C0500: BIMS Summary Score

Item Rationale

Health-related Quality of Life

• The total score:

— Allows comparison with future and past performance.

— Decreases the chance of incorrect labelling of cognitive ability and improves detection of delirium.

— Provides staff with a more reliable estimate of resident function and allows staff interactions with residents that are based on more accurate impressions about resident ability.

Planning for Care

• The BIMS is a brief screener that aids in detecting cognitive impairment. It does not assess all possible aspects of cognitive impairment. A diagnosis of dementia should only be made after a careful assessment for other reasons for impaired cognitive performance. The final determination of the level of impairment should be made by the resident’s physician or mental health care specialist; however, these practitioners can be provided specific BIMS results and the following guidance: The BIMS total score is highly correlated with Mini-Mental State Exam (MMSE; Folstein, Folstein, & McHugh, 1975) scores. Scores from a carefully conducted BIMS assessment where residents can hear all questions and the resident is not delirious suggest the following distributions:

13-15: cognitively intact

8-12: moderately impaired

0-7: severe impairment

• Abrupt changes in cognitive status (as indicative of a delirium) often signal an underlying potentially life-threatening illness and a change in cognition may be the only indication of an underlying problem.

• Care plans can be more individualized based upon reliable knowledge of resident function.

Steps for Assessment

After completing C0200-C0400:

1. Add up the values for all questions from C0200 through C0400.

2. Do not add up the score while you are interviewing the resident. Instead, focus your full attention on the interview.

Coding Instructions

Enter the total score as a two-digit number. The total possible BIMS score ranges from 00 to 15.

• If the resident chooses not to answer a specific question(s), that question is coded as incorrect, and the item(s) counts in the total score. If, however, the resident chooses not to answer four or more items, then the interview is coded as incomplete, and the Staff Assessment for Mental Status is completed.

• To be considered a completed interview, the resident had to attempt and provide relevant answers to at least four of the questions included in C0200-C0400. To be relevant, a response only has to be related to the question (logical); it does not have to be correct. See general coding tips below for residents who choose not to participate at all.

• Code 99, unable to complete interview: if (a) the resident chooses not to participate in the BIMS, (b) if four or more items were coded 0 because the resident chose not to answer or gave a nonsensical response, or (c) if any but not all of the BIMS items are coded with a dash (—).

— Note: a 0 score does not mean the BIMS was incomplete. For the BIMS to be incomplete, a resident must choose not to answer or must give completely unrelated, nonsensical responses to four or more items. If one or more of the 0s in C0200–C0300 are due to incorrect answers, the interview should continue.

Coding Tips

• Occasionally, a resident can communicate but chooses not to participate in the BIMS and therefore does not attempt any of the items in the section. This would be considered an incomplete interview; enter 99 for C0500, BIMS Summary Score, and complete the Staff Assessment for Mental Status.

Example

1. The resident’s scores on items C0200-C0400 were as follows:

C0200 (repetition) 3

C0300A (year) 2

C0300B (month) 2

C0300C (day) 1

C0400A (recall “sock”) 2

C0400B (recall “blue”) 2

C0400C (recall “bed”) 0

Coding: C0500 would be coded 12 (Sum of C0200–C0400C). C0600. Should the Staff Assessment for Mental Status be Conducted? is coded as 0, No, and the skip pattern is followed.

2. The resident’s scores on items C0200–C0400C were as follows:

C0200 (repetition) 2

C0300A (year) 2

C0300B (month) 2

C0300C (day) 1

C0400A (recall “sock”) 0

C0400B (recall “blue”) 0

C0400C (recall “bed”) 0

Coding: C0500 would be coded 07 (Sum of C0200–C0400C). C0600. Should the Staff Assessment for Mental Status be Conducted? is coded as 0, No, and the skip pattern is followed.

3. The resident’s score on items C0200–C0400C were as follows:

C0200 (repetition) 0 (no response provided)

C0300A (year) 0 (nonsensical response provided)

C0300B (month) 0 (nonsensical response provided)

C0300C (day) 0 (no response provided and the interview was stopped)

C0400A (recall “sock”) (—)

C0400B (recall “blue”) (—)

C0400C (recall “bed”) (—)

Coding: C0500 would be coded 99, resident was unable to complete the interview.

Rationale: The interview was stopped because the resident did not respond to two questions and provided nonsensical responses to two questions. Since the resident did not attempt to answer two questions and did not provide relevant answers to two questions, the BIMS interview is considered incomplete.