MyHomecareBiz recommends the following Medicare guidelines for completing OASIS M1840 Toilet Transferring:

M1840 Toilet Transferring

Current ability to get to and from the toilet or bedside commode safely and transfer on and off toilet/commode.

• 0 - Able to get to and from the toilet and transfer independently with or without a device.
• 1 - When reminded, assisted, or supervised by another person, able to get to and from the toilet and transfer.
• 2 - Unable to get to and from the toilet but is able to use a bedside commode (with or without assistance).
• 3 - Unable to get to and from the toilet or bedside commode but is able to use a bedpan/urinal independently.
• 4 - Is totally dependent in toileting.  

This M0 item Identifies the patient’s ability to safely get to and from and transfer on and off the toilet or bedside commode.  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 perform toilet transferring, 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, location of toilet or bedside commode) .  This item is assessed at Start of care,  Resumption of care,  Follow-up,  Discharge from agency - not to an inpatient facility

Best Practices for Assessing M1840 Toilet Transferring

• Excludes personal hygiene and management of clothing when toileting.
• 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.  If ability varies over time, choose the response describing the patient’s ability more than 50% of the time period under consideration.
• The toilet transferring scale presents the most optimal level first, then proceeds to less optimal toileting methods.  Read each response carefully to determine which one best describes what the patient is able to do.
• If the patient can get to and from the toilet during the day independently, but uses the commode at night for convenience, select Response 0.
• If the patient requires standby assistance to get to and from the toilet safely or requires verbal cueing/reminders, select Response 1.  
• If the patient needs assistance getting to/from the toilet or with toileting transfer or both, then Response 1 is the best option. If the patient can independently get to the toilet, but requires assistance to get on and off the toilet, select Response 1.

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