BIMS (Brief Interview for Mental Status) is a mandatory tool used to screen and identify the cognitive condition of residents upon admission into a long term care facility. The test is usually administered by a social worker who asks a series of questions while noting the answers on the BIMS scorecard.
Each question is scored according to a numeric value. The total BIMS score ranges between zero to fifteen points and is categorized into three cognitive groups: Intact, Moderate, and Severe. The objective of a BIMS assessment is not to diagnose cognitive illnesses like dementia or Alzheimer’s but rather to assist facility staff with detecting early symptoms and the potential need for further evaluation.
Facilities conduct BIMS assessments to gain a snapshot of a resident’s cognitive functioning. BIMS assessments are conducted regularly, usually every quarter for long term stay residents and more frequently for short-term stay residents. Thus, allowing facilities to systematically measure and track a resident’s BIMS score through their long term care EHR, determining whose cognitive ability is improving or declining. If a resident’s cognitive ability declines rapidly, facilities may conduct BIMS assessments more often and intervene with further treatments.
BIMS is one of many forms of data entered into a resident’s MDS charting (Minimum Data Set), a combination of assessments that impacts Medicare and Medicaid reimbursements and clinical treatments and is documented in the long term care software system.
It is of utmost importance that MDS charting is entered accurately so that facilities can create tailored resident care plans. Inaccurate MDS charting can result in a substantial financial loss for the long term care facility and poor resident outcomes due to inadequate and poor quality of care.
BIMS Score Interpretation
As mentioned earlier, there are three stages of tests that are conducted. Following these, facility staff can make their BIMS score interpretation and categorize the resident’s level of cognitive function. These tests are:
- Immediate Recall Test – The initial test requires a resident to repeat information through immediate recall. The tester will assess a resident’s attention by asking them to recall three words correctly. e.g., sock, blue, and bed. Afterward, the tester will ask the resident to repeat the words using cues like “something to wear.” There is a maximum of three points, with one point given for each of the three words that are repeated correctly.
- Temporal Orientation Test – The second test requires residents to identify the day of the week, the month, and the year. A maximum of six points are awarded during the Orientation Test, with one to three points given for each of the three sections.
The image below shows a typical Temporal Orientation Test used during a BIMS assessment. The resident’s BIMS score is calculated according to their correct answers.
- Short-Term Memory Test – This final test is purposely conducted after the distracting Orientation Test. The tester will ask a resident to recall the exact three words used in the Immediate Recall Test, e.g., sock, blue, and bed. If the resident cannot remember the words, they are given cues to trigger their memory like “something to wear” or “a piece of furniture” to see if they can recall the correct words. The maximum scoring for the Short-Term Memory Test is six points, with zero to two points given for each of the three words.
Once the BIMS assessment is complete, a final tally will be taken to combine the BIMS score from all three tests. But how do you interpret a BIMS score?
The BIMS scores are categorized into the following cognitive function groups:
If a resident obtains a high score—between thirteen to fifteen points—this suggests the resident has a high level of cognitive function. Residents with low scores—between zero and seven points—will be considered to have a severe impairment, which leads to follow-up tests with physicians so they can verify a diagnosis and create a personalized care plan in the nursing home software.
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How Is a BIMS Score Chart Used?
Facilities use a BIMS score chart to identify the individual needs of residents. Suppose a resident cannot repeat the exact three words from the Immediate Recall Test. That might signify that the resident has a hearing impairment or problems with verbal communication. Alternatively, suppose the resident can only remember the three words when prompted. In that case, the facility can update their care plan software to remind staff that verbal or visual cues are needed for these particular residents with their ADLs (Activities of Daily Living).
In most cases, the BIMS score is used as an initial assessment tool to identify a resident’s cognitive function changes. A slight decline of one or two points in a resident’s BIMS score between the regular BIMS score interpretation will indicate a considerable difference in the resident’s mental status.
While the accuracy of BIMS score assessments is somewhat limited only to providing a piece of a resident’s cognitive function, it is seen as a reliable method for cognitive function screening. Facilities can also use online tools like the BIMS score calculator to help assess cognitive function.
When facilities need further testing, they can use additional assessment tools like the Mini-Cog or the GPCOG assessment alongside BIMS to get a better and more well-rounded understanding of a resident’s cognitive function.
Why Is a BIMS Score Valuable?
The frequency of BIMS score assessments allows caregivers to monitor changes in a resident’s cognitive function with fast and reliable results. A resident’s BIMS score leaves little to interpretation even if different testers conduct the assessment. Therefore, it is a handy tool in alerting facilities of cognitive decline.
Studies show that BIMS assessments can identify seniors at risk for poor outcomes in acute and post-acute facilities. It also plays an essential role in determining a resident’s cognitive function, thus assessing how residents self-manage their conditions and predicting the likelihood of hospital readmissions. Therefore, BIMS has a high value in providing baseline information about cognitive function and is more practical in creating appropriate care plans via a facility’s care plan software, impacting the quality of care, and creating better resident outcomes.