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FIM - FAQ
| Question | Answer |
|---|---|
| What is the FIM rating if two helpers are required to perform a task? | If two helpers are required to perform a task, then the FIM rating is Level 1 - Total Assistance. |
| What ar the discharge FIM ratings if a patient expires during the rehabilitation stay? | If a patient expires during the stay on the rehabilitation unit, record all discharge FIM ratings as Level 1 - Total Assistance. |
| How should I calculate a FIM rating if a patient refuses to perform a task to the best of his ability? | The FIM rating should reflect what the patient actually performs, not what the patient should be able to do. |
| How do I complete an assessment if a patient is admitted to the rehabilitation unit and is then discharged the next morning? | Admission and discharge assessments ar not discipline - specific. In other words, documentation from any trained clinician can be used to complete the assessment. |
| Should I assess all 18 FIM items across all environents during the patient's rehabilitation? | Yes, you should assess all FIM items in differnet environments such as patient room, patient dining room, and therapy gym. |
| What steps should I consider when I assess Eating? | The Eating rating reflects the burden of care that a helper provides as the patient attempts to accomplish the following tasks: Picking up a utensil Scooping food onto utensil Bringing food to the mouth Chewing and swallowing Managing a cup or glass |
| Should I consider denturea an assistive device if a patient requires them to chew food? | Yes |
| What is the FIM rating for Eating if the patient requires a helper to open containers or pour the liquids into the patient's glass before the patient feeds himself? | The FIM rating in this case is Level 5 - Setup. |
| What is the FIM rating for Eating if a patient receives nutritional feeding through a feeding tube and the patient sets up and administers the feedings through the feeding tube without the assistance of a helper? | Level 6 |
| What is the FIM rating for Eating if a patient receives nutritional feeding through a feeding tube and the patient administers the tube feedings after the helper either opens the feeding can or sets up the equipment? | Level 5 |
| What is the FIM rating for Eating if a patient receives nutritional feedings through a feeding tube and the patient administers tube feedings after set up by a helper and the helper supervises the patient self-administer the feeding? | Level 5 |
| What is the FIM rating for Eating if a patient receives nutritional feeding through a feeding tube and the patient performs less than 25% of the effort of administering the tube feeding? | Level 1 |
| What is the FIM rating for Eating if the patient eats independently but requires a helper to administer nutritional feedings through a feeding tube? | The FIM is Level 1 - Total Assistance. The patient eats by mouth independently (Level 7), but requires a nurse to administer nutritional tube feeds (Level 1). The FIM rating should always reflect the lowest rating of the eating episode that occurred. |
| How does a feeding tube affect a patient's FIM rating if the feeding tube is no used for nutritionn and if the nurse flushes the feeding tube to maintain patency? | If the feeding tube is not used for nutrition or hydration, do not consider it when rating FIM for Eating. |
| A helper administered 300ml water flushes 4 times a day. How shoul should this episode be rated? | Because the helper administers the water for hydration without the patient's assistance, the FIM rating for this episode is Level 1 - Total Assistance. |
| What steps should I condsider when I rate Bathing? | The Bathing rating reflects the patient's ability to wash, rinse, and dry each of the 10 body areas: Chest, Right arm, Left arm, Abdomen, Front perineal area, Buttocks, Right and left upper leg, Right and left lower leg (including feet. |
| How should I rate a patient for Bathing if he has an amputated limb? | If the patient has an amputated limb, decrease the total number of body areas available for Bathing. |
| A patient has a right knee amputation and requires a helper to wash, rinse, and dry the left lower leg and foot. The patient washes, rinses, and dries the remaining body areas. What is the FIM rating for Bathing? | Because the patient performs more than 75% of the Bathing tasks, he should be rated a Level 4 - minimal contact assistance. |
| How should I assess Bathing if a patient sets up his bathing equipment independently and then washes all of his body except his lower estremities, but the patient refuses to wash his lower extremities or allow a helper to wash the lower extremities? | Bathing assessment should be based on the washed areas. In this scenario, the patient would be rated Level 7 - Complete Independence, because there was no burden of care for a helper. |
| Should I consider assistance required to transfer into or out of the tub or shower when I assess Bathing? | No, the amount of assistance required to transfer into or out of the tub or shower is rated under Transfers: Tub, Shower. |
| Should I consider a walker an assistive device for Dressing - Upper Body if a patient uses the walker to ambulate to the closed to obtain clothes? | No, the walker is rated an assistive device unde the FIM item Locomotion: Walk. |
| Should I consider a walker an assistive device for Dressing - Upper Body if a patient uses the walker for balance while reaching into the closet? | Yes, for this item the walker is considered an assistive device if the patient requires it for balance while reaching into a closet to obtain clothing. |
| How do I rate Dressing - Upper Body if the patient requires two helpers to apply an orthosis such as an abdominal binder or thoracic-lumbar-sacral orthosis and then uses the orthosis to complete upper body dressing? | Level 1 - Total Assistance. |
| How do I rate Dressing - Upper Body if the patient requires one helper to apply an orthosis, which the patient then utilizes to complete upper body dressing independently? | Level 5 - Setup |
| How do I rate Dressing - Upper Body if the patient applies an orthosis that is then used to complete upper body dressing without assistance? | Because the orthosis is an assistive device, the FIM rating for this scenario is Level 6. |
| How do I rate Dressing - Upper Body if the patient applies the orthosis, does not require the orthosis to complete upper body dresing, and completes upper body dressing independently without assistive devices? | Level 7 - Complete Independence |
| Should I consider the walker an assistive device for Dressing - Lower Body if a patient uses the walker to ambulate to the closet to obtain clothes? | No, the walker is rated as an assistive device under the FIM item Locomotion: Walk. |
| Should I consider a walker an assistive device for Dressing - Lower Body if a patient uses the walker for balance while reaching into the closet? | Yes, for this item the walker is considere an assistive device if the patient requires it for balance while reaching into a closet to obtain clothing. |
| How do I rate Dressing - Lower Body if the patient dons his underwear, pants, socks, and shoes independently but requires assistance buttoning his pants, zipping the zipper on his pants, or fastening his belt? | Level 4 - Minimal Contact Assistance |
| How do I rate Dressing - Lower Body if a helper must apply the patient's antiembolic stokings? | Because the antiembolic stockings are considered an orthosis, the FIM rating is Level 5 - Supervision/Setup. |
| How do I rate Dressing - Lower Body if the patient wears a hospital gown and does not have other clothing? | Dressing and undressing can be assessed only if the patient utilizes appropriate clothing to wear in public. This item cannot be assessed if the patient wears a hospital gown. As a result, it is a Level 0 - Activity did not occur. |
| What is the FIM rating for Dressing - Lower Body if the patient only requires assistance to tie his shoes? | Level 4 - Minimal Assistance |
| How do I rate Dressing - Lower Body for a patient who has a lower limb prosthesis and applies the prosthesis, does not use it as an assistive device for lower body dressing, and requires no other assistance or assistive devices to dress the lower body. | Level 7 |
| How do I rate Dressing - Lower Body for a patient who has a lower limb prosthesis and applies the prothesis independently, requires the lower limb to dress the lower body, and then performs the task independently? | Level 6 |
| How do I rate Dressing - Lower Body for a patient who has a lower limb prosthesis and requires a helper to apply the lower limb prosthesis after which the patient completes lower body dressing independently. | Level 5 |
| What steps should I consider when I rate Toileting? | The Toileting rating consists of three steps: Adjusting clothing prior to toilet use, perineal hygiene after toilet use, and adjusting clothing after toilet use. |
| Should I rate Toileting if a patient is incontinent of bowel or bladder during a particular episode. | No. Toileting is rated only during a continent episode. The level of assistance required to clean up after an incontinent episode is reflected in the items Bladder Level of Assistance and Bowel Level of Assistance. |
| Should I consider a handrail an assistive device if the patient requires it for balance while managing his clothes or performing perineal care during the toileting task? | Yes |
| Should I consider a handrail an assistive devide for the Toileting item if the patient requires the handrail to transfer off the toilet? | No. The handrail is considered an assistive device when you rate the FIM item Transfers: Toilet. |
| What elements factor into rating Bladder Level of Assistance? | This function modifier includes the assistance required for the following tasks: Safely using and caring for equipment and agents used to manage a bladder episode and cleaning urine after an accident (e.g., changing linen or clothing). |
| What is the look-back period for Bladder Level of Assistance? | The look back period for this function modifier is 3 days. |
| What is the Bladder Frequency of Accidents? | The function modifier reflects the number of times that the patients linen or clothing gets soiled from urine. |
| What is the FIM rating for a patient who is incontinent of urine, changes her diaper without assistance from a helper, and has not had any accidents (i.e., neither her clothing nor her linen has become soiled from urine)? | Because this patient utilized a diaper as an assistive device to manage her bladder, the FIM rating in this scenario would be a Level 6 - Modified Independence. |
| How do I rate Bladder Level of Assistance if the patient requires the helper to change his diaper, clothing, or linen? | Because the helper changes the patient's diaper, clothing, or linen without assistance from the patient, the FIM rating in this scenario would be a Level 1 - Total Assistance. |
| How do I rate the bladder Level of Assistance if the patient requires a urinal to void, uses it, and empties it independently after use? | Level 6 |
| How do I rate the bladder Level of Assistance if the helper gives the patient the urinal or empties the urinal for the patient. | Level 5 |
| How do I rate the bladder Level of Assistance if the helper positions the urinal? | Level 4 |
| How do I rate the bladder Level of Assistance if the helper positions the urinal and holds it in place. | Level 3 |
| How do I rate the bladder Level of Assistance if the urinal spills, after which the helper is required to cleanit up or change the patient's linen or clothing. | Level 1 |
| How do I rate a patient who has a foley catheter and cares for it without assistance from a helper? | Level 6 |
| How do I rate a patient who has a foley catheter and the patient requires a helper to supervise while the patient cares for the catheter, or the patient requires a helper to set up the equipment necessary for catheter care? | Level 5 |
| How do I rate a patient who has a foley catheter and the helper cares for the catheter (e.g, inserts the catheter, changes the collection bag, empties the bag) without assistance from the patient? | Level 1 |
| How do I rate Bladder Level of Assistance if the patient requires a helper to set up or empty a urinal, bedpan, or commode? | If a helper sets up (e.g., puts equipment in reach of the patient) or empties a urinal bedpan, or commodwe, the rating for this function modifier is Level 5 - Setup. |
| Should the rating for Bladder Level of Assistance reflect the amount of assistance required to collect a urine specimen or 24-hour urine collection? | No. Lab specimen collections are considered medical/laboratory procedures andthey are not rated as ADL's. The Level of Assistance rating should be the rating for Bladder Level of Assistance not including the assistance required to collect a specimen. |
| How is the bladder scan reflected in a rating for Bladder Level of Assistance? | The bladder scan is a medical procedure and should not be considered when rating this function modifier. |
| How should I rate a patient who is on renal dialysis and does not void? | Dialysis is treatment for a condition of the kidney, not the bladder. Consequently, it is not considered when rating Bladder Management. |
| How should I rate Bladder Level of Assistance if a patient who uses absorbent pads or a diaper, has no accidents, and changes the pads or diaper independently? | Level 6 - Modified Independence as the patient requires an assistive device (e.g., diaper, absorbent pad). |
| How should I rate Bladder Frequency of Accidents if a patient who uses absorbent pads or a diaper, has no accidents, and changes the pads or diaper independently? | Level 6 - Modified Independence as the patient requires an assistive device (e.g., diaper, absorbent pad). |
| How should I rate Bladder Management if a patient who uses absorbent pads or a diaper, has no accidents, and changes the pads or diaper independently? | Level 6 - Modified Independence |
| How do I rate Bladder Level of Assistance for a patient who requires intermittent catheterizations and the patient requires a helper to perform the entire straight catheterization procedure? | level 1 |
| How do I rate Bladder Level of Assistance for a patient who requires intermittent catheterizations and the patient requires a helper to supervise to to set up equipment while the patient performs the catheterization. | Level 5 |
| What is Bowel Level of Assistance? | Bowel Level of Assistance includes the assistance required for the following tasks: Safely using and caring for equipment and agents used for management during a bowel episode. Cleaning up after an accident (e.g., changing linen or clothing). |
| What is the look-back period for Bowel Level of Assistance? | The look-back period for Bowel Level of Assistance is 3 days. |
| What is Bowel Frequency of Accidents? | Bowel Frequency of Accidents reflects the number of times in the past 7 days that the patient is incontinent of stool and that the patient's linen or clothing gets soiled. |
| How do I rate a patient for Bowel Level of Assistance who has a colostomy and who is independent with colostomy care? | Level 6 - Modified Independence |
| How do I rate a patient for Bowel Frequency of Accidents who has a colostomy and who is independent with colostomy care? | Level 6 - Modified Independence |
| How do I rate a patient for Bowel Management who has a colostomy and who is independent with colostomy care? | Level 6 - Modified Independence |
| How do I rate Bowel Level of Assistance for a patient who requires a suppository for constipation, but does not require assistance from a helper, inserts the suppository and performs cleanup himself? | Level 6 |
| How do I rate Bowel Level of Assistance for a patient who requires a suppository for constipation, and requires a helper for setup, lubricating the suppository, cueing,instructions, or supervision? | Level 5 |
| How do I rate Bowel Level of Assistance for a patient who requires a suppository for constipation, and the helper inserts the suppository but does not provide digital stimulation? | Level 4 |
| How do I rate Bowel Level of Assistance for a patient who requires a suppository for constipation, and performs less than 25% of bowel management tasks. The helper sets up, administers the suppository, provides digital stimulation, and cleans up. | Level 1 |
| How do I rate a patient for Transfers who requires lifting to bring himself to a stand or to lower himself to a sitting position but who completes the remainder of the transfer with contact assistance? | Because the patient requires more help than touching and performs 50-74% of the transfering taskes, the rating in this scenario is Level 3 - Moderate Assistance. |
| How do I rate a patient for Transfers who requires assistance to lift one of his legs in or out of the bed or the tub during a transfer? | Level 4 |
| How do I rate a patient for Transfers who requires assistance to lift both of his legs in or out of the bed or the tub during a transfer? | Level 3 |
| How do I rate a patient for Transfers: Bed, Chair, Wheelchair who requires that the head of the hospital bed be raised to assist with a transfer, but who can perform the remainder of the bed-to-wheelchair transfer independently? | Because the patient requires the head of the bed (an assistive device) to be raised for the transfer and is able to raise it without assistance, the rating for this scenario is Level 6 - Modified Assistance. |
| How do I rate a patient for Transfers: Bed, Chair, Wheelchair who requires that the head of the hospital bed be raised by a helper to assist with a transfer, but who can perform the remainder of the bed-to-wheelchair transfer independently? | Level 5 - Supervision/Setup |
| Should I consider a grab bar an assistive device if the patient requires it to sit down onto a toilet or to pull himself up off the toilet? | If the patient requires a grab bar to perform the toilet transfer (i.e., to get on or off the toilet), you should consider the grab bar an assistive device when rating this item. |
| Can I rate a transfer to a bedside commode as a toilet transfer? | Yes, but you must consider the bedside commode an assistie device. |
| Should I consider a raised toilet an assistive device if the patient requires it for toilet transfers? | Yes. If the patient requires the raised toilet seat to transfer to the toilet, the raised toilet seat is an assistive device. |
| How do I rate Locomotion if the patient requires oxygen to walk, turns it on himself, manages the oxygen while completing the task, and does not need a helper? | Level 6 |
| How do I rate Locomotion if the patient requires a helper to supervise, to turn on the oxygen, or to handle the oxygen while the patient performs the task? | Level 5 |
| How do I rate Locomotion if the patient requires two helpers: one for assistance walking or propelling the wheelchair and the other for managing the oxygen tank? | Level 1 |
| How do I rate Locomotion: Stairs for a patient who goes up and down the stairs on his buttocks and performs the task in a reasonable amount of time without the assistane of a helper or a device? | Level 7 |
| How do I rate Locomotion: Stairs for a patient who goes up and down the stairs on his buttocks and performs the task but the amount of time the patient takes is longer than reasonable? | Level 6 |
| Should I consider a handrail an assistive device if a patient requires it to climb stairs? | Yes. If a patient requires a handrail to go up or down stairs, consider the handrail an assistie device. |
| Should I consider an AFO and assistive device if the patient requires it to climb stairs? | Yes. If a patient requires an AFO to go up and down stairs, consider the AFO an assistive device. |
Created by:
rehabrn