M1830: CMS OASIS Q&As

a) The patient’s environment can impact their ability to complete specific functional tasks. If the patient’s tub or shower is nonfunctioning or not safe, then the patient is currently unable to use the facilities. Response 4, 5, or 6 would apply, depending on the patient’s ability to participate in bathing activities outside the tub/shower. b) The patient’s medical restrictions mean that the patient is unable to bathe in the tub or shower at this time. Select Response 4 - Unable to use the shower or tub, but able to bathe self independently with or without the use of devices at the sink, in chair, or on commode, 5 - Unable to use the shower or tub, but able to participate in bathing self in bed, at the sink, in bedside chair, or on commode, with the assistance or supervision of another person, or 6 - Unable to effectively participate in bathing and is bathed totally by another person, whichever most closely describes the patient’s ability at the time of the assessment. c) If the patient’s fear is a barrier to their ability to get in/out of the shower safely, then their ability to bathe in the tub/shower may be affected. The clinician will need to determine whether there is a physical, cognitive, or emotional barrier that is temporarily or permanently limiting their ability to use the tub/shower. If due to fear, they refuse to enter the shower even with the assistance of another person; either Response 4, 5, or 6 would apply, depending on the patient’s ability at the time of assessment. If they are able to bathe in the shower when another person is present to provide required supervision/assistance, then Response 3 would describe their ability. d) The patient’s environment must be considered when responding to the OASIS items. If the patient chooses not to navigate the stairs, but is able to do so with supervision, then the need for that supervision should be considered when selecting a code.

Medical restrictions that impact the OASIS-included bathing tasks are considered when determining the score for M1830 - Bathing. Therefore, the tasks required to allow compliance with medically prescribed precautions for bathing could impact the patient's ability. In the scenario above, Response 2 is appropriate since the patient needs intermittent human assistance.

Response 4 - Unable to bathe in tub/shower but independent in bathing at sink, would be selected if, on the day of the assessment, the patient's usual status was that they were unable to bathe in the tub/shower due to fear, even with assistance, but was independent in bathing at the sink. In your scenario the patient’s ability changed after clinical intervention. After the nurse’s instruction, the patient could bathe themself in the tub/shower with the intermittent assistance of another person for the tub transfer only, but the new changed ability was not the patient's usual status (more than 50% of the time) on the day of assessment. At the next OASIS data collection time point, if the patient remained at that new functional level, it would be appropriate to select M1830 Response 2 - Able to bathe in tub/shower with intermittent assistance.

The item addresses the patient’s ability to bathe in the shower or tub, not preference, regardless of where or how the patient currently bathes. Willingness and adherence are not the focus of the item. If assistance is needed to bathe in the shower or tub, then the level of assistance needed must be noted, and Response 2, or 3 should be selected.

When responding to M1830 - Bathing, the patient’s ability to transfer in and out of the tub/shower and then “wash the entire body” should be considered. Bathing-related tasks, such as those mentioned, should not be considered in scoring this item.

The correct response for the patient described here would be Response 2 - Able to bathe in the shower or tub with the assistance of another person: c) for washing difficult to reach areas, because that response describes that patient's ability at that time.

The intent of the bathing item is to identify the patient's ability to wash the entire body. Guidance for this item indicates that when medical restrictions, environmental or other barriers prevent the patient from accessing the tub/shower, their bathing ability will be 'scored' at a lower level. The ability to transfer into and out of the tub/shower is evaluated and also impacts the score when responding to M1830 - Bathing. If the patient requires assistance to transfer into or out of the tub/shower, they would be scored a 2 or 3, based on the amount of human supervision or assistance is required throughout the bath.

For M1830 - Bathing, the amount of assistance the patient requires to get to the location bathing occurs would be considered. In the scenario cited, the patient requires assistance (another person to provide verbal cueing, stand-by or hands-on assistance) to safely ambulate down the hallway and no other assistance with transfer and bathing. This is intermittent assistance, therefore Response 2 - Able to bathe in shower or tub with the intermittent assistance of another person should be reported.

Since at the time of the assessment the patient requires intermittent assistance of another person to wash difficult to reach areas, then Response 2 should be selected. If the clinician determined that the patient could become more independent (i.e., require less assistance) with the use of adaptive equipment, then such equipment could be obtained or recommended as part of the home health Plan of Care. If at discharge the patient is able to wash their entire body using the equipment provided, then Response 1 should be reported. If even with the equipment the patient continues to require intermittent assistance, then Response 2 would apply.

Assistive devices promote greater independence for the user by enabling them to perform tasks they were previously unable to or had great difficulty safely performing. The intention of the use of the term “devices” in the Response 1 for M1830 - Bathing is to differentiate a patient who is capable of washing their entire body in the tub/shower independently (Response 0), from that patient who is capable of washing their entire body in the tub/shower only with the use of (a) device(s). This differentiation allows a level of sensitivity to change to allow outcome measurement to capture when a patient improves from requiring one or more assistive devices for bathing, to a level of independent function without devices. Individuals with typical functional ability (e.g., functional range of motion, strength, balance, etc.) do not "require" special devices to wash their body. An individual may choose to use a device (e.g., a long-handled brush or sponge) to make the task of washing the back or feet easier. If the patient’s use of a device is optional (e.g., it is their preference, but not required to complete the task safely), then the score selected should represent the patient’s ability to bathe without the device. If the patient requires the use of the device in order to safely bathe, then the need for the device should be considered when selecting the appropriate score. CMS has not identified a specific list of equipment that defines “devices” for the scoring of M1830. The clinician should assess the patient’s ability to wash their entire body and use their judgment to determine if a device, assistance, or both is required for safe completion of the included bathing tasks.

Upon discovering the patient is bathing at the sink, the clinician should evaluate the patient in attempts to determine why they are not bathing in the tub/shower. If it is the patient’s personal preference to bathe at the sink (e.g., “I don’t get that dirty.” “I like using the sink.”), but they are physically and cognitively able to bathe in the tub/shower; the clinician will pick the response option that best reflects the patient’s ability to bathe in the tub/shower. If the patient no longer bathes in the tub/shower due to personal preference and has since begun using the tub/shower as a storage area, the patient would be scored based on their ability to bathe in the tub/shower if it was empty. If the patient has a physical or cognitive/emotional barrier that prevents them from bathing in the tub/shower and therefore has since starting using the tub/shower as a storage area, the clinician will score the patient either as a Response 4, 5, or 6, depending on the patient’s ability at the time of assessment. Note that the responses of 4, 5, and 6 are due to the patient’s inability to safely bathe in the tub/shower (even with help) due to the physical and/or cognitive barrier, not due to the alternative use of the tub for storage.

M1830 - Bathing identifies the patient’s ability to bathe their entire body and the assistance that may be required to safely bathe, including transferring in/out of the tub/shower. Select Code 3 if the patient is “Able to participate in bathing self in shower or tub, but requires the presence of another person throughout the bath for assistance or supervision.” If the patient does not require the presence of another person throughout the bath for assistance or supervision, Code 3 is not the appropriate response. Select Code 2 if the patient is “Able to bathe in shower or tub with the intermittent assistance of another person.”