Head, shoulders, curbs and elbows

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Renee Kinder
Renee Kinder

This week our family has experienced new milestones with the graduation of two kiddos who will move on to middle school next year.

As a parent, these times cause us to reflect on our children's early accomplishments.

One such achievement I remember was when our eldest was learning his body parts via the classic song, “Head, Shoulders, Knees and Toes.” We all know how the tune goes, “Head, shoulders, knees and toes, knees and toes. Eyes and ears and mouth and nose …”

In my joy, I recall sharing his new skill with my mother, his grandmother, during a family visit.

I will never forget her response.

He sang and then she said, “Good Lawson, now what is this?” and pointed to her elbow.

I remember thinking, “Really?!?”

My mother and her expectations ... Don't get lost in praising, focus on the next steps.

I mean don't you see how fabulous it is that he knows the basics?

The problem, I now understand, is that knowledge and acceptance of knowledge of the basics does not get us very far in life.

Similarly, in our post-acute world if we depend on basics alone, we limit ourselves in the specificity of measures we can achieve.

I liken this to my past annoyance that much of what we “measure” related to our patients' activities of daily living scores have historically been tied to late loss ADL measures. If we focus on late loss, what does that say about us as caregivers? I mean, shouldn't we promote success across all levels of ADLs: instrumental, basic and late?

For this reason, there are many positive opportunities being allowed for the entire interdisciplinary team, including rehab professionals, with the addition of higher level ADL elements to the Minimum Data Set for Quality Reporting Program measures. Data collection begins in October 2018 and will include current and additional elements from Section GG in Self Care and Mobility, and allow for comparison between admission and discharge status.

It's time to increase the expectations. It's time to graduate to the next level.

These measures include (new in bold):

Self-Care:

•  GG0130A. Eating: The ability to use suitable utensils to bring food and/or liquid to the mouth and swallow food and/or liquid once the meal is placed before the resident.

•  GG0130B. Oral hygiene: The ability to use suitable items to clean teeth. Dentures (if applicable): The ability to insert and remove dentures into and from the mouth, and manage denture soaking and rinsing with use of equipment.

•  GG0130C.Toilet hygiene: The ability to maintain perineal hygiene, adjust clothes before and after voiding or having a bowel movement. If managing an ostomy, include wiping the opening but not managing equipment.

•  GG0130E. Shower/bathe self: The ability to bathe self, including washing, rinsing, and drying self (excludes washing of back and hair). Does not include transferring in/out of tub/shower.

•  GG0130F. Upper body dressing: The ability to dress and undress above the waist; including fasteners, if applicable.

•  GG0130G. Lower body dressing: The ability to dress and undress below the waist, including fasteners; does not include footwear.

•  GG0130H. 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; including fasteners, if applicable.

Mobility:

•  GG0170A. Roll left and right: The ability to roll from lying on back to left and right side, and roll back to back on the bed.

•  GG0170B. Sit to lying: The ability to move from sitting on side of bed to lying flat on the bed.

•  GG0170C. Lying to sitting on side of bed: The ability to move from lying on the back to sitting on the side of the bed with feet flat on the floor, no back support.

•  GG0170D. Sit to stand: The ability to come to a standing position from a position of sitting in a chair, wheelchair or on the side of the bed.

•  GG0170E. Chair/bed-to-chair transfer: The ability to transfer to and from a chair (or wheelchair).

•  GG0170F.Toilet transfer: The ability to get on and off a toilet or commode.

•  GG0170G. 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.

•  GG0170I. Walk 10 feet: Once standing, the ability to walk at least 10 feet (3 meters) in room, corridor, or similar space.

•  GG0170J. Walk 50 feet with two turns: Once standing, the ability to walk 50 feet and make two turns.

•  GG0170K. Walk 150 feet: Once standing, the ability to walk at least 150 feet (45 meters) in corridor or similar space.

•  GG0170L. Walking 10 feet on uneven surfaces: The ability to walk 10 feet on uneven or sloping surfaces (indoor or outdoor), such as turf or gravel.

•  GG0170M. 1 step (curb): The ability to step over a curb and/or up and down one step

•  GG0170N. 4 steps: The ability to go up and down four steps with or without a rail.

•  GG0170P. 12 steps: The ability to go up and down 12 steps with or without a rail.

•  GG0170O. 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

The additional focus on Section GG of course is not isolated to the QRP program alone as we also see focus on these areas within the recently proposed rule related to the Patient Driven Payment Model (PDPM).

What does this mean for providers and rehab professionals?

It means that we can no longer settle for the basics.

It means it is time to consider elements such as curbs, and how we promote a successful discharge and re-entry in the community that includes elements such as curbs, and steps, and the ability to reach down and pick up an object from the standing position.

It means that we need to continue our collaborative efforts in understanding each other's language and how we communicate function across teams for accuracy in MDS coding.

Graduation time, you all! Time to step up our expectations to the next level.

Renee Kinder, MS, CCC-SLP, RAC-CT, is Director of Clinical Education for Encore Rehabilitation and is the Silver Award winner in the 2018 American Society of Business Publishing Editors competition for the Upper Midwest Region in the Service/How To Blogs category. Additionally, she serves as Gerontology Professional Development Manager for the American Speech Language Hearing Association's (ASHA) gerontology special interest group, is a member of the University of Kentucky College of Medicine community faculty, and is an advisor to the American Medical Association's Relative Value Update Committee (RUC) Health Care Professionals Advisory Committee (HCPAC).


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Rehab Realities is written by Renee Kinder, MS, CCC-SLP, RAC-CT.  She currently serves as Director of Clinical Education for Encore Rehabilitation and acts as editor of Perspectives on Gerontology, a publication of the American Speech Language Hearing Association.

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