV the score would be 2 of the 17 points)
  • If a ‘late-loss’ ADL does not occur (G1A or B=8), then the score will be 0 points
  • The ADL levels that subdivide the major hierarchies or categories into payment categories will be standardized, rather than random



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