F677 ADL care provided for dependent residents is one of the top 10 areas cited for deficient practice in the nation. This regulation states that a resident who is unable to carry out activities of daily living should receive the necessary services to maintain good nutrition, grooming, and personal and oral hygiene.

How do we evaluate a resident’s abilities?

To determine whether a resident is unable to carry out ADLs, review the MDS, care plan, physician orders, as well as ADL documentation/flow sheets on various shifts. Observe for the provision of ADL’s (e.g., teeth clean, hair clean and brushed, nails clean and trimmed, bathing, based upon preferences whether shaving is provided or female facial hair removed, appropriate hygiene including toileting and continence care, and dressed per resident’s preference).

What are necessary services?

Necessary services are specific to the individual and their needs as identified through evaluation and assessment. Services may include, but are not limited to

      • Skilled Therapy
      • Restorative Nursing Programs
      • Assistive Devices
      • Adaptive Equipment

How do we monitor for decline?

For evaluating a resident’s ADLs and determining whether a resident’s abilities have declined, improved, or stayed the same, review the MDS, care plan, physician orders, as well as ADL documentation/flow sheets on various shifts and compare to previous data. Identify whether the facility has:

      • Recognized and assessed an inability to perform ADLs, or a risk for decline in any ability they have to perform ADLs;
      • Developed and implemented interventions in accordance with the resident’s assessed needs, goals for care, preferences, and recognized standards of practice that address the identified limitations in ability to perform ADLs;
      • Monitored and evaluated the resident’s response to care plan interventions and treatment; and
      • Revised the approaches as appropriate.

How do we monitor our facility practices?

Use the Activities of Daily Living (ADL) Critical Element Pathway for a resident who requires assistance with or is unable to perform ADLs (Hygiene – bathing, dressing, grooming, and oral care; Elimination – toileting; Dining – eating, including meals and snacks; and Communication including – speech, language, and other functional communication systems) to determine if facility practices are in place to identify, evaluate, and intervene, to maintain, improve, or prevent an avoidable decline in ADLs.

Join Proactive on August 2, 2022 – Analysis of top 10 citations in nation: F677 ADL Care Provided for Dependent Residents for a deep dive review of Survey Procedures related to this topic, as well as examples of IJ citations and recommended action steps to avoid the same or similar issues. Learn more and register at: Survey Success! Avoiding Top Citations – Proactive Medical Review



Eleisha Wilkes, RN, GERO-BC, RAC-CT, DNS-CT
Clinical Consultant

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