MDS Alert
Be Forewarned When You Code B4
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A quick assessment won't do the trick. If a resident seems to have severe cognitive impairment and is nonverbal, but usually clamps his mouth shut when offered a bit of food, would the resident be considered moderately or severely impaired?
OR
If a resident does not generally make conversation or make his needs known, but replies "yes" when asked if he would like to take a nap, would the resident be considered moderately or severely impaired?
Answer: "These examples are similar in that the residents are primarily non-verbal and do not make their needs known, but do make basic verbal or nonverbal responses or simple gestures to questions regarding care routines (e.g., comfort)," states the RAI user's manual.
Based on the limited information provided about the residents, "one would gather that their communication is only focused on very particular circumstances, in which case [you'd regard it as] 'rarely/never' in terms of the relative number of decisions a person could make during the course of a week," according to the manual. So you'd code B4 as "3" for severe impairment.
Yet the assessor should determine if the resident would respond in a similar fashion to other requests made during the 7-day observation period, the manual instructs. "If such 'decisions' are more frequent, the resident may only be moderately impaired or better" (RAI manual, page 3-47).
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