March 25 2025
OASIS

My Favorite OASIS Item: Insights from a National OASIS Educator

by Megan Bernier, MSPT RAC-CT COS-C

Why is item M1100 – Patient Living Situation one of my favorites? While it has limited use in the Home Health Quality Reporting Program—serving only for risk adjustment—it remains one of my favorite items to teach. The reason? Its guidance is far less straightforward than it may seem at first glance.

First, it’s a complex item. There are two different considerations for OASIS accuracy in this item:

What is the patient’s usual living situation AND
What is the availability of caregiver(s) to provide in person assistance for the upcoming episode of care

Here’s how I like to approach this item:

Determine the patient’s usual living situation.

To accurately assess and code for this item, first determine the patient’s usual living situation. This might not be their current living situation! There are three living arrangements to consider:

Does the patient live alone
Does the patient live with others
Does the patient live in a congregate situation

Living alone means the patient lives in an independent (non-assisted) setting which includes a home, an apartment, or a room in a boarding house. Patients are also considered to be living alone if they have someone (non-related to them) that is paid to live in the patient’s home to provide care to the patient. Additional considerations for this option are:

Assess whether someone who is “staying” with the patient is a temporary situation, if it is temporary and no one else normally lives with the patient they live alone.

If the only assistance available to the patient is to summon emergency help by phone or life-line and no other people live with the patient, the patient lives alone.

Living with others is the next option. Again, the patient must be in an independent (non-assisted) setting where at least one other person is living in the same home. This could be a spouse, a significant other, or a family member. If the patient has someone being paid to provide live-in, paid help and the person providing that care is related to the patient then they live with others. Even if the patient lives with someone who occasionally travels out of town this would be considered as the patient living with others.

Lives in a congregate setting is the final option. This means that there is some sort of assistance, supervision and/or oversight that is being provided as part of the living arrangement. We see this most commonly in assisted living facilities, residential care homes, and/or personal care homes.

Now remember, the key to this first step is to figure out the patient’s usual living arrangement. Sometimes, patients will have a change in their living arrangement due to their condition, for example they normally live alone but their daughter is staying with them temporarily. We want to continue to report what is usual unless the new living arrangement is expected to become permanent.

Once the living situation is determined, the next step is to determine the availability of assistance for the upcoming episode of care.

To do this, we need to ask ourselves, how often will someone other than the home health agency staff be available and willing to provide in-person assistance to the patient for the upcoming episode of care?

There are 5 options to choose from:

Around the clock – someone is in the home and willing and able to provide assistance 24 hours a day and this will continue for the entire episode of care.
Regular Daytime – someone is available to provide assistance during the patients regular daytime hours.
Regular Nighttime – someone is available to provide assistance during the patients regular nighttime hours.
Occasional/short term assistance – someone is in the home to provide assistance only a few hours a day or on an irregular basis.
No assistance available – there is no one available and/or willing to provide any in-person assistance.

For this step, use clinical judgment to determine if someone will be available to provide assistance to the patient. Do not consider someone who is unwilling or unable to provide assistance. Do not include help that is summoned by telephone. If the patient lives in a congregate setting with a call bell determine how often that call bell will summon in-person assistance.

Once you have worked your way through these 2 steps and determined the most appropriate responses for the patient’s usual living situation and availability for assistance, you will be able to accurately code M1100.

If you’re like me and find OASIS fascinating, or if you’re not so fascinated but are in need of OASIS training, consider learning about more OASIS items at an upcoming Blueprint for OASIS Accuracy 2-day workshop. The OASIS Answers Team would love to meet you and help YOU find YOUR favorite OASIS item!