F688 – Mobility and Range of Motion

F688 requires that nursing homes provide services to first achieve the resident’s highest practicable physical functioning including mobility and ambulation. The regulatory language includes that if the resident is admitted without any functional impairments that they don’t experience a reduction in range of motion or mobility unless the clinical condition demonstrates that it is unavoidable. Similarly, if the resident has functional impairments, that the nursing home implements programs to ensure that their functional impairment improves or does not further decline unless it is unavoidable.

In the interpretative guidance, the surveyors are instructed to review the resident’s Minimum Data Set (MDS) for functional performance including mobility, activities of daily living (ADL) performance, and range of motion. If the surveyors note from one MDS to another that the resident’s functional performance has declined (or the need for assistance increased) they will then review the resident’s record to determine whether the functional impairment was unavoidable. The MDS should also identify possible risks for functional declines such as being chair or bed fast, neurological conditions such as strokes, Amyotrophic Lateral Sclerosis (ALS), Muscular Dystrophy among others. Even if a resident has these conditions (or other conditions that may limit mobility and range of motion) the nursing home will still need to take steps to prevent decline to the extent possible.

What is considered unavoidable? The interpretative guidance doesn’t define what unavoidable includes as it may vary with each resident. Generally, the surveyors will review the residents record if there is a decline to identify the steps the nursing home took to either correct the decline or if unable to correct it, to ensure that it doesn’t become worse. Most providers use a restorative program to ensure that resident’s stay at their highest practicable well-being. While range of motion and assistance with ADLs are routine and can be used as a method to help prevent decline, restorative programs are meant to be used as an additional tool to assist in this effort. Think of a restorative program as someone’s work out routine. In order to code a restorative program on the MDS, you must ensure that you’re meeting all the requirements outline in the Resident Assessment Instrument (RAI) manual for restorative care. You can view all of the information on restorative programs in this resource document Restorative Nursing Program FAQ & Plan Worksheet.

F688 is cited nearly every month during surveys and generally because the staff are not completing the restorative program as outlined in the resident’s care plan. Periodically, this deficiency is cited when a resident had a decline in range of motion and/or mobility that wasn’t recognized by the nursing home staff and interventions implemented (such as physical, occupational, or speech therapy) to reduce the decline.