Functional Independence Measure Handout Flashcards
Codes for assessing activity
No helper
7: Complete independence (patient does activities safely)
6: Modified independence (requires specialized equipment, more than a reasonable amount of time, or there are safety considerations)
Helper
5: Supervision or setup (requires supervision/setup/initial preparation)
4: Minimal contact assistance (patient performs 75% or more of task)
3: Moderate assistance (patient performs 50% - 74% or more of task)
2: Maximal assistance (patient performs 25% - 49% or more of task)
1: Total assistance (patient performs less than 25% of task)
0: Activity does not occur (use of this code is rare)
Eating
Use of suitable utensils to bring food to mouth, chew and swallow, once the meal is presented in the customary manner on a table or tray
If activity does not occur, code “0” on admission and “1” on discharge
No helper
7: Complete independence
Eats from a dish, variety of food consistencies, drinks from cup.glass, opens containers, uses tools to bring food to mouth (chewed and swallowed), performed safely
6: Modified independence
Safety considerations, or adaptive/assistive device, more time needed to eat, modified food consistency, blenderized foods, if patient has other means of alimentation (parenteral/gastronomy feedings), they self feed.
5: Supervision or setup (requires supervision/setup/another person to open containers, butter bread, cut meat, or pour liquids)
4: Minimal contact assistance (patient performs 75% or more of task)
3: Moderate assistance (patient performs 50% - 74% or more of task)
2: Maximal assistance (patient performs 25% - 49% or more of task)
1: Total assistance (patient performs less than 25% of task)
0: Activity does not occur (use of this code is rare)- patient doesn’t eat or receive parenteral/enteral nutrition during the entire assessment time frame
Grooming
Grooming: oral care, hair grooming (combing or brushing hair), washing the hands (rinse and dry), washing the face (rinse and dry), and shaving face or applying make-up; does independently and safely; includes obtaining articles necessary for grooming
Assess only activities in the definition, DOES NOT include flossing teeth, shampooing hair, applying deodorant, shaving legs; don’t assess activities that the patient doesn’t do
No helper
7: Complete independence
Cleans teeth/dentures, combs/brushes hair, washing the hands (rinse and dry), washing the face (rinse and dry), and shaving face or applying make-up including all preparations; does safely
6: Modified independence
Patient requires specialized equipment (includes prosthesis/orthosis) for activities, takes more time, or there are safety considerations
Helper
5: Supervision or setup (requires supervision/setup) for setup of grooming equipment or initial preparation (put toothpaste onto toothbrush)
4: Minimal contact assistance (patient performs 75% or more of task)
3: Moderate assistance (patient performs 50% - 74% or more of task)
2: Maximal assistance (patient performs 25% - 49% or more of task)
1: Total assistance (patient performs less than 25% of task)
0: Activity does not occur (use of this code is rare)- does not perform grooming activities stated above and not groomed by a helper during entire assessment time frame
Bathing
Bathing: washing, rinsing, drying the body from the neck down (excludes neck and back) in either a tub, shower, or sponge/bed bath. The patient performs the activity safely and independently
In this item, think of the body as 10 areas/parts and evaluate how the patient bathes in each part (each 10% of the total) Chest Left arm Right arm Abdomen Perineal area Buttocks Left upper leg Right upper leg Left lower leg, including foot Right lower leg, including foot
No helper
7: Complete independence (does above activities safely)
6: Modified independence (requires specialized equipment, more than a reasonable amount of time, or there are safety considerations)
Helper
5: Supervision or setup (requires supervision/setup/initial preparation)
4: Minimal contact assistance (patient performs 75% or more of task)
3: Moderate assistance (patient performs 50% - 74% or more of task)
2: Maximal assistance (patient performs 25% - 49% or more of task)
1: Total assistance (patient performs less than 25% of task)
0: Activity does not occur (use of this code is rare)
Dressing
Dressing- Upper Body: dressing and undressing above the waist, applying and removing a prosthesis/orthosis when applicable; activity performed safely and independently
For assessing dressing/undressing, patient should be wearing clothes that are appropriate to wear in public
If patient only wears hospital gowns/PJs, rate activity as 0.
From the time the patient is admitted to the IRF through admission assessment time period, IRF’s staff should attempt to obtain source clothing for patient (upper and lower body including footwear); when clothing is obtained, the previous score on the admission assessment should be updated
Dressing should be scored during the usual time of day that the patient is awake/alert → reflects their actual functional performance
No helper
7: Complete independence
Dress/undress safely, including getting clothes from closet, may include managing a bra, pullover garment, etc., and the application and removal of a prosthesis or orthosis
6: Modified independence (requires special adaptive closure (ex: Velcro) or assistive device (prosthesis/orthosis) to dress, takes more than a reasonable amount of time
Helper
5: Supervision or setup (requires supervision/setup/initial preparation)
4: Minimal contact assistance (patient performs 75% or more of task)
3: Moderate assistance (patient performs 50% - 74% or more of task)
2: Maximal assistance (patient performs 25% - 49% or more of task)
1: Total assistance (patient performs less than 25% of task)
0: Activity does not occur (use of this code is rare; code 0 for patient who does not dress in clothing that is appropriate to wear in public during the entire assessment time frame)
Toileting
Toileting: maintaining perineal hygiene and adjusting clothing before and after using a toilet, commode, bedpan, or urinal. The patient performs this activity safely and independently.
No helper
7: Complete independence (patient does activities safely, cleanses after void/bowel movements, adjusts clothing before/after toilet)
6: Modified independence (requires specialized equipment during toileting, takes more than a reasonable amount of time, or there are safety considerations)
Helper
5: Supervision or setup (requires supervision/setup)
4: Minimal contact assistance (patient performs 75% or more of task)
3: Moderate assistance (patient performs 50% - 74% or more of task)
2: Maximal assistance (patient performs 25% - 49% or more of task)
1: Total assistance (patient performs less than 25% of task)
0: Activity does not occur (Patient does not perform any toileting tasks and helper does not perform any of the activities for the subject; use of this code is rare)
Transfers: Bed, Chair, Wheelchair
Transfers: Bed, Chair, Wheelchair: all aspects of transferring from a bed to a chair and back, or from a bed to a wheelchair and back, or coming to a standing position if walking is typical mode of locomotion. The patient performs this activity safely and independently.
Note: For bed-to-chair transfer, the subject begins and ends in supine
No helper
7: Complete independence
Walking- patient safely approaches, sits down on chair, and gets up to standing position from regular chair and also safely transfers from bed to chair
In a wheelchair- patient safely approaches bed/chair, locks brakes, lifts foot rests, removes arm rest if needed, and does a standing pivot or sliding transfer (without a board) and returns.
6: Modified independence (requires specialized equipment like a sliding board, lift, grab bars or special seat/chair/brace/crutches; it takes more than a reasonable amount of time, or there are safety considerations; prosthesis or orthosis is considered an assistive device if used for the transfer.)
Helper
5: Supervision or setup (requires supervision/setup- positioning sliding board, moving foot rests, etc./initial preparation)
4: Minimal contact assistance (patient performs 75% or more of task with no more help than touching)
3: Moderate assistance (patient performs 50% - 74% or more of task with more help than touching)
2: Maximal assistance (patient performs 25% - 49% or more of task)
1: Total assistance (patient performs less than 25% of task)
0: Activity does not occur (use of this code is rare)
Transfers: Tub
Transfers: Tub: getting into and out of a tub safely
SEPARATE CODE FOR SHOWER TRANSFERS (Item 34) vs. TUB (Item 33); CODE ONLY ONE!
No helper
7: Complete independence
Walking- patient safely approaches tub, gets into and out of it
In a wheelchair- patient safely approaches tub, locks brakes, lifts foot rests, removes arm rest if needed, and does a standing pivot or sliding transfer (without a board) and returns.
6: Modified independence (requires specialized equipment like a sliding board, lift, grab bars or special seat; it takes more than a reasonable amount of time, or there are safety considerations; prosthesis or orthosis is considered an assistive device if used for the transfer)
Helper
5: Supervision or setup (requires supervision/setup- positioning sliding board, moving foot rests, etc./initial preparation)
4: Minimal contact assistance (patient performs 75% or more of task with no more help than touching)
3: Moderate assistance (patient performs 50% - 74% or more of task with more help than touching)
2: Maximal assistance (patient performs 25% - 49% or more of task)
1: Total assistance (patient performs less than 25% of task)
0: Activity does not occur (by the patient nor with a helper; use of this code is rare)
If patient does NOT transfer into and out of a tub OR shower, code Tub Transfer as “0” and leave Shower Transfers (Item 34) blank, Code “0” may be used for Transfers: Tub on admission and discharge
Transfers: Shower
Transfers: Shower: getting into and out of a shower safely
SEPARATE CODE FOR SHOWER TRANSFERS (Item 34) vs. TUB (Item 33); CODE ONLY ONE! Item 39K should equal either Item 33 or 34, whichever was performed.
No helper
7: Complete independence
Walking- patient safely approaches shower stall, gets into and out of it
In a wheelchair- patient safely approaches shower stall, locks brakes, lifts foot rests, removes arm rest if needed, and does a standing pivot or sliding transfer (without a board) and returns.
6: Modified independence (requires specialized equipment like a sliding board, lift, grab bars or special seat; it takes more than a reasonable amount of time, or there are safety considerations; prosthesis or orthosis is considered an assistive device if used for the transfer)
Helper
5: Supervision or setup (requires supervision/setup- positioning sliding board, moving foot rests, etc./initial preparation)
4: Minimal contact assistance (patient performs 75% or more of task with no more help than touching)
3: Moderate assistance (patient performs 50% - 74% or more of task with more help than touching)
2: Maximal assistance (patient performs 25% - 49% or more of task)
1: Total assistance (patient performs less than 25% of task)
0: Activity does not occur (by the patient nor with a helper; use of this code is rare)
If patient does NOT transfer into and out of a tub OR shower, code Tub Transfer as “0” and leave Shower Transfers (Item 34) blank; don’t use code “0” for shower transfer
Social Interaction
Social Interaction: skills related to getting along and participating with others in therapeutic and social situations. It represents how one deals with one’s own needs TOGETHER WITH the needs of others
Socially inappropriate behaviors include: temper tantrums, loud, foul, or abusive language; excessive laughing or crying; physical attack; or very withdrawn or non-interactive behavior
No helper
7: Complete independence (patient interacts appropriately with people and no medications needed for control)
6: Modified independence (patient interacts appropriately with people and occasionally loses control; no supervision needed but more time may be needed to adjust to social situations, medications may be needed for control)
Helper
5: Supervision (requires supervision-monitoring, cueing, coaxing under stressful/unfamiliar conditions but <10% of the time, may need encouragement to initiate participation)
4: Minimal direction (patient interacts appropriately 75% - 90% of the time)
3: Moderate direction (patient interacts appropriately 50% - 74% of the time)
2: Maximal direction (patient interacts appropriately 25% - 49% of the time)
1: Total assistance (patient interacts appropriately < 25% of the time or no at all, may need restraint due to socially inappropriate behaviors)
DO NOT USE CODE “0” for social interaction
Problem Solving
Problem Solving: skills related to problem solving in daily living- making reasonable, safe, and timely decisions regarding financial, social, and personal affairs, as well as the initiation, sequencing, and self-correcting of tasks and activities to solve problems.
Examples of “Complex problem solving”: activities like managing a checking account, confronting interpersonal problems, etc.
Examples of “Routine problem solving”: successfully completing daily tasks or dealing with unplanned events or hazards that occur during daily activities
No helper
7: Complete independence (patient does above activities to solve complex problems until the task is completed, and self-corrects errors)
6: Modified independence (patient recognizes problem, does above activities with mild difficulty, or takes more than reasonable time to make appropriate decisions or solve complex problems)
Helper
5: Supervision (requires supervision to solve less routine problems only under stressful/unfamiliar conditions but no more than 10% of the time)
4: Minimal direction (patient solves routine problems 75% - 90% of the time)
3: Moderate direction (patient solves routine problems 50% - 74% of the time)
2: Maximal direction (patient solves routine problems 25% - 49% of the time)
1: Total assistance (patient solves routine problems < 25% of the time, needs direction almost all the time, does not effectively solve problems, and may require 1:1 direction for daily activities, may need a restraint due to safety)
DO NOT USE CODE “0” for problem solving
Memory
Memory: skills related to recognizing and remembering while performing daily activities in an institutional or community setting. Ability to store and retrieve information (like verbal and visual). Functional evidence of memory is recognizing people frequently encountered, daily routines, and executing requests without being reminded. A memory deficit impairs learning and task performance
No helper
7: Complete independence (patient does above activities)
6: Modified independence (patient does above activities with mild difficulty, may use self-initiated or environmental cues, prompts, aids)
Helper
5: Supervision (requires prompting under stressful/unfamiliar conditions, but no more than 10% of the time)
4: Minimal prompting (patient recognizes and remembers 75% - 90% of the time)
3: Moderate prompting (patient recognizes and remembers 50% - 74% of the time)
2: Maximal prompting (patient recognizes and remembers 25% - 49% of the time, needs prompting more than half the time)
1: Total assistance (patient recognizes and remembers <25% of time, or does not effectively recognize/remember)
DO NOT USE CODE “0” for memory
