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| Question | Answer |
| Since his stroke, Tom has required a mechanical soft diet with thickened liquids. Tom does not require physical assistance from the staff. What is Tom’s FIM® rating for Eating? | Level 6, Modified Independence: His diet is modified; mechanical soft diet and thickened liquids. He does not require assistance from staff members. |
| Jacob eats independently after a helper applies a universal cuff. What is Jacob’s FIM® rating for Eating? | Level 5, Supervision/Setup: The helper must apply a universal cuff so that Jacob can eat. |
| Samantha is on a feeding tube and is ready for discharge. After a nurse sets up the equipment, Samantha independently administers her tube feeding, just as the staff taught her to do. What is Samantha’s FIM® rating for Eating? | Level 5, Supervision/Setup: A nurse sets up the equipment, after which Samantha administers her tube feedings independently. |
| Roger eats breakfast and lunch after a helper provides setup assistance. In the evening, however, he is fatigued and requires a nurse to feed him supper. Roger refuses liquids during this meal. What is Roger’s FIM® rating for Eating? | Level 1, Total Assistance: The nurse is completely responsible for feeding Roger his meal. Overall, Roger performs less than 25 percent of his eating tasks. |
| Polly gathers all her grooming items and sets up at the sink at a wheelchair level. She requires incidental help to comb the back of her hair, but she completes all other grooming tasks without assistance. What is Polly’s FIM® rating for Grooming? | Level 4, Minimal Assistance: Polly requires only incidental help to comb her hair. She does not require additional assistance. |
| Sandy has difficulty applying her eye makeup and requires assistance from a helper. She completes all other grooming tasks after a helper provides setup assistance. What is Sandy’s FIM® rating for Grooming? | Level 4, Minimal Assistance: Sandy needs help with her make-up only (less than 25%). |
| George sits in a wheelchair when he performs grooming tasks. After a helper turns on the water and adjusts the water temperature, George completes his grooming tasks without assistance. What is George’s FIM® rating for Grooming? | Level 5, Supervision/Setup: The helper turns on the water and adjusts it but does not provide physical assistance. George’s use of a wheelchair as he grooms is not part of the rating for this item. |
| John requires constant cues as he begins to wash his face and brush his teeth. Because of his difficulty, a helper must rinse and dry John’s face; assist in completing his oral care; wash, rinse, and dry his hands; comb his hair; and shave his face. What is John’s FIM® rating for Grooming? | Level 1, Total Assistance: John attempts his grooming tasks, but a helper must complete more than 90 percent of them due to John’s difficulties. |
| Sally washes, rinses, and dries herself in bed after a helper sets her up. Sally requires extra time to bathe all body parts except her lower legs and feet, which the helper bathes for her. What is Sally’s FIM® rating for Bathing? | Level 4, Minimal Assistance: Sally requires setup assistance from a helper (level 5) and extra time (level 6) to bathe while in bed. The helper bathes Sally’s lower legs and feet (20 percent), but Sally bathes all other body parts (80 percent, level 4). When a scenario describes more than one rating, record the lowest rating. |
| As the result of a traumatic brain injury, Kathy loses her train of thought easily. A helper sets up Kathy’s supplies and provides constant cueing as Kathy completes her bathing tasks. Kathy does not require additional assistance. What is Kathy’s FIM® rating for Bathing? | Level 5, Supervision/Setup: Kathy requires supervision and verbal cueing from the helper. Kathy bathes herself. |
| Kevin bathes his chest, arms, abdomen, and perineal area while sitting on a tub bench in a shower. A helper washes, rinses, and dries all other body parts. What is Kevin’s FIM® rating for Bathing? | Level 3, Moderate Assistance: Kevin completes 50 percent of his bathing tasks. |
| Tony has suffered a stroke. He tries very hard to help with each activity he is asked to perform. After a helper sets up Tony’s bathing supplies and puts a wash mitt on Tony’s left hand, Tony washes, rinses, and dries his right arm, chest, abdomen, and perineal area. The helper completes the rest of Tony’s bathing tasks. What is Tony’s FIM® rating for Bathing? | Level 2, Maximal Assistance: Tony bathes 4 of 10 body parts (40 percent). |
| Margaret wears a bra and a pullover sweater. She uses a walker basket to gather her clothing from her closet. Margaret threads her arms into her bra, but her nurse hooks it in back. Margaret threads both arms into the sweater, but the nurse pulls the sweater over Margaret’s head and pulls it down over her trunk. What is Margaret’s FIM® rating for Dressing – Upper Body? | Level 3, Moderate Assistance: Margaret performs four of seven steps; overall, she performs 57 percent of the effort. |
| A helper brings Tom’s clothes to him in the morning. The helper threads Tom’s right arm into his sweatshirt, after which Tom threads his left arm, pulls the sweatshirt over his head, and pulls it down over his trunk. What is Tom’s FIM® rating for Dressing – Upper Body? | Level 4, Minimal Assistance: Tom performs 75 percent or more of the effort to dress himself; he requires assistance for one of four steps. |
| Samantha wears a bra, a blouse, and a zip-up sweater. A helper brings Samantha her clothing. The helper hooks Samantha’s bra. Samantha puts on her blouse and sweater independently, but the helper buttons and zippers her clothes. What is Samantha’s FIM® rating for Dressing – Upper Body? | Level 3, Moderate Assistance: Samantha completes 8 of 11 steps; overall, she performs 73 percent of the effort. |
| If a patient refuses to perform an activity, but you know he/she can do it, how are you to rate him? | The FIM score is measuring what the patient actually does, not what they might be able to do. If the patient refuses you must indicate the activity as 0 – Activity does not occur. |
| What score would be recorded for the patient whose nurse reports bed - w/c transfers as Mod A, but the therapist reports bed – w/c transfers as Supervision? | The lower score represents the burden of care. It might be a reflection of patients’ actual performance vs. peak performance. Environments may be different. Patients’ attitude; “work” in therapy and “nurses” are supposed to help. |
| The definition for Eating includes chewing and swallowing. How do you score a patient with a swallowing problem? | REMEMBER – BURDEN OF CARE. (what did helper do??) Level 5 – If the helper supervised the meal for speed or portion size. Level 4 – If the helper checks for pocketing of food by inserting a finger into the mouth. Level 1 – If the patient receives tube feedings and the helper administers. |
| Are dentures considered assistive devices?? | ONLY if the patient requires the dentures to Eat. If the patient is independent and requires dentures, then score would be …. Level 6 – Modified Independence. |
| If a patient is eating with Set up assist for meals but is being supplemented with tube feedings administered by the nurse, what would the score be? | The patient’s FIM score would be a Level 1 – Total Assistance. FIM is always the lowest score. |
| If the nurse brings the patient a towel and washcloth, is that considered setup for Grooming? | Passing linen is part of the regular hospital routine. We do not expect the patient to get their own linen from a cart. If the helper places the linens in the patient’s lap or at the sink then this would be considered Level 5 - Setup |
| How do you score a patient who needs help applying a TLSO or other type of brace? | If the patient needs assist of 1 helper to apply a brace. The score would be…. Level 5 – Supervision and Setup. Level 5 – requires supervision (standby, cuing, or coaxing or setup (application of orthosis or setting out clothes) |
| How do you score a patient with an upper body or limb prosthesis? | If applied by a helper and no other assist – Level 5 (setup for dressing – upper body). If applied by patient and no other assist needed, Level 7 (complete independence). If applied by patient and used to complete dressing, Level 6 (modified independence). |
| Mary is independent with dressing (she safely and timely completes dressing), but she uses a walker to get her clothes from the closet. What is Mary’s FIM score for dressing? | Mary is a Level 7 – Complete Independence for Dressing. Getting to and from the closet is scored under Locomotion: Walk/Wheelchair |
| Are sneakers with velcro closures considered and adaptive device? | If the sneakers were obtained from a retail store for convenience… they are not considered an adaptive device. If the sneakers were recommended or adapted by a therapist then YES, they would be considered an adaptive device. |
| Do you assess Toileting if the patient uses a bedpan and not a toilet? | Yes. Toileting includes perineal hygiene and adjusting clothing before and after toilet or bedpan use. Use of the bedpan itself falls under Bladder or Bowel Management. |
| John is usually cooperative, but he becomes frustrated and verbally abusive toward others when challenged with complex tasks. He requires redirection greater than 25% of the time. What is John’s FIM rating for Social Interaction? | Level 3, Moderate Assistance. John interacts appropriately between 50 and 74% of the time. He does need direction just over 25% of the time. |
| Patrick does not ask for assistance when he attempts to transfer. Because of his recent amputation he is at risk for falls, he is restrained and requires redirection over half the time. What is Patrick’s FIM rating for Problem Solving? | Level 2 Maximal Assistance: Patrick is a safety problem. He shows poor judgment and must be restrained and requires redirection more than 50% of the time. Patrick appropriately solves routine problems between 25 and 49% of the time. |
| Steven recognizes his family and friends. Throughout the day, however, he uses a memory book that the therapists created to remind him of his daily routine: bathing, dressing, meal times, etc. What is Steven’s FIM rating for Memory? | Level 6 Modified Independence: Steven uses an assistive device ( the memory book) to remind him of his daily activities. |
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