UNDERSTANDING
THE FIM
Functional
Independent
Measure
Part 4
Important Reminders
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You must understand the definition of the
each item in order to document accurately
Do NOT merge tasks
Do not rate simulations, clinical judgments
NEVER copy and paste from a previous
document because your FIM scores will not
be recorded
Important Reminders
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A number does not support a number! (You must
supply detailed documentation within the
document.)
Min, Mod or Max does not support a number.
(You must document why the need the assistance,
i.e., decreased balance, decreased strength)
“More than reasonable time” to complete a task
independently is defined as 3 times the norm and
would be scored as modified independence (6).
Important Reminders
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If in a hurry & don’t have time to allow the patient
to do a task & the therapist/nurse does it for the
pt, this is max assist.
Consider: How much assist did the pt require in
this point in time? Who performed the task? Do
not modify the assist in order to factor in how
busy you are. If you do perform the task for a
patient due to your time constraints, document
the assistance and the reason (i.e. time
constraints) this level was needed to perform the
task.
Important Reminders
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Plan the care you provide by allowing
adequate time for the patient to perform the
task versus performing the task for the
patient. This is rehab, doing the task for the
patient should be a rare occurrence.
Transfers: Tub, Shower Definition
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Tub: includes getting in and out of a tub
Shower: includes getting in and out of a
shower
Tub/shower - Considerations
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Simulations cannot be rated
Patient must be fully undressed and wet to
rate this item
Rating includes the patient’s approach to the
tub or shower once the patient is in the
bathroom
Tub/shower transfers
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Note the ability to score only one of these
transfers or both shower and tub transfers
Transfers: Toilet
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Includes safely getting on and off a standard
toilet
Standard toilet is a regular toilet without
attachments such as arm rests or handles to
assist patient
Includes approach to the toilet once in the
bathroom and wheelchair set up
/
Wheelchair
Sequence
Expected Mode of Locomotion
Considerations
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PT identifies the expected primary locomotion
mode at discharge, based on initial
assessment
PT identifies the primary mode of locomotion
achieved at discharge
Admission and discharge modes must match
Locomotion: Wheelchair Definition
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Wheelchair includes using a manual or
motorized wheelchair on a level surface once
in a seated position
Locomotion - Considerations
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P.T. brings an oxygen tank behind is a level 5
If patient is pushed to the gym in a
wheelchair, this needs to be assessed as
total assist noting the level of assistance
provided at that moment in time.
Locomotion: Walk - Definition
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Walk includes walking on a level surface
once in a standing position
Walk - Considerations
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Score will be affected by both distance and
assistance
Only include distance without any rest
periods or breaks.
Locomotion Walk/WC
Exception
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Exception to distance and assistance rule:
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If a patient routinely ambulates more than 150
feet throughout the day but is not required to walk
150 feet in every situation, do not consider the
distance for that episode of locomotion in the FIM
rating, consider only the level of assistance
If patient does not perform maximum locomotion
distance, do not score this sub max activity.
HOWEVER: patient must perform maximum
locomotion distance at least once a day.
Locomotion: Stairs Definition
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Includes going up and down 12-14 stairs (one
flight) indoors in a safe manner
Stairs - Considerations
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Score is affected by both number of stairs
and level of assistance/use of devices
Step height is NOT a factor in rating
If patient requires different levels of
assistance for ascending and descending the
stairs, choose options for the lower rating
Stairs must be assessed on admission and
discharge. Cannot put “not addressed”.
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Note numerous types of assistive device
available for stairs
Comprehension - Definition
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Understanding of either auditory or visual
communication (e.g., writing, sign language,
gestures)
Comprehension Considerations
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Document the amount of assistance required,
NOT the measurement of the severity of
cognitive deficit
Documentation must include the length of
time of the interaction AND how much of the
day the note represents
Patient should not receive a lower score due
to English as a second language
Comprehension Considerations
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Remember that comprehension needs to
include complex or abstract ideas/questions
and your assessment must include open
ended questions in order to accurately
determine the patient’s actual comprehension
status.
Complex and abstract questions are
generally not part of conversation during
usual sleep hours and therefore should not
be scored.
Expression - Definition
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Includes clear vocal or nonvocal expression
of language. This item includes either
intelligible speech or clear expression of
language using writing or communication
device
Expression - Considerations
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Remember that expression needs to include
complex or abstract information and your
assessment must include more than a “yes”
or “no” answer.
Language of confusion should be considered
a deficit. Language may be clearly
articulated but if patient is confused at times,
this should be assessed in expression.
Social Interaction - Definition
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Includes 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.
Social Interaction Considerations
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In therapeutic and social situations includes
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In the therapy gym
In the dining room
During therapeutic group activities
During visiting hours with family, friends
Sharing room and bathroom with room mate
Social Interaction Considerations
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Need to answer three questions
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Is the patient cooperating?
Is the patient participating?
Is the patient exhibiting any inappropriate
behaviors?
Problem Solving - Definition
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Includes skills related to solving problems of
daily living. This means making reasonable,
safe, and timely decisions regarding financial,
social, and personal affairs, as well as
initiating, sequencing, and self correcting
tasks and activities to solve problems.
Problem Solving Considerations
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Includes BOTH complex and routine problem
solving
Includes 5 important skills:
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Recognizing a problem is present
Making appropriate decisions
Initiating steps & readjusting to changing
circumstances
Carrying out a sequence of steps
Evaluating the solution
Memory - Definition
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Includes skills related to recognizing and
remembering while performing daily activities
in an institutional or community setting.
Memory in this context includes ability to
store and retrieve information, particularly
verbal and visual.
Memory - Considerations
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Look for information related to the following:
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Recognizing people frequently encountered
Remembering daily routines
Executing requests without reminders
Summary
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Read the prompts carefully each time in order
to document accurately
Remember we are documenting the burden
of care required to help the patient at home
perform basic personal tasks
Burden of care can be translated into
financial cost
Careful documentation will support the
burden of care and our payments