UNDERSTANDING THE FIM

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UNDERSTANDING THE FIM

• Functional Independent Measure
• Part 4

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Important Reminders

• You must understand the definition of the each
  item in order to document accurately
• Do NOT merge tasks
• Do not rate simulations, clinical judgments
• NEVER copy and paste from a previous document
  because your FIM scores will not be recorded

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Important Reminders

• A number does not support a number! (You must
  supply detailed documentation within the
  document.)
• Min, Mod or Max does not support a number. (You
  must document why the need the assistance, i.e.,
  decreased balance, decreased strength)
• More than reasonable time to complete a task
  independently is defined as 3 times the norm and
  would be scored as modified independence (6).

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Important Reminders

• If in a hurry dont have time to allow the
  patient to do a task the therapist/nurse does
  it for the pt, this is max assist.
• Consider How much assist did the pt require in
  this point in time? Who performed the task? Do
  not modify the assist in order to factor in how
  busy you are. If you do perform the task for a
  patient due to your time constraints, document
  the assistance and the reason (i.e. time
  constraints) this level was needed to perform the
  task.

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Important Reminders

• Plan the care you provide by allowing adequate
  time for the patient to perform the task versus
  performing the task for the patient. This is
  rehab, doing the task for the patient should be a
  rare occurrence.

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Transfers Tub, Shower - Definition

• Tub includes getting in and out of a tub
• Shower includes getting in and out of a shower

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Tub/shower - Considerations

• Simulations cannot be rated
• Patient must be fully undressed and wet to rate
  this item
• Rating includes the patients approach to the tub
  or shower once the patient is in the bathroom

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Tub/shower transfers

• Note the ability to score only one of these
  transfers or both shower and tub transfers

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Transfers Toilet

• Includes safely getting on and off a standard
  toilet
• Standard toilet is a regular toilet without
  attachments such as arm rests or handles to
  assist patient
• Includes approach to the toilet once in the
  bathroom and wheelchair set up

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Locomotion/Walk/Wheelchair Sequence
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Expected Mode of Locomotion Considerations

• PT identifies the expected primary locomotion
  mode at discharge, based on initial assessment
• PT identifies the primary mode of locomotion
  achieved at discharge
• Admission and discharge modes must match

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Locomotion Wheelchair - Definition

• Wheelchair includes using a manual or motorized
  wheelchair on a level surface once in a seated
  position

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Locomotion - Considerations

• P.T. brings an oxygen tank behind is a level 5
• If patient is pushed to the gym in a wheelchair,
  this needs to be assessed as total assist noting
  the level of assistance provided at that moment
  in time.

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Locomotion Walk - Definition

• Walk includes walking on a level surface once in
  a standing position

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Walk - Considerations

• Score will be affected by both distance and
  assistance
• Only include distance without any rest periods or
  breaks.

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Locomotion Walk/WC Exception

• Exception to distance and assistance rule
• If a patient routinely ambulates more than 150
  feet throughout the day but is not required to
  walk 150 feet in every situation, do not consider
  the distance for that episode of locomotion in
  the FIM rating, consider only the level of
  assistance
• If patient does not perform maximum locomotion
  distance, do not score this sub max activity.
  HOWEVER patient must perform maximum locomotion
  distance at least once a day.

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Locomotion Stairs - Definition

• Includes going up and down 12-14 stairs (one
  flight) indoors in a safe manner

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Stairs - Considerations

• Score is affected by both number of stairs and
  level of assistance/use of devices
• Step height is NOT a factor in rating
• If patient requires different levels of
  assistance for ascending and descending the
  stairs, choose options for the lower rating
• Stairs must be assessed on admission and
  discharge. Cannot put not addressed.

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• Note numerous types of assistive device available
  for stairs

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Comprehension - Definition

• Understanding of either auditory or visual
  communication (e.g., writing, sign language,
  gestures)

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Comprehension - Considerations

• Document the amount of assistance required, NOT
  the measurement of the severity of cognitive
  deficit
• Documentation must include the length of time of
  the interaction AND how much of the day the note
  represents
• Patient should not receive a lower score due to
  English as a second language

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Comprehension - Considerations

• Remember that comprehension needs to include
  complex or abstract ideas/questions and your
  assessment must include open ended questions in
  order to accurately determine the patients
  actual comprehension status.
• Complex and abstract questions are generally not
  part of conversation during usual sleep hours and
  therefore should not be scored.

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Expression - Definition

• Includes clear vocal or nonvocal expression of
  language. This item includes either intelligible
  speech or clear expression of language using
  writing or communication device

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Expression - Considerations

• Remember that expression needs to include complex
  or abstract information and your assessment must
  include more than a yes or no answer.
• Language of confusion should be considered a
  deficit. Language may be clearly articulated but
  if patient is confused at times, this should be
  assessed in expression.

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Social Interaction - Definition

• Includes skills related to getting along and
  participating with others in therapeutic and
  social situations. It represents how one deals
  with ones own needs together with the needs of
  others.

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Social Interaction - Considerations

• In therapeutic and social situations includes
• In the therapy gym
• In the dining room
• During therapeutic group activities
• During visiting hours with family, friends
• Sharing room and bathroom with room mate

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Social Interaction - Considerations

• Need to answer three questions
• Is the patient cooperating?
• Is the patient participating?
• Is the patient exhibiting any inappropriate
  behaviors?

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Problem Solving - Definition

• Includes skills related to solving problems of
  daily living. This means making reasonable,
  safe, and timely decisions regarding financial,
  social, and personal affairs, as well as
  initiating, sequencing, and self correcting tasks
  and activities to solve problems.

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Problem Solving - Considerations

• Includes BOTH complex and routine problem solving
• Includes 5 important skills
• Recognizing a problem is present
• Making appropriate decisions
• Initiating steps readjusting to changing
  circumstances
• Carrying out a sequence of steps
• Evaluating the solution

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Memory - Definition

• Includes skills related to recognizing and
  remembering while performing daily activities in
  an institutional or community setting. Memory in
  this context includes ability to store and
  retrieve information, particularly verbal and
  visual.

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Memory - Considerations

• Look for information related to the following
• Recognizing people frequently encountered
• Remembering daily routines
• Executing requests without reminders

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Summary

• Read the prompts carefully each time in order to
  document accurately
• Remember we are documenting the burden of care
  required to help the patient at home perform
  basic personal tasks
• Burden of care can be translated into financial
  cost
• Careful documentation will support the burden of
  care and our payments