How to Use Barthel Index in Point of Care

Long term care facilities tend to offer a variety of services that meet both the medical and non-medical needs of residents with chronic illnesses or disabilities. Most residents are typically senior citizens struggling with ADLs (Activities of Daily Living) and can no longer care for themselves. 

The results from measuring a resident’s independence in ADLs provide the foundations for facilities to create tailored care plans that meet the resident’s needs. For an overview of how ADL scores can be integrated into a facility’s point of care software, watch the below video of Charles Oliver, Experience Care’s Director of Customer Success, demonstrating just how useful it is to determine ADL scores and how they can impact a facility’s POC:

While some residents need around-the-clock care, others may just need a helping hand. There are several tools that long term care facilities use to measure the need for ADL senior care. The most commonly used tool is the Barthel Index (BI). The Barthel Index was developed by Mahoney and Barthel in 1965, using a scaling system. Physicians assess whether a resident can function on basic, everyday living activities, giving them an overall ADL score based on their performance. 

The Barthel Index assesses ten variables to determine a resident’s independent function and mobility, these being: 

1. Toileting
2. Bathing
3. Eating
4. Dressing
5. Continence
6. Chair transfers 
7. Ambulation
8. Grooming
9. Bladder control
10. Stair climbing

These activities are scored and valued according to a resident’s ability to perform the task independently, with some assistance, or wholly dependent. An overall ADL score between 0 (totally dependent) and 100 (completely independent) is given by adding the scores after each rating. 

Trained physicians and therapists administer a Barthel Index using a set of standardized instructions with time allocations for the resident to perform the tasks. A typical Barthel Index takes between 20 to 30 minutes to administer. However, these times can vary depending on a resident’s capabilities and the time needed to complete the tasks. 

The Barthel Index tool is handy for and during rehabilitation, as it allows physicians to observe and determine a resident’s current level of function. The tool can also be administered frequently so that physicians can monitor a resident’s ADL improvements (or decline) over time.

Most studies also advise that the Barthel Index should be used with other measuring tools like the Katz Index to provide more accurate predictions and results.

 

Barthel Index Concerns

Despite the ease and widespread use of the Barthel Index, several concerns need to be addressed. For starters, while Barthel Index scoring is used to assess different variable tasks, the scoring method can be somewhat inconsistent, as it does not consider the changes in disability across the various functions. 

There are also restrictions on how improvements are recorded. There are times when a resident may physically improve so they can perform tasks, yet they still need some supervision. Therefore, the scale limits their scoring on said tasks. 

There are also limitations on environmental circumstances, as the scale does not consider situational factors such as ramps, wider doorways, or grab bars for the toilet or shower. While a resident may be able to independently perform ADLs with the help of aides, he or she would be significantly limited in functionality without such support, thus lowering their Barthel Index scores.  

This highlights the importance for facilities to have proper documentation with detailed and accurate records. While some facilities have modernized their nursing home software to a paperless EHR system (Electronic Health Record), others are still using a traditional, paper Kardex system which comes with limitations like illegible records, inaccurate documentation, and liability issues. Therefore, adopting a reliable nursing home EHR system is advisable if facilities want to improve their ADL senior care and reduce administrative work for facility staff.

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What is a Katz Index?

At the heart of every facility should be nursing home software that integrates ADL documentation. This should be a combination of restorative services, MDS (Minimum Data Set), reimbursements, with relevant resident information like ADL scores from both the Barthel Index and Katz Index. 

A Katz Index or Katz ADL is similar to a Barthel index, as both tools are used to assess activities of daily living by focusing on a resident’s level of independence (or dependence) when performing certain activities daily living (ADLs).  However, where they differ is that a Katz Index monitors the prognosis and treatment of residents and chronically ill people. 

The Barthel Index also measures ten ADL activities, while a Katz Index measures six functions, the six BADLs (Basic Activities of Living), which include:

1. Eating
2. Maintaining continence
3. Transferring
4. Toileting
5. Dressing
6. Bathing 

Each function is organized into two categories, dependent (requires assistance) or independent (able to perform tasks without assistance). Residents are scored either a “yes or no” for each function, with ADL scores ranging from 0 to 6. 

The results from the Katz Index helps physicians to determine what problems residents have with performing ADLs. Therefore, the results should be integrated into the facility’s long term care software so staff can create personalized care plans for their residents. 

Why Integrate the Katz Index into POC?

Part of an effective long term care EHR system includes having an integrated Point of Care or POC Charting, which tracks resident care delivery. When correctly implemented, POC software can increase the quality and quantity of information recorded by facility staff. Oliver also mentioned a useful commodity for every facility: “One can document activities and attendance to get rid of all unnecessary paperwork in every department.”

Facilities with an integrated long term care EHR POC system can display resident information more easily. This is made possible because they have collected and stored relevant data, including ADLs, Restorative Nursing, Therapy, and Mood Observation, all onto a centralized system. Once this data is collected, the POC charting allows authorized staff to access the data and send useful alerts when real-time changes occur.  

An effective POC software, like Experience Care’s EHR, incorporates three key features that significantly aid facility staff while improving the quality of care to residents. Oliver highlighted these features, showing why Experience Care’s POC software is “superior to the other products on the market right now” while also arguing that these features significantly aid facility staff to improve the quality of care given to residents:

1. Key Performance Indicator Dashboard (KPI)

This built-in feature allows facilities to view and change clinical Key Performance Measures at a glance. 

There are 34 pre-defined KPIs that are categorized into four groups: Census, Vitals, Care Delivery, Documentation, and Diagnoses. Each KPI provides details with actionable information and reporting through a number link. The number represents how many residents triggered the KPI; by clicking the number, staff can see which residents are listed and find associated information with the trigger.

Another valuable tool within this feature is the ESM, an alert messaging system. This allows facilities to note any irregularities for different resident groups/ categories, setting off the triggers when the abnormalities occur. Once a trigger is flagged, the correct personnel will then be notified to investigate the issue. 

Oliver uses the example of recording the resident’s meal intake. If an average meal intake is lower than 75 percent, an alert would be sent to the dietitian, appearing on the dashboard when they log in. Immediately, they would be able to see the list of residents eating below the average without the need to sift through months of data. 

The dashboard is handy and accessible in managing residents’ care so that staff can quickly identify issues and make critical clinical changes without needing to dig through piles of data. It gives a facility a clear idea of “how to find out what’s going on in the facility from what the nurses have documented,” says Oliver. This is particularly important for nursing staff who are already stretched for time. 

2. Point of Care Charting (POC)

One of the most time-consuming tasks for facility staff is administration duties which can disrupt workflow and take time away from resident care. If both the quality and quantity of information are not chartered correctly, not only will reimbursement funding be jeopardized, but so will the quality of care.

Experience Care’s Point of Care charting compiles all forms of care activity, including CNA/ADLs, Restorative Nursing, Therapy, and Mood Observation, into a comprehensive care plan. As Oliver commented, “all the time that you would spend going through paper, you would then save.” It is user-friendly and easily accessible to authorized staff, therefore, improving a facility’s efficiency. 

The built-in Kardex tool is handy in allowing nursing staff to access relevant resident data, from critical information like DNRs to everything in between. Oliver notes that the Kardex, allows nurse aides to “have information about how to take care of the patient,” therefore providing them with a resident’s day-to-day needs on a simple-to-navigate screen, making it easier to provide optimum resident care.

The Kardex is also integrated into the nursing home charting software to include a color-coded deck with red and green cards. This alerts staff of any resident changes and updates to their worklist showing what tasks have been completed and what still needs to be done. 

The primary function of the worklist tool is to flag items that have and have not been documented during a shift. This helps facilities to address and identify ADL problems thus improving resident care. The worklist has visual and textual cues that are quick and easy to understand, therefore eliminating paperwork by using the nursing home EHR instead.

3. User-Defined Assessments (UDA)

For nursing home charting software (POC) to be effective, it needs to have an integrated system that makes compliance easier. If the software is too complicated, facilities simply will not have the time to train staff to use it effectively. 

The best part about the software is that it allows for multiple functions so users can “make sure to get their documentation in place,” says Oliver. Users have the ability to enter assessment responses online to:

• Calculate scores
• Maintain histories
• Notify staff of assessed responses (beyond deep tissue injuries or fall risk eAssignments)

This is a highly user-friendly feature with plenty of flexibility to capture real-time data stored in worksheets and assessments. Oliver notes there is also a seven-day report which “allows users a functional look back” to see the exact activities that have taken place in the previous week. These are shared responses that are linked to care plans, and with the simple click of the import button, staff can see all responses saving a significant amount of time.

The handy ad hoc reporting feature also allows facilities to combine data from MDS 3.0, ADT/Prospects, and User-Defined Assessments (UDA) to create specific reports for different resident categories. These on-demand reports can be generated for individual or all residents to include their history, due dates, and resident comparison.

With such ease, facilities can easily check their documentation and reporting to ensure full compliance within the facility. It also helps that the nursing software programs have been designed to be compatible with Windows and Android systems, eliminating the need to purchase expensive devices. 

Why Measure an ADL Score? 

As a person ages, it is common to gradually lose the ability to perform ADLs, whether it is through natural aging, worsening physical conditions, or cognitive decline like Alzheimer’s or other forms of dementia. This is why it is essential to measure the ADL score of seniors. 

There are a variety of ADL measuring tools, like the Minnesota Case Mix, which is used to classify residents into different groups based on their condition and the level of care received during the time of the assessment. 

The ADL score is calculated seven days before the assessment, with changes in improvements (or declines) outside the seven days not considered. It is compiled from two components:

1. ADL self-performance: This measures what the resident did in the ADL category according to the performance-based scale.
2. ADL Support: This measures the level of staff support needed during the last seven days.

The residents are classified and allocated a specific value according to the calculated daily rate of payment, which comes into play with government funding reimbursements. 

The value is based on the ADL score, which is assessed in accordance with four functions: transfer, bed mobility, toileting, and eating. The self-performance of the resident and the level of staff support needed during the evaluation is also assessed.

Other ADL measuring tools, like the Barthel Index, allow physicians to calculate a resident’s functional independence (ADL score) using the Barthel Index calculator. While the Katz Index can also be used to identify how much care assistance is required. 

Together, all three tools can determine which activities will cause potential safety hazards like slipping down the stairs or falling while walking. In using these measuring tools, physicians gain a comprehensive view of a resident’s current and future needs, consequently determining the most appropriate long term care facility along with the level of assistance needed to best suit the individual. 

Even though the Katz Index may seem simple, it is the ideal tool to assess residents’ quality of life in long term care facilities. By measuring the six BADLs, this simple checklist uses objective data to indicate the future decline or improvement in a resident’s health, thus allowing facility workers to intervene when appropriate. 

Making the Barthel Index Work For You 

The Barthel Index was one of the first standardized ADL functional assessment tools. It has since been modified into a comprehensive tool that is still commonly used today. With its multifunctional form, it can be used to assess patients with neuromuscular, musculoskeletal disorders and functional ability. 

The Barthel Index is widely considered to be one of the most appropriate ADL measuring tools, as it has the capacity to predict a resident’s morbidity and hospital outcome. The data taken from its assessment scales is both clinically useful and scientifically reliable due to its subjective assessment. Therefore, it would be wise for facilities to incorporate the Barthel Index into their long term care EHR and POC system so that they can form suitable care plans that maximize the quality of care.

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