Nursing Home Quality Improvement Initiative
Quality Measure Fact Sheet:
Percent of Chronic/Long Term Care Residents Whose Need for Help
with Daily Activities has Increased
What this means:
This measure reflects the percent of long term residents who are worsening in their ability to perform at least one of four activities of daily living (ADLs). These activities include the ability to move in bed, move from one chair to another, independence in eating, and the ability to go to the bathroom independently.
Why residents may experience a decline in ability to perform activities of daily living (ADLs):
Most individuals who are admitted to nursing homes require help with some self-care functions. Most long term care residents have chronic illnesses and other conditions that can affect their ability to perform basic daily tasks, especially as diseases progress. Side effects of medications (drowsiness and confusion) and other treatment can also contribute to this loss of self sufficiency. This loss of independence can lead to diminished feelings of self worth, fear and anxiety, and isolation. These may in turn lead to further loss in abilities, as the decreased activity may lead to pressure ulcers, falls, and muscle wasting. Residents may become unwilling to initiate or participate in self-care.
Nursing home staff may try to improve resident function in activities of daily living by encouraging independence, physical and occupational therapy, medication adjustment, and prompt attention to medical problems, such as infections or pain. Certain medical conditions, such as a new stroke or congestive heart failure, may cause residents to experience severe loss of function. Some residents are hospitalized and come back to the facility in a weakened state, thus reflecting an increased need for help with daily activities. Even with the best efforts of nursing homes, many residents may worsen in their ability to perform activities of daily living, especially as they approach end of life situations.
What conditions exclude a resident from this measure: (Risk adjustment)
Residents who are totally dependent, comatose, have end-stage disease or are receiving hospice care are excluded from this measure.
| Questions you can ask the facility if they are rated high in this measure:
- How many of the residents who decline in ability to perform basic daily tasks suffered new medical conditions, such as stroke?
- How does the facility assess residents for lack of independence in doing basic daily tasks?
- How does the facility encourage residents to willingly initiate or participate in self-care?
- What rehabilitative care does the facility provide to residents to maintain or expand self-care?
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