Are you Careplanning for a Vision Deficit?
Patients typically have risk factors that make clinical and rehabilitative care more complicated – confusion, non-compliance, lack of family support…and a vision deficit. These are just a few example of factors that create impediments to a successful discharge.
B1000 Vision has been on the OASIS Assessment since its initiation in 1998. Like other risk factors, a vision deficit poses an additional obstacle to successful patient care.
First, Answer B1000 Correctly.
The Purpose of the Question. If a vision deficit is present, teaching the patient/caregiver safety measures is indicated. Include teaching on preparing a safe home for the patient with a vision deficit.
The Question. (B1000) Ability to see in adequate light (with glasses or other visual appliances):
The Available Answers.
0. Adequate – sees fine detail, such as regular print in newspapers/books
1. Impaired – sees large print, but not regular print in newspapers/books
2. Moderate impaired – limited vision; not able to see newspaper headlines but can identify objects
3. Highly impaired – object identification in question, but eyes appear to follow objects
4. Severely impaired – no vision or sees only light, colors or shapes; eyes do not appear to follow objects
Medicare’s Guidance for Answering B1000
From the Medicare Guidance Manual for OASIS E:
- Be sensitive to requests to read, as patient may not be able to read though vision is adequate.
- “Nonresponsive” means that the patient is not able to respond.
- As specified within the OASIS question, only assess functional vision with corrective lenses if the patient usually wears corrective lenses.
- A magnifying glass (as might be used to read newsprint) is not an example of corrective lenses.
- Reading glasses (including “grocery store” reading glasses) are considered to be corrective lenses.
- Physical deficits or impairments that limit the patient’s ability to use their existing vision in a functional way should be considered. For example, if a physical deficit/impairment (like limited neck range of motion) prevents a patient from seeing objects in his path, affecting safe function in his environment, B1000 should be Response 2 – Severely impaired.
- Assessment strategies: In the health history interview, ask the patient about vision problems (for example, cataracts) and whether or not the patient uses glasses. Observe ability to locate signature line on consent form, to count fingers at arm’s length and ability to differentiate between medications, especially if medications are self-administered.
CMS485 Goal (Form Locator 22) for Vision Deficit
"Patient/caregiver accurately recall and/or demonstrate safety measures for the patient with a vision deficit including home modification for kitchen, living area, bathroom, garage, entryways"
CMS485 Intervention (Form Locator 21) for Vision Deficit
"Teach patient/caregiver home modifications to prevent injury related to vision deficit, including eliminating clutter, lighting, storage of medications, specific modifications for bathroom, bedroom, kitchen and living area."
Etiology and Manifestation Home Health Coding on OASIS
