CARE Tool Calculator / Decision Tree (CMS IMPACT Act)

Quick Facts

• Changes are result of Improvement Medicare Post-Acute Care Transformation (IMPACT) Act.

• CARE = Continuity Assessment Record and Evaluation

• Outcome measures are being implemented across all post-acute care (PAC) settings for Medicare beneficiaries

  • IRF – Inpatient Rehabilitation Facilities

  • MDS – Minimum Data Set (Skilled Nursing Facilities – SNFs)

  • LTCH – Long Term Care Hospitals

  • OASIS – Outcome and Assessment Information Set (Home Health)

Changes from FIM

• CARE did away with the 7 point system of the FIM and ranges from 1-6.
• Most notably, instead of min/moderate/maximal assistance having its own description, they are now grouped into 2 possible values (CARE 2 or CARE 3).
• They are defined as either “less than 50%” for CARE 3  and “more than 50%” for CARE 2.
• This should make it easier to conceptualize in terms of < or > 50% compared to FIM having 25% increments (0%, 25%, 50%, 75%, 100%).
• However, critics argue that CARE will be less sensitive to changes including functional gains since the CARE scale is now 6 instead of 7.
• Another challenge involves adoption.
• New adopters of CARE who have never used FIM will find the new scale intuitive.
• However, practitioners transitioning from FIM will be initially confused because the scale does not correlate, e.g. Supervision for FIM is 5, but CARE is now 4.

Overview: FIM vs. CARE

CARE Decision Tree Tool

• This decision tree will help practitioners figure out the CARE score by answering simple Yes/No questions.
• UPDATE: Current work in progress with v2 which expands on this tool with for more specific tasks.