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Home Health Best Practices: Gait Abnormality & M1860 Ambulation

Posted by Nathan Hope on Jan 10, 2017

In the home heallth environment the admitting clinician (typically an RN) will assess the patient's mobility first using the OASIS assessment.  If deficits are identified on M1860 Ambulation/Mobility, an additional evaluation may be performed by the Physical Therapist. For the patient with ambulation deficits, in addition to assessing Ambulation/Locomotion M1860 on OASIS C2 home health care forms, also include these MyHomecareBiz Best Practice assessment strategies by the Skilled Nurse:  

Best Practice Skilled Nursing Assessment Strategies for Gait & Mobility

  • Assess for obstacles in the home that are preventing safe mobility.
  • Assess presence and/or level of pain affecting mobility.
  • Assess the patient's strength, joint ROM, endurance and their effect on safe mobility.
  • Assess input, output and nutritional pattern and their effect on mobility.
  • Evaluate the patient's use of assistive devices and if training is needed.
  • Assess the patient’s or caregiver’s understanding of immobility and its implications.download-home-health-fall-risk-teaching
  • Check for skin integrity for signs of redness and tissue ischemia (especially over ears, shoulders, elbows, sacrum, hips, heels, ankles, and toes).
  • Note elimination status (e.g., usual pattern, present patterns, signs of constipation).

 

(M1860) Ambulation/Locomotion

ambulation_3.jpgIdentifies the patient’s ability and the type of assistance required to safely ambulate or propel self in a wheelchair over a variety of surfaces. Answer options include:

  • 0 - Able to independently walk on even and uneven surfaces and negotiate stairs with or without railings (specifically: needs no human assistance or assistive device).
  • 1 - With the use of a one-handed device (for example, cane, single crutch, hemi-walker), able to  independently walk on even and uneven surfaces and negotiate stairs with or without railings.
  • 2 - Requires use of a two-handed device (for example, walker or crutches) to walk alone on a level surface and/or requires human supervision or assistance to negotiate stairs or steps or uneven surfaces.
  • 3 - Able to walk only with the supervision or assistance of another person at all times
  • 4 - Chairfast, unable to ambulate but is able to wheel self independently
  • 5 - Chairfast, unable to ambulate and is unable to wheel self.
  • 6 - Bedfast, unable to ambulate or be up in a chair.
 

Best Practice Assessment Strategies for M1860

The intent of M1860 is to identify the patient’s ABILITY to mobilize self, not necessarily the actual performance

"Willingness" and "adherence" are not the focus of these items. 

These items address the patient's ability to safely ambulate or use a wheelchair, given the current physical and mental/emotional/cognitive status, activities permitted, and environment.  The patient must be viewed from a holistic perspective in assessing ability to perform ADLs.  Ability can be temporarily or permanently limited by physical impairments (for example, limited range of motion, impaired balance), emotional/cognitive/behavioral impairments (for example, memory deficits, impaired judgment, fear), sensory impairments (for example, impaired vision or pain), environmental barriers (for example, stairs, narrow doorways, unsafe flooring).

  • Variety of surfaces refers to typical surfaces that the patient would routinely encounter in his/her environment, and may vary based on the individual residence.
  • The patient’s ability may change as the patient’s condition improves or declines, as medical restrictions are imposed or lifted, or as the environment is modified.  The clinician must consider what the patient is able to do on the day of the assessment. 
  • The ambulation/locomotion scale presents the most optimal level first, then proceeds to less optimal mobility abilities.  Read each response carefully to determine which one best describes what the patient is able to do.
  • Regardless of the need for an assistive device, if the patient requires human assistance (hands on, supervision and/or verbal cueing) to safely ambulate, select Response 2 or Response 3, depending on whether the assistance required is intermittent (“2”) or continuous (“3”).

For more information on Medicare's Home Health Care Quality Indicators click here.

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