Our agency admits several patients who must live in an ALF's because of dementia/cognitive function to the point of not being safe in their home. Their BIMS indicate severe impairment; they have an activated POA and are unable to learn/retain new information. In these situations, when scoring M1700 Cognitive Functioning, would it be compliant to code 4: Totally dependent due to disturbances such as constant disorientation, coma, persistent vegetative state, even if they don't exhibit the examples given in the guidance? Per the Guidance Manual, when the term examples are used, "the clinician may consider other relevant circumstances or attributes when scoring the item." If a patient must live in an ALF due to their cognitive decline and are coded 4, they would be excluded from many OASIS outcome measures, such as M2020 Improvement in Management of Oral Medications, which seems appropriate as they wouldn't be expected to improve.
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Lisa Johnson
Aspirus VNA Home Health Inc. dba Aspirus At Home
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