Measuring Rehabilitation Progress: The Critical "Functional Independence" Score
Although Medicare will cover "up to" 100 days of inpatient rehabilitation, in truth how much skilled rehabilitation therapy someone receives after a hospitalization always depends on his or her rate of improvement. Most rehabilitation patients are expected to make measurable gains every week. If they do not, then eventually the rehabilitation facility will determine that they have "plateaued," or stopped making progress. At that point Medicare-covered rehabilitation will cease.
Knowing how "rate of improvement" is measured can be extremely helpful when we want to be effective advocates and cheerleaders.
Many rehabilitation facilities use a version of the Functional Independence Measure Score (FIMS). This is a standardized way of keeping track, or "score," of how a patient is or is not improving. The FIMS measures progress in activities of daily living, mobility, and communication. Barring unusual circumstances, a rehab patient is typically expected to gain one or two points per day.
What the Functional Independence Measure Score Evaluates
The FIMS measures a patient's ability in five primary areas and 18 individual task areas:
1. Self-Care: Eating, Bathing, Upper Body Dressing, Lower Body Dressing, Toileting
2. Sphincter Control: Bladder Management, Bowel Management
3. Transfers: Bed, Chair and Wheelchair, Toilet, Tub and Shower
4. Locomotion : Walking or using a Wheelchair, Stairs
5. Cognitive: Communication (Comprehension & Expression), Social Cognition (Social Interaction and Problem Solving), Memory
Scoring the FIMS
There are 7 possible scores a patient can receive on each of the functions above. The first assessment is usually performed within three days of admission to the rehabilitation facility. Most facilities will re-score weekly.
1. Total Assistance Required - The patient is able to do 25% or less of the activity independently.
2. Maximum Assistance Required - The patient can do more than 25% of the activity, but less than 50% of the activity without assistance.
A score of "1" or a "2" means that the patient is completely unable to do the activity without physical help.
3. Moderate Assistance Required - The patient requires only "helping" or "touching" to do between 50% and 74% of the activity independently
4. Minimal Contact Assistance - The patient can do 75% of the task without any more assistance than touch
5. Supervision or Setup - The patient is able to do the task if someone either sets up the needed items or assistive devices in advance, or simply stands by to offer cues and/or coaxing without any physical contact
A score of "3," "4," or "5" classifies the patient as "Modified Dependent" because the patient is able to do at least 50% of the task independently.
6. Modified Independence - The patient needs an assistive device, but no human assistance is needed, OR the patient needs no assistive devices or help, but does not do the task safely or takes longer than reasonably necessary to do a task
7. Total Independence
Although each activity is given a score between 1 and 7, the FIMS score is usually referenced as a total score ranging from 18, the lowest possible score, to 126, the highest possible score. Although patients may not show measurable progress in every category, showing a steady increase in the cumulative, or bottom line, number is generally enough to satisfy the "measureable improvement" requirement.
Meeting With the Therapists
When you attend a care conference, or when you meet with a therapist, ask to review a copy of their most recent functional assessment. This will be much more informative than simply hearing that "he has improved," or "he hasn't improved." You want to know in which areas improvement is or is not occurring. Has the rate of improvement simply slowed, as it often will over time, or has it ceased completely? Is improvement continuing in some areas while it has plateaued in others?
Eventually all inpatient rehabilitation will come to an end. If your elder has not reached the perfect score of 126, having a clear idea of where he or she has had difficulties all along will give you a much clearer indicationof the amount of assistance that will be needed going forward. The Functional Independence Score, if measured by a well-trained and competent therapist, is just as valuable for families as it is for the professionals in the facility.