CARE Tool Calculator / Decision Tree (CMS IRF-PAI IMPACT Act)

Quick Facts

• Changes are result of Improvement Medicare Post-Acute Care Transformation (IMPACT) Act.

• CARE = Continuity Assessment Record and Evaluation

• Outcome measures are being implemented across all post-acute care (PAC) settings for Medicare beneficiaries

  • IRF – Inpatient Rehabilitation Facilities

  • MDS – Minimum Data Set (Skilled Nursing Facilities – SNFs)

  • LTCH – Long Term Care Hospitals

  • OASIS – Outcome and Assessment Information Set (Home Health)

Changes from FIM

• CARE did away with the 7 point system of the FIM and ranges from 1-6.
• Most notably, instead of min/moderate/maximal assistance having its own description, they are now grouped into 2 possible values (CARE 2 or CARE 3).
• They are defined as either “less than 50%” for CARE 3 and “more than 50%” for CARE 2.
• This should make it easier to conceptualize in terms of < or > 50% compared to FIM having 25% increments (0%, 25%, 50%, 75%, 100%).
• However, critics argue that CARE will be less sensitive to changes including functional gains since the CARE scale is now 6 instead of 7.
• Another challenge involves adoption.
• New adopters of CARE who have never used FIM will find the new scale intuitive.
• However, practitioners transitioning from FIM will be initially confused because the scale does not correlate, e.g. Supervision for FIM is 5, but CARE is now 4.

Overview: FIM vs. CARE

CARE Decision Tree Tool

• This decision tree will help practitioners figure out the CARE score by answering simple Yes/No questions.
• UPDATE: Current work in progress with v2 which expands on this tool with for more specific tasks.

1. Was the task attempted?

Yes

Refused

Not applicable

Not attempted due to environmental limitations

Not attempted due to medical condition or safety concern

2. Can the client complete the task with no assistance? (with or without adaptive equipment)

Yes

No, they require some assistance

Result

07: Refused

Result

09: Not applicable

Result

10: Not attempted due to environmental limitations

Result

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88: Not attempted due to medical condition or safety concern

Result

6: Independent

3. Can the person be left alone to do the task after setup?

Yes

No

Result

5: Setup or Cleanup Assistance

4. Does the helper provide only supervision (verbal cues) or light touch?

Yes

No

Result

4: Supervision or Touching Assistance

5. Does the helper provide LESS THAN HALF of the effort to complete the task?

Yes

No (helper provides MORE than half of the effort)

Result

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3: Partial/Moderate Assistance

6. Does the helper provide MORE THAN HALF, but less than 100%, of the effort to complete the task?

Yes

No

Result

2: Substantial/Maximal Assistance

One or both of the following apply

Helper needs to do 100% of the task

2 or more helpers are needed

Both

Result

1: Dependent

Result

1: Dependent

Result

1: Dependent

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