E0500: Impact on Resident

E0500: Impact on Resident

Item Rationale

Health-related Quality of Life

• Behaviors identified in item E0200 impact the resident’s risk for significant injury, interfere with care or their participation in activities or social interactions.

Planning for Care

• Identification of the impact of the behaviors noted in E0200 may require treatment planning and intervention.

• Subsequent assessments and documentation can be compared to a baseline to identify changes in the resident’s behavior, including response to interventions.

Steps for Assessment

1. Consider the previous review of the medical record, staff interviews across all shifts and disciplines, interviews with others who had close interactions with the resident and previous observations of the behaviors identified in E0200 for the 7-day look-back period.

2. Code E0500A, E0500B, and E0500C based on all of the behavioral symptoms coded in E0200.

3. Determine whether those behaviors put the resident at significant risk of physical illness or injury, whether the behaviors significantly interfered with the resident’s care, and/or whetherthe behaviors significantly interfered with the resident’s participation in activities or social interactions.

Coding Instructions for E0500A. Did Any of the Identified Symptom(s)

Put the Resident at Significant Risk for Physical Illness or Injury?

• Code 0, no: if none of the identified behavioral symptom(s) placed the resident at clinically significant risk for a physical illness or injury.

• Code 1, yes: if any of the identified behavioral symptom(s) placed the resident at clinically significant risk for a physical illness or injury, even if no injury occurred.

Coding Instructions for E0500B. Did Any of the Identified Symptom(s)

Significantly Interfere with the Resident’s Care?

• Code 0, no: if none of the identified behavioral symptom(s) significantly interfered with the resident’s care.

• Code 1, yes: if any of the identified behavioral symptom(s) impeded the delivery of essential medical, nursing, rehabilitative or personal care, including but not limited to assistance with activities of daily living, such as bathing, dressing, feeding, or toileting.

Coding Instructions for E0500C. Did Any of the Identified Symptom(s)

Significantly Interfere with the Resident’s Participation in Activities or Social Interactions?

• Code 0, no: if none of the identified symptom(s) significantly interfered with the resident’s participation in activities or social interactions.

• Code 1, yes: if any of the identified behavioral symptom(s) significantly interfered with or decreased the resident’s participation or caused staff not to include residents in activities or social interactions.

Coding Tips and Special Populations

• For E0500A, code based on whether the risk for physical injury or illness is known to occur commonly under similar circumstances (i.e., with residents who exhibit similar behavior in a similar environment). Physical injury is trauma that results in pain or other distressing physical symptoms, impaired organ function, physical disability, or other adverse consequences, regardless of the need for medical, surgical, nursing, or rehabilitative intervention.

• For E0500B, code if the impact of the resident’s behavior is impeding the delivery of care to such an extent that necessary or essential care (medical, nursing, rehabilitative or personal that is required to achieve the resident’s goals for health and well-being) cannot be received safely, completely, or in a timely way without more than a minimal accommodation, such as simple change in care routines or environment.

• For E0500C, code if the impact of the resident’s behavior is limiting or keeping the resident from engaging in solitary activities or hobbies, joining groups, or attending programmed activities or having positive social encounters with visitors, other residents, or staff.

Examples

1. A resident frequently grabs and scratches staff when they attempt to change their soiled brief, digging their nails into staff members’ skin. This makes it difficult to complete the care task.

Coding: E0500B would be coded 1, yes.

Rationale: This behavior interfered with delivery of essential personal care.

2. During the last 7 days, a resident with vascular dementia and severe hypertension, hits staffduring incontinent care making it very difficult to change them. Six out of the last seven days the resident refuses all their medication including their antihypertensive. The resident closes their mouth and shakes their head and will not take it even if re-approached multiple times.

Coding: E0500A and E0500B would both be coded 1, yes.

Rationale: The behavior interfered significantly with delivery of their medical and nursing care and put them at clinically significant risk for physical illness.

3. A resident paces incessantly. When staff encourage them to sit at the dinner table, they return to pacing after less than a minute, even after cueing and reminders. They are so restless that they cannot sit still long enough to feed themself or receive assistance in obtaining adequate nutrition.

Coding: E0500A and E0500B would both be coded 1, yes.

Rationale: This behavior significantly interfered with personal care (i.e., feeding) and put the resident at risk for malnutrition and physical illness.

4. A resident repeatedly throws their markers and card on the floor during bingo.

Coding: E0500C would be coded 1, yes.

Rationale: This behavior interfered with their ability to participate in the activity.

5. A resident with severe dementia has continuous outbursts while awake despite all efforts made by staff to address the issue, including trying to involve the resident in prior activities of choice.

Coding: E0500C would be coded 1, yes.

Rationale: The staff determined the resident’s behavior interfered with the ability toparticipate in any activities.