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
|7 – Independent||(eliminated in CARE)|
|6 – Modified Indepndent||6 – Independent|
|5 – Supervision||5 – Setup for Cleanup Assistance|
|4 – Minimal Assistance||4 – Supervision or Touching Assistance|
|3 – Moderate Assistance||3 – Partial/Moderate Assistance|
|2 – Maximal Assistance||2 – Substantial/Maximal Assistance|
|1 – Total Assistance||1 – Dependent|
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.