Eating/hygiene/Shower
Dressing/Footwear
Bed moblity
Transfer/Moblity
General
100

CNA provides Mrs. K with water and toothpaste to clean her dentures. Mrs. K cleans her upper denture plate. Mrs. K then cleans half of her lower denture plate, but states she is tired and unable to finish. The CNA finishes cleaning the lower denture and Mrs. K replaces the dentures in her mouth.

03, Partial/moderate assistance 

100

Mrs. Marshall has multiple fractures and sprains due to a fall. She has been issued a knee brace, to be worn during the day. Mrs. Marshall threads her legs into her garments and pulls up and down their clothing to and from just below her hips. Only a little assistance from a helper is needed to pull up her garments over her hips. Mrs. Marshall requires the helper to fasten her knee brace because of grasp and fine motor weakness.

03, Partial/Moderate Assistance

100

Mrs. B attempts to get herself from a lying to a seated position as the occupational therapist provides much of the lifting assistance necessary for her to sit upright. The CNA provides additional lifting assistance as Mr. B scoots himself to the edge of the bed and lowers his feet to the floor.

02, Substantial/maximal assistance

100

Mrs. Q transfers onto and off the elevated toilet seat with the certified nursing assistant supervising due to her unsteadiness.

 04, Supervision or touching assistance.

100

True or false? Since Mr. W uses a quad cane, he cannot be considered independent for the Section GG walking items.

False

200

Mrs. L uses the toilet to void and have bowel movements. Mrs. L is unsteady, so the CNA  walks into the bathroom with her in case she needs help. During the assessment period, a staff member has been present in the bathroom, but has not needed to provide any physical assistence with managing clothes or cleaning. 

04, Supervision or touching assistance 

200

Mrs. Y has right-side upper extremity weakness as a result of a stroke and has worked in therapy to relearn how to dress her upper body. During the day, she requires a certified nursing assistant only to place her clothing next to her bedside. Mrs. Y can now use compensatory strategies to put on her bra and top without any assistance. At night she removes her top and bra independently and puts the clothes on the nightstand, and the certified nursing assistant puts them away in her dresser.

05, Setup or clean-up assistance.

200

Mrs. 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 her right side. The CNA lifts and positions Mrs. H’s right leg. Mrs. H uses her arms to position her upper body and lowers herself to a lying position flat on her back.

03,Partial/moderate assistance

200

Mrs. T can transfer from the wheelchair onto the toilet by herself safely. The CNA moves the footrest out of the way before Mrs. T transfers but is not present during the transfer because supervision is not required. Once Mrs. T completes the transfer from the toilet back to the wheelchair, she flips the footrest back down herself. 

05, Setup or clean-up assistance 

200

Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.

02. Substantial/maximal assistance

300

Mrs. M has a fracture of her left wrist and hip from a recent fall. She is left-handed. Mrs. M starts eating on her own, but she does not have the coordination in her right hand to manage the eating utensils to feed herself without great effort. Mrs. M tires easily and cannot complete eating the meal. The CNA feeds her more than half of the meal.

02,Substantial/maximal assistance 

300

Mrs. F was admitted to the SNF for a neurologic condition and experiences visual impairment and fine motor coordination and endurance issues. She requires setup for retrieving her socks and shoes, which she prefers to keep in the closet. Mrs. F often drops her shoes and socks as she attempts to put them onto her feet or as she takes them off. Often a certified nursing assistant must first thread her socks or shoes over her toes, and then Mrs. F can complete the task. Mrs. F needs the certified nursing assistant to initiate taking off her socks and unstrapping the Velcro used for fastening her shoes.

02, Substantial/maximal assistance.

300

Mrs. H requires assistance from two CNAs to transfer from sitting at the edge of the bed to lying flat on the bed due to paralysis on her right side, obesity, and cognitive limitations. One of the CNAs explains to Mrs. H each step of the sitting to lying activity. Mrs. H is then fully assisted to get from sitting to a lying position on the bed. Mrs. H makes no attempt to assist when asked to perform the incremental steps of the activity

 01, Dependent

300

Mrs. T walks 50 feet with the CNA providing trunk support and a second CNA following behind with the wheelchair providing supervision. Mrs. T walks the 50 feet with two turns.

01, Dependent 

300

True or false- Coding eating includes tube feedings?

False

400

The dietary aide opens all of Mr. S’ cartons and containers on his food tray before leaving the room. There are no safety concerns regarding Mr. S’ ability to eat. Mr. S eats the food himself, bringing the food to his mouth, using appropriate utensils, and swallowing the food safely.

05, Setup or clean -up assistance.

400

Mrs. R has peripheral neuropathy in her upper and lower extremities. Each morning, Mrs. R needs assistance from a helper to place her lower limb into, or to take it out of (don/doff), her lower limb prosthesis. She needs no assistance to put on and remove her underwear or slacks.

03, Partial/moderate assistance

400

Mrs. F requires assistance from a CNA to get from a sitting position to lying flat on the bed. The CNA cradles and supports her trunk and right leg to transition Mrs. F from sitting at the side of the bed to lying flat on the bed. Mrs. F assists herself a small amount by bending her elbows and left leg while pushing her elbows and left foot into the mattress only to straighten her trunk while transitioning into a lying position.

 02, Substantial/maximal assistance

400

Ms. R has severe rheumatoid arthritis and uses forearm crutches to ambulate. The CNA brings Ms. R her crutches and helps her to stand at the side of the bed. The CNA provides some lifting assistance to get Ms. R to a standing position but provides less than half the effort to complete the activity.

03, Partial/moderate assistance 

400

True and false? Toileting hygiene does not include the transfer on and off the toilet.

True

500

Mr. J sits on a tub bench as he washes, rinses, and dries himself. A CNA stays with him to ensure his safety, as Mr. J has had instances of losing his sitting balance. The certified nursing assistant also provides lifting assistance as Mr. J gets onto and off of the tub bench.

04, Supervision or touching assistance

500

Mr. M is undergoing rehabilitation for right-side upper and lower body weakness following a stroke. He has made significant progress toward his independence and will be discharged to home tomorrow. Mr. M wears an ankle-foot orthosis that he puts on his foot and ankle after he puts on his socks but before he puts on his shoes. He always places his AFO, socks, and shoes within easy reach of his bed. While sitting on the bed, he needs to bend over to put on and take off his AFO, socks, and shoes, and he occasionally loses his sitting balance, requiring staff to place their hands on him to maintain his balance while performing this task.

04, Supervision or touching assistance.

500

Ms. P is being treated for sepsis and has multiple infected wounds on her lower extremities. Full assistance from the certified nursing assistant is needed to move Ms. P from a lying position to sitting on the side of her bed because she usually has pain in her lower extremities upon movement

01, Dependent

500

Mrs. C has Parkinson’s disease and walks with a walker. A physical therapist must advance the walker for Mrs. C with each step. The physical therapist assists Mrs. C by physically initiating the stepping movement forward, advancing Mrs. C’s foot, during the activity of walking 10 feet.

02, Substantial/maximal assistance.

500

True and false. Hospital gown is included in upper body dressing?

Falase

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