Stay Ahead of Key Changes to the Function Quality Measures

In the skilled nursing industry, function quality measures play a vital role in quantifying facility performance. These measures provide valuable insights for consumers and providers alike into resident outcomes, helping facilities improve care and comply with regulatory requirements.

Recently, the two critical long stay function quality measures were redefined, unfrozen and fully in affect. Here’s what you need to know.

Measure	Key Changes
Percent of Residents Whose Need for Help With Activities of Daily Living Has Increased	Replaced section G late-loss ADLs (i.e., bed mobility, eating, transfer, and toileting) with GG items: – Sit to Lying (GG0170B) – Sit to Stand (GG0170D) – Eating (GG0130A) – Toilet Transfer (GG0170F)
Percent of Residents Whose Ability to Walk Independently Worsened	– Slight name change from Percent of Residents Whose Ability to – Move Independently Worsened. – Includes only residents who can walk 10 feet – Excludes residents using wheelchairs

1. Percent of Residents Whose Need for Help with Activities of Daily Living Has Increased (LS)

This measure tracks the percentage of long-stay residents whose need for assistance with late-loss Activities of Daily Living (ADLs) has worsened compared to a prior assessment. Late-loss ADLs include:

Sit to Lying (GG0170B)
Sit to Stand (GG0170D)
Eating (GG0130A)
Toilet Transfer (GG0170F)

A decline is recorded if:

There is a two-point decrease in one of these ADLs, or
There is a one-point decrease in two or more ADLs.

Exclusions: Residents are excluded if:

All four late-loss ADL items indicate dependence or activity was not attempted on the prior assessment.
Three late-loss ADLs indicate dependence or activity was not attempted, and the fourth indicates substantial/maximal assistance.
The resident is comatose or has missing data on comatose status.
Prognosis of life expectancy is less than six months.
The resident is receiving hospice care.
There is missing data for any of the late-loss ADLs.
No prior assessment is available for comparison.

Why This Matters: Increased dependence on ADLs can indicate declining health, reduced mobility, or ineffective rehabilitation interventions. Facilities should proactively identify residents at risk and implement early interventions to maintain functional abilities.

2. Percent of Residents Whose Ability to Walk Independently Worsened (LS)

This measure assesses the percentage of long-stay residents who have lost independent mobility. The assessment compares the resident’s ability to walk 10 feet (GG0170I) between two MDS evaluations.

A resident is flagged in this measure if:

Their ability to walk independently declines by at least one level from the prior assessment.
If previously coded as 07, 09, 10, or 88 (activity not attempted or dependent), they are recoded as 01 (dependent), indicating a loss of function.

Exclusions: Residents are excluded if:

The resident was comatose or had missing data on comatose status in the prior assessment.
Prognosis of less than six months at the prior assessment.
The resident was receiving hospice care at the prior assessment.
The resident was already dependent on walking 10 feet in the prior assessment.
Missing data on “Walk 10 feet” in either the target or prior assessment.
The prior assessment was a discharge assessment or no prior assessment is available for comparison.
The target assessment is an OBRA Admission assessment, a PPS 5-Day assessment, or the first assessment after an admission.

Why This Matters: Loss of independent mobility increases the risk of falls, pressure ulcers, and overall decline in health. Encouraging physical therapy, mobility exercises, and strength training should be considered to mitigate risks.

Tips and Strategies to Improve These Function Quality Measures

Ensure exclusions are coded on the Target assessment, if applicable (comatose, Hospice, Prognosis <6mos).
Enhance coding accuracy. Assessing usual performance is still tricky. Ongoing education and training is imperative to accuracy and should occur upon hire, annually, and as any gaps in process and/or performance are identified. There is a wealth of training material available through AAPACN and other resources.
Be proactive. Have a system in place for therapy to screen residents well before they are due for an MDS. If decline is noted, implement interventions to facilitate attaining prior level before the observation window opens. Being proactive is much better than waiting until after they show up on your QM report.
Leverage daily point-of-care (POC) charting to support care planning and timely identification of negative trends. While CNA documentation can be inconsistent and add workload, the ability to identify meaningful, yet subtle shifts in functional performance overtime outweighs the challenges. Enhancing documentation with training and automation can improve data reliability. You can’t manage what you don’t track.
Use technology to proactively identify changes in between assessments. Predictive software solutions like MedaSync can identify the meaningful shifts captured through point of care charting and pinpoint those at risk of triggering a long-stay functional item before the MDS. An ideal tool to target declines, prompt timely interventions and care plan changes.
Engage therapy and restorative nursing where appropriate. Utilize internal monitoring practices to identify potential or actual declines in function which will facilitate the hand-off to therapy. Therapy can provide treatments to improve patient mobility or assist with restorative programming to promote functional ability and slow decline.
Plan the next assessment. When a case triggers on the QM report for a long stay functional measure, now is the perfect time to plan for the next assessment window. For both items, a case may be cleared from the list if a new target assessment is established 46 days out from the last ARD in the same quarter.

Final Thoughts

These MDS 3.0 quality measures provide essential benchmarks for nursing facilities to evaluate resident care and improve outcomes. By actively monitoring these indicators, facilities can enhance rehabilitation strategies, reduce functional decline, and ensure residents maintain their highest level of independence.

For facilities aiming to excel in quality measures, proactive monitoring technologies and predictive solutions will provide the early interventions necessary to inform timely care plan changes which are imperative strategies for success.

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