The behavior symptoms measure counts long-stay residents with behaviors coded in Section E on their most recent assessment. Despite the name, it counts more than behavior toward other people: rejection of care and wandering are in it too. It’s a survey measure, seen on iQIES reports rather than Care Compare.
What the measure is, and who sees it
- CMS ID N034.02, Prevalence of Behavior Symptoms Affecting Others, a long-stay MDS measure.
- Not on Care Compare, not in Five-Star. Like the prevalence of falls, it is a state surveyor measure, available only on the iQIES quality measure reports.
- None of the state programs we checked scores it (Ohio, Florida, Texas and New York).
“This measure reports the percentage of long-stay residents who have behavior symptoms that affect others during the target period.”
What puts a resident in the numerator
On the target assessment, any of these coded 1, 2 or 3 (present on at least 1 day of the 7-day look-back):
| Item | Behavior |
|---|---|
| E0200A | Physical behavioral symptoms directed toward others |
| E0200B | Verbal behavioral symptoms directed toward others |
| E0200C | Other behavioral symptoms not directed toward others |
| E0800 | Rejection of care |
| E0900 | Wandering |
Frequency doesn’t matter to the measure. One day in seven counts the same as every day.
A resident not in the numerator is excluded when the target assessment is a discharge, or when any of the five items is dashed or skipped. There is no risk adjustment.
When it counts, and when it clears
All five items look back 7 days, and the measure reads only the target assessment: the resident’s latest qualifying assessment, dated no more than 120 days before the episode ends or the quarter closes. There is no look-back scan. When a target assessment’s 7 days are free of all five behaviors, the resident is out.
A worked example. Resident G throws a cup at a tablemate once during the 7-day look-back for the quarterly. E0200A is 1 (1 to 3 days), and Resident G is in the numerator, even though the tablemate had been taunting Resident G. The RAI Manual codes the behavior because it occurred, whatever its explanation.
Code what happened
Section E is coded from what staff saw and the record shows, not from how the team has come to see the resident.
“Code as present, even if staff have become used to the behavior or view it as typical or tolerable.”
To see it, the RAI Manual asks for the record, interviews with staff across all shifts and disciplines (and family who visit often), and observation during the 7 days.
When a refusal is the resident’s choice
E0800 isn’t meant to record a resident’s informed choices. When the team has looked into a refusal, found it reflects what the resident wants, and built it into the care plan, it stops being coded.
“When rejection/decline of care is first identified, the team then investigates and determines the rejection/decline of care is really a matter of resident’s choice. Education is provided and the resident’s choices become part of the plan of care. On future assessments, this behavior would not be coded in this item.”
The documentation is what makes that hold: the conversation with the resident (or family), the choice, and the care plan that reflects it.
Wandering is narrower than it sounds
- Pacing back and forth in a small space is not wandering.
- Wandering can happen on a locked unit.
“Traveling via a planned course to another specific place (such as going to the dining room to eat a meal or to an activity) is not considered wandering.”
See how your building compares on the public quality measures, free.
SuperQM scores this survey measure from each resident’s latest assessment, so you can see who counts in it before the surveyor’s report does.
