BIMS score explained
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 score card.
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. This allows facilities to systematically measure and track a resident’s BIMS score through their long-term care EHR and determine when cognitive ability improves or declines. 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 components that contribute to a resident’s Minimum Data Set (MDS) charting, which tracks assessments that impact Medicare and Medicaid reimbursements and clinical treatments in the resident’s care plan. MDS charting must be entered accurately to create tailored resident care plans. Inaccurate MDS charting can result in substantial financial loss for a long-term care facility and poor resident outcomes.
BIMS score interpretation
There are three tests that are conducted in BIMS, after which facility staff can determine the resident’s score and categorize their 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 ability to pay attention by asking them to recall three words correctly, like “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.
Here is 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, (like “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”. 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 score between thirteen to fifteen points, this suggests the resident’s cognition is intact. Residents with scores between zero to seven points are determined to have a severe impairment. The next step for them is follow-up tests with physicians, who look to verify the diagnosis and create a personalized care plan that can be managed via the nursing home software.
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. In that case, this can 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 residents to perform their ADLs (activities of daily living).
In most cases, the BIMS score is used as an initial assessment tool to identify changes in a resident’s cognitive function. A slight decline of one or two points in a resident’s BIMS score that is realized during BIMS score interpretation will indicate a considerable difference in the resident’s status. Facilities can also use online tools like the BIMS score calculator to help assess cognitive function.
While a BIMS score only provides a piece of a resident’s cognitive function, it is still seen as a reliable method for cognitive function screening. When facilities need further testing, they can use additional assessment tools like the Mini-Cog or the GPCOG (general practitioner assessment of cognition) assessment alongside BIMS to get a better and more well-rounded understanding of a resident’s cognitive function.
What is the value of a BIMS score?
Regular BIMS score assessments allow caregivers to monitor changes in a resident’s cognitive function with fast and reliable results. Downward trends in a resident’s BIMS score can alert facilities to possible cognitive decline.
Research supports the idea that BIMS assessments are effective in identifying seniors at risk for poor outcomes in acute and post-acute facilities. The BIMS test also plays an essential role in determining if residents can self-manage their conditions and in predicting the likelihood of hospital readmissions.
In short, the value of BIMS tests is that they provide baseline information about cognitive function and facilitate the creation of appropriate care plans via a facility’s care plan software. This, in turn, results in better outcomes.
For more on recent trends in long-term care, visit http://ltcheroes.com/.