MDS Alert
Take The Guesswork Out Of ADL Index Calculation
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The calculation isn't a straightforward one.
A resident's ADL index is one score that you need to know is right on the mark.
The MDS software calculates the score invisibly, "but you need to understand the methodology to validate the index and understand how scoring the ADLs drives the calculation," says Diane Brown, CEO of Brown LTC Consultants in Boston.
Also, "most MDS software isn't going to calculate an ADL index until after the staff has completed the MDS," comments Nathan Lake, RN, an MDS expert in Seattle.
Thus, "some facilities do an ADL score calculation by hand using a worksheet or they develop an Excel spread sheet that calculates the score," he says.
Key point: Most of the money derives from coding in column A (self-performance), says Brown.
For example: If a 0 or 1 is coded in column A for a "late-loss" ADL (transfer, bed mobility or toileting), the computer system never goes to column B (support provided), says Brown. The ADL score for the ADL will be 1. If a 2 (limited assistance) is coded in column A at G1 for those late-loss ADLs, the ADL score will be 3.
But if a 3, 4 or 8 is coded in column A for bed mobility, transfer or toileting--and column B has a code of 0 to 2--the ADL score will be 4. If a 3, 4 or 8 is in column A, and column B shows a two-or more person assist (3) or 8 (ADL activity itself did not occur over the last seven days), the ADL score will be 5.
Know the 2 Ways the Eating Score Is Calculated
The ADL score for eating is calculated in two ways, as follows:
If you check K5a (parenteral/IV), the eating ADL score will be 3. If you check K5b (feeding tube) and EITHER (1) K6a is 51% or more calories OR (2) K6a is 26% to 50% calories and K6b is 501cc or more per day fluid enteral intake, then the eating ADL score is 3.
Otherwise, the ADL score comes from the resident's self-performance in eating. A score of 0 or 1 translates into an ADL index of 1.
A 2 coded for self-performance will be a 2 ADL index. A 3, 4 or 8 equals an ADL index of 3.
Editor's note: See the chart on the right for a summary of the ADL index calculation. 
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