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Home Health Best Practices for GERD - Skilled Nursing Teaching and Care Plan

Posted by Patty Jampolsky on Nov 29, 2016

For the patient with Gastroesophageal Reflux Disease (GERD), in addition to feeding and eating ability on OASIS C M1870, also include these Best Practice assessment strategies:  

The following symptoms may indicate un-treated Gastroesophageal Reflux Disease (GERD)

  • inadequate food intake
  • altered taste
  • weight loss
  • decreased peristalsis
  • muscle mass loss
  • nausea and vomiting
  • abdominal pain or discomfort
  • intolerance of fatty foods
  • epigastric pain after eating
  • heartburn
  • regurgitation
  • dysphagia

    Download Home Health Careplan for GERD

Home Health Care Policies for Answering (M1870) Feeding or Eating: Current ability to feed self meals and snacks safely.

This refers only to the process of eating, chewing, and swallowing, not preparing the food to be eaten. The current assessment choices on home health care forms are:

  • 0 - Able to independently feed self.
  • 1 - Able to feed self independently but requires: (a) meal set-up; OR (b) intermittent assistance or supervision from another person; OR (c) a liquid, pureed or ground meat diet.
  • 2 - Unable to feed self and must be assisted or supervised throughout the meal/snack.
  • 3 - Able to take in nutrients orally and receives supplemental nutrients through a nasogastric tube or gastrostomy.
  • 4 - Unable to take in nutrients orally and is fed nutrients through a nasogastric tube or gastrostomy.
  • 5 - Unable to take in nutrients orally or by tube feeding.


This item Identifies the patient’s ability to feed him/herself, including the process of eating, chewing, and swallowing food. The intent of the item is to identify the patient’s ABILITY, not necessarily actual performance. "Willingness" and "adherence" are not the focus of these items. 

These items address the patient's ability to safely self-feed, 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 hearing, pain)

Best Practice Assessment Strategies for M1870

This item excludes evaluation of the preparation of food items, and transport to the table. 

You should respond to this item based on the assistance needed by the patient to feed himself once the food is placed in front of him.  Assistance means human assistance by verbal cueing/reminders, supervision, and/or stand-by or hands-on assistance.

● The patient’s ability may change as the patient’s condition improves or declines, or as medical restrictions are imposed or lifted.  The clinician must consider what the patient is able to do on the day of the assessment.  If ability varies over time, choose the response describing the patient’s ability more than 50% of the time period under consideration.

● The feeding/eating scale presents the most optimal level first, then proceeds to less optimal feeding/eating abilities.  Read each response carefully to determine which one best describes what the patient is able to do.

● Meal "set-up" (Response 1) includes activities such as mashing a potato, cutting up meat/vegetables when served, pouring milk on cereal, opening a milk carton, adding sugar to coffee or tea, arranging the food on the plate for ease of access, etc. -- all of which are special adaptations of the meal for the patient.

● Select Response 2 if the patient is either unable to feed themselves and/or must be assisted or supervised while eating.

 Why are contingency plans good for your home health business?

 Why are Best Practices good for your home health business?