(ADL) DECLINE - Primaris

ACTIVITIES OF DAILY LIVING (ADL) DECLINE
Essential Systems for Quality Care
The following information suggests areas to focus on while evaluating facility processes for minimizing ADL decline.
Systems to Review
Organizational
Commitment
Screening and
Assessment Processes
Key Interventions to Promote Functional Independence and Minimize ADL Decline
Establish top-down commitment from administrator, medical director, director of nursing, and rehab director to
gain facility-wide support for managing all components of health influencing function and disability.
Identify key staff members to participate in an interdisciplinary workgroup for facility’s ADL restorative
programs.
Analyze current ADL screening, assessment processes, and ADL program management practices.
Articulate and implement acceptable standards of practice.
Establish accountability for monitoring general health and functional abilities.
Provide appropriate resources and training materials to staff.
Evaluate outcomes related to screening/assessment practices and ongoing management of functional abilities.
Revise policies, procedures, and practices as needed to improve functional outcomes.
Develop processes to screen and evaluate (as needed) ADL function upon admission, readmission, with each MDS
assessment, as well as with significant change in condition and/or decline in ADL abilities.
Review facility screening and assessment forms to see if they identify all significant health components that may
influence functioning and disability [ICF Model of Functioning and Disability 2001
www.who.int/classification/icf].
Use validated, standardized measures of ADL function to establish baseline performance and to objectively
measure future ADL performance (e.g., Katz ADL Index, Barthel Scale, MDS scores for ADL items).
Document clinical findings and record test results and response to activity.
Use assessment data to establish diagnosis and match treatment interventions to specific conditions.
Use screening and assessment data to inform plan of care, recommendations for follow-up, and referrals to other
health professionals for management of conditions outside your scope of practice.
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Systems to Review
Care Planning Process
Interventions and
Treatment Processes
Key Interventions to Promote Functional Independence and Minimize ADL Decline
Identify all health components impacting functional abilities.
Establish a diagnosis and prognosis.
Develop a plan of care that matches treatments to specific conditions.
Identify interventions/treatments (i.e., functional training, training in simulated environments, exercise, device and
equipment use, task adaptation, barrier accommodation or modification, safety awareness training, injury
prevention/reduction training, restorative nursing program, family/caregiver training, referrals to other health
professionals). Identify treatment frequency and duration.
Identify caregiver to implement care plan interventions.
Record expected outcomes. Record response to treatments.
Review and revise care plans based on resident’s response and feedback from resident and all other team members
[Guide to Physical Therapist Practice. 2 nd ed. Phys Ther. 2001;81:9-744].
Identify and treat all health conditions that may influence functional abilities.
Match treatment interventions to specific conditions. Select rehabilitation interventions appropriate to the
impairment, disability, and limitation in activity or restricted ability to participate. Rehab interventions may
include functional training, training in simulated environments, exercise, device and equipment use, task
adaptation, barrier accommodation or modification, safety awareness training, injury prevention/reduction
training, restorative nursing program, family/caregiver training, and/or referrals to other health professionals.
Manage general health throughout all stages of treatment including comorbid conditions, acute illness, nutrition,
hydration, bowel and bladder function. Prevent complications of DVT, dysphagia, aspiration, skin breakdown,
UTI, falls, loss of ROM, immobility, edema, adverse drug reactions, depression [Clinical Practice Guideline, Post-
Stroke Rehabilitation, Quick Ref. Guide 16, AHCPR].
Educate and document training provided to residents, family/caregiver, and staff regarding function, interventions,
use of adaptive/assistive equipment, precautions, and safety issues.
Institute restorative programs, maintenance programs, and post-discharge exercise programs to improve, maintain
or prevent/minimize ADL decline.
Identify and treat residents in need of skilled therapy services or restorative ADL programs.
Identify and address environmental factors influencing ADL function (e.g., available equipment, assistive devices,
restraint use, environmental barriers (building, furniture), attitudes, institutional support, staff knowledge/training,
institutionally induced helplessness of residents, policies, family support and relationships).
[ICF Model of Functioning and Disability 2001 www.who.int/classification/icf]
[Morris JN, Fiatarone M, Kiely DK, Belleville-Taylor P, Murphy K, Littlehale S, Ooi WL, O’Neill E, and Doyle N.
Nursing rehabilitation and exercise strategies in the nursing home. Journal of Gerontology: Medical Sciences. 1999
Oct;54(10):M494-500.]
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Systems to Review
Monitoring and
Reassessing
Policies and Procedures
Staff Education and
Training
Key Interventions to Promote Functional Independence and Minimize ADL Decline
Develop documentation tools to record and monitor general health condition, significant changes, current
interventions, response to interventions, duration and frequency of treatments, functional performance and
capacity, amount of assistance required, adaptive techniques, assistive equipment used, progress toward goals,
need for reassessment, need for referral to other health professionals.
Establish ongoing channels of communication between resident, all involved health professionals, restorative
aides, family, and caregivers regarding current status, progress toward goals, and related issues (e.g.,
interdisciplinary team meetings, care plan meetings, family conferences, discharge planning meetings).
Facility policies, procedures, and clinical practice standards are in place to screen and evaluate ADL functions at
appropriate intervals.
Involve all appropriate health professionals in managing residents’ health conditions.
Communicate current condition and performance to designated MDS recorder, to ensure correct coding on MDS
functional items.
Measure current staff knowledge and competencies with ADL skills and all health components related to function
and disability.
Identify learning needs.
Organize staff training to address all components of health influencing function and disability (e.g., physiological,
psychological, anatomical, functional, environmental, social).
Solicit training from health professionals with knowledge and skills to educate staff about various health
components (i.e., physicians, nurses, therapists, dieticians, social workers, psychologists).
Identify a clinical expert in the facility for ADL skills and restorative programs.
Provide ongoing staff training (at least quarterly) to address all aspects of ADL management.
Educate staff in documentation methods to record residents’ general condition, changes, functional performance,
decline in functional abilities.
Teach staff how to make referrals to other health professionals for management of significant health conditions.
Incorporate training into orientation of newly hired employees regarding all components of health influencing
functional abilities.
Provide ongoing information to residents, families, caregivers, and staff regarding current treatment interventions,
ADL programs, and how to get involved.
MO-03-01-NHAD January 2003
This material was prepared by Primaris under contract
with the Centers for Medicare & Medicaid Services (CMS).
The contents presented do not necessarily reflect CMS policy.
Version 01/14/2003
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