C0600: Should the Staff Assessment for Mental Status (C0700-C1000) Be Conducted?

Item Rationale

Health-related Quality of Life

• Direct or performance-based testing of cognitive function using the BIMS is preferred as it decreases the chance of incorrect labelling of cognitive ability and improves detection of delirium. However, a minority of residents are unable or unwilling to participate in the BIMS.

• Mental status can vary among persons unable to communicate or who do not complete the interview.

— Therefore, report of observed behavior is needed for persons unable to complete the BIMS interview.

— When cognitive impairment is incorrectly diagnosed or missed, appropriate communication, activities, and therapies may not be offered.

Planning for Care

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

— This remains true for persons who are unable to communicate or to complete the BIMS.

• Specific aspects of cognitive impairment, when identified, can direct nursing interventions to facilitate greater independence and function.

Steps for Assessment

1. Review whether BIMS Summary Score item (C0500), is coded 99, unable to complete interview.

Coding Instructions

• Code 0, no: if the BIMS was completed and scored between 00 and 15. Skip to C1310.

• Code 1, yes: if the resident chooses not to participate in the BIMS or if four or more items were coded 0 because the resident chose not to answer or gave a nonsensical response. Continue to C0700, Short-term Memory OK, to perform the Staff Assessment for Mental Status. Note: C0500 should be coded 99.

Coding Tips

• If a resident is scored 00 on C0500, the Staff Assessment for Mental Status should not be completed. 00 is a legitimate value for C0500 and indicates that the interview was complete. To have an incomplete interview, a resident had to choose not to answer or had to give completely unrelated, nonsensical responses to four or more BIMS items.