Hygiene
Oral Hygiene: Mr. Hamilton has dentures. He can brush his gums and cleans both his dentures the best he can. But because he can only use one hand, it's tough for him to get them thoroughly cleaned. The staff help him finish cleaning the dentures. He places them back in his mouth. Staff do less than half of the effort
Partial/Moderate- staff provide less than half of the effort.
Mr. Alex faces mobility challenges due to several medical issues. He prefers to wash his body while sitting near the sink in his bathroom. A CNA steps in to help with washing, rinsing, and drying Alex's arms/hands, upper legs, lower legs, buttocks, and back
Substantial/maximal assistance- The CNA completed more than half the effort. Remember, bathing at the sink can be used for bathing and washing, rinsing, or drying the person's back is not included.
Resident Z wears a bra and a sweatshirt most days while in the SNF. They require assistance from a CNA to initiate the threading of their arms into their bra. Resident Z completes the placement of the bra over their chest. The helper hooks the bra clasps. Resident Z pulls the sweatshirt over their arms, head, and trunk. When undressing, Resident Z removes the sweatshirt, with the helper assisting them with one sleeve. Resident Z slides the bra off, once it has been unclasped by the helper.
Partial/moderate assistance.
Sit-to-lay: Resident H requires assistance from a nurse to transfer from sitting at the edge of the bed to lying flat on the bed because of paralysis on their right side. The helper lifts and positions Resident H’s right leg. Resident H uses their arms to position their upper body and lowers themself to a lying position flat on their back
Partial/moderate assistance. A helper lifts Resident H’s right leg and helps them position it as they move from a seated to a lying position; the helper performs less than half of the effort.
Toilet Transfer: The CNA moves the wheelchair footrests up so that Resident T can transfer from the wheelchair onto the toilet by themself safely. The CNA is not present during the transfer, because supervision is not required. Once Resident T completes the transfer from the toilet back to the wheelchair, they flip the footrests back down themself.
Setup or clean-up assistance
Toileting hygiene: When Mr. Jones used the toilet, the certified nursing assistant (CNA) provided steadying assistance while he pulled down his pants and underwear. When he finished, the CNA provided steadying assistance as he wiped his perineal area and pulled up his pants and underwear without assistance.
Supervision or Touching- The CNA provided steadying (touching) assistance to complete toileting hygiene.
Resident J sits on a tub bench as they wash, rinse, and dry themself. A certified nursing assistant stays with them to ensure their safety, as Resident J has had instances of losing their sitting balance. The certified nursing assistant also provides lifting assistance as Resident J gets onto and off of the tub bench.
Supervision or touching assistance. Remember: The helper provides supervision as Resident J washes, rinses, and dries themself. The transfer onto or off of the tub bench is not considered when coding the Shower/bathe self activity.
Resident K sustained a spinal cord injury that has affected both movement and strength in both upper extremities. They place their left hand into one-third of their left sleeve of their shirt with much time and effort and are unable to continue with the activity. A CNA then completes the remaining upper body dressing for Resident K
Substantial/maximal assistance
Lay-to-sit: Resident P is recovering from Guillain-Barre Syndrome with residual lower body weakness. The CNA steadies Resident P’s trunk as they get to a fully upright sitting position on the bed and lifts each leg toward the edge of the bed. Resident P then scoots toward the edge of the bed and places both feet flat on the floor. Resident P completes most of the effort to get from lying to sitting on the side of the bed.
Partial/moderate assistance.
Resident S is on bedrest due to a medical complication. They use a bedpan for bladder and bowel management.
Not attempted due to medical condition or safety concerns.
Personal Hygiene: Mrs. Maple is not able to complete any part of hygiene. In the morning, staff wash and dry her face and comb her hair before breakfast.
Dependent- Staff does ALL the effort.
Mr. Q requires 2 staff members to assist when performing a bed bath.
Dependent. A resident who requires 2 staff to assist in providing a care task is charted as dependent.
Resident M has severe rheumatoid arthritis and multiple fractures and sprains due to a fall. They have been issued a knee brace, to be worn during the day. Resident M threads their legs into their garments and pulls up and down their clothing to and from just below their hips. Only a little assistance from a helper is needed to pull up their garments over their hips. Resident M requires the helper to fasten their knee brace because of grasp and fine motor weakness.
Partial/moderate assistance
Resident Z has amyotrophic lateral sclerosis with moderate weakness in their lower and upper extremities. Resident Z has prominent foot drop in their left foot, requiring the use of an ankle foot orthosis (AFO) for standing and walking. The certified nursing assistant applies Resident Z’s AFO and places the platform walker in front of them; Resident Z uses the walker to steady themself once standing. The certified nursing assistant provides lifting assistance to get Resident Z to a standing position and must also provide assistance to steady Resident Z’s balance to complete the activity
Substantial/maximal assistance
Walk 10 feet: Resident C walks using the parallel bars with therapy in the gym.
Not attempted due to medical condition or safety concerns
Resident J is morbidly obese and has a diagnosis of debility. They request the use of a bedpan when voiding or having bowel movements and require two certified nursing assistants to pull down their pants and underwear and mobilize them onto and off the bedpan. Resident J is unable to complete any of their perineal/perianal hygiene. Both certified nursing assistants help Resident J pull up their underwear and pants.
Dependent. The assistance of two helpers was needed to complete the activity of toileting hygiene.
Chair-Bed Transfer: Resident F recently underwent bilateral above-the-knee amputations. Resident F requires mechanical hoyer lift for transfers from the bed to the wheelchair.
Dependent.
Walk 10 feet: Resident L had bilateral amputations three years ago, and prior to the current admission they used a wheelchair and did not walk. Currently Resident L does not use prosthetic devices and uses only a wheelchair for mobility.
Not applicable, not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury.
Resident J completed all hygiene tasks independently two out of six times during the observation period. The other four times they were unable to complete brushing and styling their hair and washing and drying their face because of elbow pain after initiating the tasks, so a staff member completed these tasks.
Substantial/maximal assistance. Although Resident J was able to complete their personal hygiene tasks independently on two of the six occasions the activity occurred, a staff member had to complete their personal hygiene tasks after the resident initiated them on four of the six occasions. Because the staff had to complete Resident J’s personal hygiene tasks on four of the six occasions the activity occurred during the observation period, the staff provided more than half the effort to complete the personal hygiene tasks.
Chair-Bed Transfer: Resident U had their left lower leg amputated Resident U uses a transfer board for chair/bed-to-chair transfers. The CNA places the transfer board under their buttock. Resident U then attempts to scoot from the bed onto the transfer board. Resident U assists with the transfer. The CNA assists them in side scooting by lifting their buttocks/trunk in a rocking motion across the transfer board and into the wheelchair.
Substantial/maximal assistance