Form Type | Variable | ID | Question | History |
|---|---|---|---|---|
Form 1 | MOB12StepsA | 3988 | O. 12 steps: The ability to go up and down 12 steps with or without a rail. | 2019-10-01 - Variable Added |
Form 1 | MOB12StepsD | 3988 | O. 12 steps: The ability to go up and down 12 steps with or without a rail. | 2019-10-01 - Variable Added |
Form 1 | MOB1StepCurbA | 3988 | M. 1 step (curb): The ability to step over a curb or up and down one step. | 2019-10-01 - Variable Added |
Form 1 | MOB1StepCurbD | 3988 | M. 1 step (curb): The ability to step over a curb or up and down one step. | 2019-10-01 - Variable Added |
Form 1 | MOB4StepsA | 3988 | N. 4 steps: The ability to go up and down four steps with or without a rail. | 2019-10-01 - Variable Added |
Form 1 | MOB4StepsD | 3988 | N. 4 steps: The ability to go up and down four steps with or without a rail. | 2019-10-01 - Variable Added |
Form 1 | MOBCarTranA | 3988 | G. Car transfer: The ability to transfer in and out of a car or van on the passenger side. Does not include the ability to open/close door or fasten seat belt. | 2019-10-01 - Variable Added |
Form 1 | MOBCarTranD | 3988 | G. Car transfer: The ability to transfer in and out of a car or van on the passenger side. Does not include the ability to open/close door or fasten seat belt. | 2019-10-01 - Variable Added |
Form 1 | MOBChairTranA | 3988 | E. Chair/bed-to-chair transfer: The ability to safely transfer to and from a bed to a chair (or wheelchair). | 2019-10-01 - Variable Added |
Form 1 | MOBChairTranD | 3988 | E. Chair/bed-to-chair transfer: The ability to safely transfer to and from a bed to a chair (or wheelchair). | 2019-10-01 - Variable Added |
Form 1 | MOBLyingA | 3988 | C. Lying to sitting on side of bed: The ability to safely move from lying on the back to sitting on the side of the bed with feet flat on the floor, and with no back support. | 2019-10-01 - Variable Added |
Form 1 | MOBLyingD | 3988 | C. Lying to sitting on side of bed: The ability to safely move from lying on the back to sitting on the side of the bed with feet flat on the floor, and with no back support. | 2019-10-01 - Variable Added |
Form 1 | MOBPickUpA | 3988 | P. Picking up object: The ability to bend/stoop from a standing position to pick up a small object, such as a spoon, from the floor. | 2019-10-01 - Variable Added |
Form 1 | MOBPickUpD | 3988 | P. Picking up object: The ability to bend/stoop from a standing position to pick up a small object, such as a spoon, from the floor. | 2019-10-01 - Variable Added |
Form 1 | MOBRollA | 3988 | A. Roll left and right: The ability to roll from lying on back to left and right side, and return to lying on back. | 2019-10-01 - Variable Added |
Form 1 | MOBRollD | 3988 | A. Roll left and right: The ability to roll from lying on back to left and right side, and return to lying on back. | 2019-10-01 - Variable Added |
Form 1 | MOBScooterTypeA | 3990 | SS1. Indicate the type of wheelchair/scooter used. | 2019-10-01 - Variable Added |
Form 1 | MOBScooterTypeD | 3990 | SS3. Indicate the type of wheelchair/scooter used. | 2019-10-01 - Variable Added |
Form 1 | MOBSitA | 3988 | B. Sit to lying: The ability to move from sitting on side of bed to lying flat on the bed. | 2019-10-01 - Variable Added |
Form 1 | MOBSitD | 3988 | B. Sit to lying: The ability to move from sitting on side of bed to lying flat on the bed. | 2019-10-01 - Variable Added |
Form 1 | MOBSitStandA | 3988 | D. Sit to stand: The ability to safely come to a standing position from sitting in a chair or on the side of the bed. | 2019-10-01 - Variable Added |
Form 1 | MOBSitStandD | 3988 | D. Sit to stand: The ability to safely come to a standing position from sitting in a chair or on the side of the bed. | 2019-10-01 - Variable Added |
Form 1 | MOBToilettranA | 3988 | F. Toilet transfer: The ability to safely get on and off a toilet or commode. | 2019-10-01 - Variable Added |
Form 1 | MOBToilettranD | 3988 | F. Toilet transfer: The ability to safely get on and off a toilet or commode. | 2019-10-01 - Variable Added |
Form 1 | MOBWCScooterA | 3999 | Q1. Does the patient use a wheelchair/scooter? | 2019-10-01 - Variable Added |
Form 1 | MOBWCScooterD | 3999 | Q3. Does the patient use a wheelchair/scooter? | 2019-10-01 - Variable Added |
Form 1 | MOBWCtypeA | 3990 | RR1. Indicate the type of wheelchair/scooter used. | 2019-10-01 - Variable Added |
Form 1 | MOBWCtypeD | 3990 | RR3. Indicate the type of wheelchair/scooter used. | 2019-10-01 - Variable Added |
Form 1 | MOBWalk10ftA | 3988 | I. Walk 10 feet: Once standing, the ability to walk at least 10 feet in a room, corridor or similar space. | 2019-10-01 - Variable Added |
Form 1 | MOBWalk10ftD | 3988 | I. Walk 10 feet: Once standing, the ability to walk at least 10 feet in a room, corridor or similar space. | 2019-10-01 - Variable Added |
Form 1 | MOBWalk150ftA | 3988 | K. Walk 150 feet: Once standing, the ability to walk at least 150 feet in a corridor or similar space. | 2019-10-01 - Variable Added |
Form 1 | MOBWalk150ftD | 3988 | K. Walk 150 feet: Once standing, the ability to walk at least 150 feet in a corridor or similar space. | 2019-10-01 - Variable Added |
Form 1 | MOBWalkUnevenA | 3988 | L. Walking 10 feet on uneven surfaces: The ability to walk 10 feet on uneven or sloping surfaces, such as grass or gravel. | 2019-10-01 - Variable Added |
Form 1 | MOBWalkUnevenD | 3988 | L. Walking 10 feet on uneven surfaces: The ability to walk 10 feet on uneven or sloping surfaces, such as grass or gravel. | 2019-10-01 - Variable Added |
Form 1 | MOBWalkturnA | 3988 | J. Walk 50 feet with two turns: Once standing, the ability to walk at least 50 feet and make two turns. | 2019-10-01 - Variable Added |
Form 1 | MOBWalkturnD | 3988 | J. Walk 50 feet with two turns: Once standing, the ability to walk at least 50 feet and make two turns. | 2019-10-01 - Variable Added |
Form 1 | MOBWheel150ftA | 3988 | S. Wheel 150 feet: Once seated in wheelchair/scooter, the ability to wheel at least 150 feet in a corridor or similar space. | 2019-10-01 - Variable Added |
Form 1 | MOBWheel150ftD | 3988 | S. Wheel 150 feet: Once seated in wheelchair/scooter, the ability to wheel at least 150 feet in a corridor or similar space. | 2019-10-01 - Variable Added |
Form 1 | MOBWheel50ftA | 3988 | R. Wheel 50 feet with two turns: Once seated in wheelchair/scooter, the ability to wheel at least 50 feet and make two turns. | 2019-10-01 - Variable Added |
Form 1 | MOBWheel50ftD | 3988 | R. Wheel 50 feet with two turns: Once seated in wheelchair/scooter, the ability to wheel at least 50 feet and make two turns. | 2019-10-01 - Variable Added |
CARE (CONTINUITY ASSESSMENT RECORD AND EVALUATION)
Definition
The Continuity Assessment Record and Evaluation (CARE) Item Set was developed as part of the larger Post-Acute Care Payment Reform Demonstration (PAC-PRD), authorized by the Deficit Reduction Act of 2005. It was developed as a standardized set of items for measuring medical, functional, cognitive, and social support factors in the acute hospital, long-term care hospital (LTCH), inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), and home health agency (HHA) settings to provide a way to compare the health status of Medicare beneficiaries across provider types.
Section GG Functional Abilities and Goals (Self-Care and Mobility Activities) includes admission and discharge self-care and mobility performance data elements. Qualified clinicians code each data element, which are activities, using a 6-level rating scale to reflect the patient’s/resident’s functional abilities based on the type and amount of assistance provided by a helper. If the patient/resident did not perform the activity and a helper did not perform the activity for the patient/resident during the assessment period, one of four “activity not attempted codes” is used.
The 6-Point Scale and Activity Not Attempted Codes
Coding:
Safety and Quality of Performance - If helper assistance is required because patient’s/resident’s performance is unsafe or of poor quality, score according to amount of assistance provided.
Activities may be completed with or without assistive devices.
01 - Dependent - Helper does ALL of the effort. Patient/resident does none of the effort to complete the activity.
Or, the assistance of 2 or more helpers is required for the patient/resident to complete the activity.
02 - Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.
03 - Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort.
04 - Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient/resident completes activity. Assistance may be provided throughout the activity or intermittently.
05 - Setup or clean-up assistance - Helper sets up or cleans up; patient/resident completes activity. Helper assists only prior to or following the activity.
06 - Independent – Patient/resident safely completes the activity by him/herself with no assistance from a helper.
If activity was not attempted, code reason:
77 - Patient/resident refused
81 - Not applicable - Not attempted and the patient/resident did not perform this activity prior to the current illness, exacerbation, or injury.
82 - Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)
83 - Not attempted due to medical condition or safety concerns
84 - Did Not Meet Criteria for Administration (To be used if participant leaves AMA, returns to ICU and does not return to rehab, or is only on rehab unit for 24 hours or less).
99 - Unknown No information, form not completed
Form
[X] Form 1
[ ] Form 2
Source
Abstracted from CARE tool data submitted to ERehab, UDS or CMS
Details
Each core item for functional mobility is scored on a six-level rating scale measuring the need for assistance- dependent, substantial assistance, partial assistance, supervision or touching assistance, set-up or cleanup assistance, or independent.
Code “84 - Did not meet criteria for administration” to be used if participant leaves AMA, returns to ICU and does not return to rehab, or is only on rehab 24 hours.
Links
Final IRF-PAI Version 3.0 - Effective October 1 2019 (FY2020) (PDF)
IRF-PAI Manual Chapter 2 - Section GG v3.0-508C
Characteristics
CARE Tool was added on 10/01/2019.
MOBILITY
Variables
Codes and Values
ID | Code | Description |
|---|---|---|
3988 | 1 | Dependent ( Helper does ALL of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity ) |
3988 | 2 | Substantial/maximal assistance ( Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort ) |
3988 | 3 | Partial/moderate assistance ( Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort ) |
3988 | 4 | Supervision or touching assistance ( Helper provides VERBAL CUES or TOUCHING/STEADYING assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently ) |
3988 | 5 | Setup or clean-up assistance ( Helper SETS UP or CLEANS UP; patient completes activity. Helper assists only prior to or following the activity ) |
3988 | 6 | Independent ( Patient completes the activity by him/herself with no assistance from a helper ) |
3988 | 66 | Variable did not exist |
3988 | 77 | Patient refused |
3988 | 81 | Not applicable ( Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury ) |
3988 | 82 | Not attempted due to environmental limitations ( e.g. Lack of equipment, weather constraints ) |
3988 | 83 | Not attempted due to medical condition or safety concerns |
3988 | 84 | Did not meet criteria for administration ( To be used if participant leaves AMA, returns to ICU and does not return to rehab, or is only on rehab 24 hours ) |
3988 | 99 | Unknown ( No information, form not completed ) |
3990 | 1 | Manual |
3990 | 2 | Motorized |
3990 | 88 | N/A |
3999 | 0 | No |
3999 | 1 | Yes |
3999 | 66 | Variable did not exist |
History
No history found for the Domain.
SELF CARE
Variables
Form Type | Variable | ID | Question | History |
|---|---|---|---|---|
Form 1 | SCEatA | 3988 | A. Eating: The ability to use suitable utensils to bring food to the mouth and swallow food once the meal is presented on a table/tray. Includes modified food consistency | 2019-10-01 - Variable Added |
Form 1 | SCEatD | 3988 | A. Eating: The ability to use suitable utensils to bring food to the mouth and swallow food once the meal is presented on a table/tray. Includes modified food consistency | 2019-10-01 - Variable Added |
Form 1 | SCFootwearA | 3988 | H. Putting on/taking off footwear: The ability to put on and take off socks and shoes or other footwear that is appropriate for safe mobility. | 2019-10-01 - Variable Added |
Form 1 | SCFootwearD | 3988 | H. Putting on/taking off footwear: The ability to put on and take off socks and shoes or other footwear that is appropriate for safe mobility. | 2019-10-01 - Variable Added |
Form 1 | SCLBDressA | 3988 | G. Lower body dressing: The ability to dress and undress below the waist, including fasteners; does not include footwear. | 2019-10-01 - Variable Added |
Form 1 | SCLBDressD | 3988 | G. Lower body dressing: The ability to dress and undress below the waist, including fasteners; does not include footwear. | 2019-10-01 - Variable Added |
Form 1 | SCOralHygA | 3988 | B. Oral hygiene: The ability to use suitable items to clean teeth. [Dentures (if applicable): The ability to remove and replace dentures from and to the mouth, and manage equipment for soaking and rinsing them.] | 2019-10-01 - Variable Added |
Form 1 | SCOralHygD | 3988 | B. Oral hygiene: The ability to use suitable items to clean teeth. [Dentures (if applicable): The ability to remove and replace dentures from and to the mouth, and manage equipment for soaking and rinsing them.] | 2019-10-01 - Variable Added |
Form 1 | SCShowerA | 3988 | E. Shower/bathe self: The ability to bathe self in shower or tub, including washing, rinsing, and drying self. Does not include transferring in/out of tub/shower. | 2019-10-01 - Variable Added |
Form 1 | SCShowerD | 3988 | E. Shower/bathe self: The ability to bathe self in shower or tub, including washing, rinsing, and drying self. Does not include transferring in/out of tub/shower. | 2019-10-01 - Variable Added |
Form 1 | SCToiletA | 3988 | C. Toileting hygiene: The ability to maintain perineal hygiene, adjust clothes before and after using the toilet, commode, bedpan or urinal. If managing an ostomy, include wiping the opening but not managing equipment. | 2019-10-01 - Variable Added |
Form 1 | SCToiletD | 3988 | C. Toileting hygiene: The ability to maintain perineal hygiene, adjust clothes before and after using the toilet, commode, bedpan or urinal. If managing an ostomy, include wiping the opening but not managing equipment. | 2019-10-01 - Variable Added |
Form 1 | SCUBDressA | 3988 | F. Upper body dressing: The ability to put on and remove shirt or pajama top; includes buttoning, if applicable. | 2019-10-01 - Variable Added |
Form 1 | SCUBDressD | 3988 | F. Upper body dressing: The ability to put on and remove shirt or pajama top; includes buttoning, if applicable. | 2019-10-01 - Variable Added |
Codes and Values
ID | Code | Description |
|---|---|---|
3988 | 1 | Dependent ( Helper does ALL of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity ) |
3988 | 2 | Substantial/maximal assistance ( Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort ) |
3988 | 3 | Partial/moderate assistance ( Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort ) |
3988 | 4 | Supervision or touching assistance ( Helper provides VERBAL CUES or TOUCHING/STEADYING assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently ) |
3988 | 5 | Setup or clean-up assistance ( Helper SETS UP or CLEANS UP; patient completes activity. Helper assists only prior to or following the activity ) |
3988 | 6 | Independent ( Patient completes the activity by him/herself with no assistance from a helper ) |
3988 | 66 | Variable did not exist |
3988 | 77 | Patient refused |
3988 | 81 | Not applicable ( Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury ) |
3988 | 82 | Not attempted due to environmental limitations ( e.g. Lack of equipment, weather constraints ) |
3988 | 83 | Not attempted due to medical condition or safety concerns |
3988 | 84 | Did not meet criteria for administration ( To be used if participant leaves AMA, returns to ICU and does not return to rehab, or is only on rehab 24 hours ) |
3988 | 99 | Unknown ( No information, form not completed ) |
History
No history found for the Domain.