Maine

Adult Family Care Home RUG and Classification Group CalculatorItemDescriptionALS ScoreADL or IADL/B scoreInstructions: Using the codes from the MDS-ALS assessment form, enter the appropriate scores into Column (A) to determine the Assistance with Living Skills (ALS) score. Step 1: Calculate Assistance with Living Skills scoreModified Cognitive SkillsIf value B3>0 then Score=1, otherwise score =0B3Cognitive skills for daily decision-makingIndicators of Depression, Anxiety, and/or Sad Mood Count number of items in Section E1 that are >0. If total count is 0, 1 or 2 then Score = 0; if total count is 3 or more, then score =1 in the shaded score area.E1aNegative statementsE1b Repetitive questionsE1cRepetitive verbalizationsE1dPersistent anger with self or othersE1eSelf deprecationE1fExpressions of what appear to be unrealistic fearsE1gRecurrent statements that something terrible is about to happenE1hRepetitive health complaintsE1iRepetitive anxious complaints/concernsE1jmood in morning UnpleasantE1kInsomnia/change in usual sleep patternE1lSad, pained, worried facial expressionsE1mCrying, tearfulnessE1nRepetitive physical movementsE1oWithdrawal from activities of interestE1pReduced social interactionE1qInflated self-worthE1rExcited behavior, motor excitationTotal Assistance with use of the telephone or arranging transportationIf value of G5ac or G5ag=1 or 2, Score =1 in the shaded score area, otherwise enter 0 in the shaded areaG5AcTransportationG5AgAssistance to use telephoneTotalManagement of Incontinence SuppliesIf H4=0, Score=0; If H4=1, Score=1;If H4=2, Score=2; If H4=3, Score=0H4Ability to manage incontinent suppliesSelf-Administration of MedicationsIf O5f=1, Score = 0; Otherwise Score = 1;O5fSelf-administration of over the counter medicationsMedication Preparation and AdministrationIf O6=0, Score=1; If O6=1, Score=2;If O6=2, Score=1; If O6=3, Score=0;O6Did resident prepare and administer any of his/her own medicationsPhysician’s OrdersIf value P10>0, Score=1; Otherwise Score=0.P102947670181610Number of days physician changed ordersTotal of all shaded boxes in Step 1, column A. This is the Daily Living Assistance ScoreItemDescriptionALS Score(A)ADL or IADL/B Score(B)Step 2: Calculate ADL scoreActivities of Daily Living (ADL) If response = 0, Score 0;If response = 1, Score 1If response = 2, Score 2;If response = 3, Score 3If response = 4, Score 4; If response = 8, Score 4;G1AaBed mobility, self-performance1229995105283000G1BaTransfer, self-performanceG1CaLocomotion, self-performanceG1DaDressing, self-performanceG1EaEating, self-performanceG1FaToilet Use, self-performanceG1GaPersonal hygiene, self-performanceTotal all ADL items to calculate ADL scoreStep 3: Instrumental Activities of Daily Living and Bathing (IADL/B)Bathing If G2 =0, Score=0;If G2 =1, Score=1If G2 =2, Score=2;If G2 =3, Score=3If G2 =4, Score=4;If G2 =8, Score=0;G2Bathing, self-performanceInstrumental Activities of Daily LivingIf response = 0, Score=0;If response = 1, Score=1If response = 2, Score=2;If response = 3, Score=3If response = 4, Score=4;If response = 8, Score=0;G5AaArranging for shoppingG5AbShoppingG5AdManaging financesG5AeManaging cash, allowanceG5AfPrepares snackG5AhLight houseworkG5AiLaundryTotal IADL122999514795500Total IADL and Bathing (IADL/B)472884544386500MaineCare Adult Family Care Home RUG group: Use scores from Assistance with Living Skills score and the higher of ADL and IADL/B scores to determine classification group from chart below. RUG codeRUG CodeALS ScoreADL ScoreIADL/B ScoreWeightRate 7/1/191AV2ALS 7-9ADL 7-281.657$91.622AV1ALS 7-9ADL 0-61.210$66.903AH2ALS 5-6ADL 7-281.360$75.194AH1ALS 5-6ADL 0-61.027$56.785AM2ALS 2-4IADL 12-180.924$51.096AM1ALS 2-4IADL 10-110.804$44.457AL1ALS 0-4IADL 0-90.551$30.478BC1Unclassified0.551$30.47 ................
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