LHCR / Home Health Newsletters

November 2007

TRANSFERRING

Transferring (M0690) identifies the patient’s ability to safely transfer in a variety of situations.  The situations are limited to:  moving from bed to chair; on and off toilet or commode; into and out of the tub or shower; and if patient is bedfast, the ability to turn and position self in bed.

The most important thing is ensuring your staff consistently understands the question and knows how to answer it correctly.  Observe the patient during transfers and determine the amount of assistance required for safe transfer.  A combination of assessment, observation and interview with the patient and/or caregiver may be required to make the correct determination.  Here are some tips to make your assessment smoother:

• If the patient’s ability varies between transfer activities, record the level of ability applicable to the majority of the activities.  Only three types of transfers are addressed for non-bedfast patients - bed to chair, on/off toilet or commode and in/out of tub or shower (responses 0, 1, 2, or 3).  The patient must demonstrate at least 75% ability to the majority of the tasks.
   

• Focus on ability and safety, not on compliance or willingness.
   

• If patients require extra time and use their arms to push up, evaluate the transfer for safety, not the length of time to complete.  Even though this patient may be slow and use their arms, if the transfer is done safely, they are independent.

• The phrase “able to bear weight” refers to the patient’s ability to support the majority of their body weight through any combination of weight-bearing extremities, this includes legs and arms.
   

• Minimal human assistance includes verbal cueing, environmental set-up (as in positioning wheelchair, placing elevated seat on toilet), and/or hands-on assistance, where the level of assistance is equal to or less than 25% of the total effort.
   

• Bedfast defines a patient who is confined to bed and unable to tolerate being out of bed, even to sit in chair.  For these patients, only assess the ability to turn and position self in bed (responses 4 or 5).

• Would therapy potentially help the patient be more independent and safer? 
   

• Are there any transfer or DME aids the patient could rent or purchase?
   

• Could the home environment benefit from any minor modifications?

Proper and consistent assessment is important in managing your patient’s health status.  We can provide you with the tools to improve performance and increase efficiency while still providing patient centered care.  For additional intervention tools, click here to view RESOURCES and download LHCR developed brochures and posters that may be useful for in-servicing staff on the importance of consistent assessment.