Technical information about the loss of ability in basic daily tasks quality measure.

September 20, 2009 by admin

Residents who are admitted to nursing homes almost always have some problems in performing one or more of their "basic daily tasks", which are known as Activities of Daily Living (ADLs). One of the many jobs of the staff in a nursing home is to try to prevent loss in the resident's ability to function after admission, and in some cases, to actually contribute to an improvement in function. Improved function in ADLs can be achieved by encouraging independence in resident daily activities, through physical and occupational therapy, by avoiding medications with side effects such as drowsiness or confusion, and by attending promptly to any medical problems which may arise, such as infections or pain. Nursing homes should always strive, with every resident, to try to improve functional ability as much as possible. Regardless of how much effort a nursing home program puts into improving function in their population of frail elderly residents, some residents will inevitably experience a loss in function over time. This is especially true of very sick or very frail residents, especially near the end of their lives. The scientists who constructed this measure were very sensitive to the fact that many nursing home residents can be expected to suffer a decline in function over time. For that reason, the risk adjustment for this measure excludes the following types of patients from measurement: those already totally dependent in all four ADLs, those in coma, those who are known to be in the end stages of many chronic diseases, and those enrolled in the hospice program (many times the end stages of cancer). The scientists also constructed the measure such that a gradual, slow decline in function (such as is seen with many patients with Alzheimer's Disease) will not cause a positive result on the measure. Only those residents observed to have relatively sudden and severe loss of function will be counted with a positive result. A sudden and severe loss of function sometimes indicates a serious medical problem, which, if treated promptly, can lead the patient to regain function to their previous level. Still, in spite of the best possible efforts of the best possible nursing homes, some patients will still suffer sudden and severe losses of function under circumstances, which cannot be prevented. Therefore, even the best nursing homes will still have some patients for which this measure will be positive. For a Quality Improvement program in any nursing home, the goal should be to try to support programs, which will keep this number as low as possible. When you visit the nursing home, ask what programs are in place to maintain and improve the physical function of the residents.