0
Adequate
No difficulty in normal conversation, social interaction, or
listening to TV. The resident hears all normal conversational speech and telephone or
group conversation.
DiraChart MDS item reference
B0200Section Bv1.20.1Manual page B-2
Hearing
Item Rationale
Quick coding
Answer Codes
Use the item-specific response choices below when structured codes apply.
Response format: Coded response
1
Minimal difficulty
Difficulty in some environments (e.g., when a person
speaks softly or the setting is noisy). The resident hears speech at conversational levels
but has difficulty hearing when not in quiet listening conditions or when not in one-on-
one situations. The resident’s hearing is adequate after environmental adjustments are
made, such as reducing background noise by moving to a quiet room or by lowering the
volume on television or radio.
2
Moderate difficulty
Speaker has to increase volume and speak distinctly.
Although hearing-deficient, the resident compensates when the speaker adjusts tonal
quality and speaks distinctly; or the resident can hear only when the speaker’s face is
clearly visible.
3
Highly impaired
Absence of useful hearing. The resident hears only some
sounds and frequently fails to respond even when the speaker adjusts tonal quality,
speaks distinctly, or is positioned face-to-face. There is no comprehension of
conversational speech, even when the speaker makes maximum adjustments.
Item-specific instructions
Coding Guidance
Review what the item asks, how to choose the response, and what should be verified before submission.
Steps for Assessment
1.
Ensure that the resident is using their normal hearing appliance if they have one. Hearing
devices may not be as conventional as a hearing aid. Some residents by choice may use
hearing amplifiers or a microphone and headphones as an alternative to hearing aids. Ensure
the hearing appliance is operational.
2.
Interview the resident and ask about hearing function in different situations (e.g. hearing
staff members, talking to visitors, using the telephone, watching TV, attending activities).
3.
Observe the resident during your verbal interactions and when they interact with others
throughout the day.
4.
Think through how you can best communicate with the resident. For example, you may
need to speak more clearly, use a louder tone, speak more slowly or use gestures. The
resident may need to see your face to understand what you are saying, or you may need to
take the resident to a quieter area for them to hear you. All of these are cues that there is a
hearing problem.
5.
Review the medical record.
6.
Consult the resident’s family, caregivers, direct care staff, activities personnel, and speech or
hearing specialists.
Coding Instructions
•
Code 0, adequate: No difficulty in normal conversation, social interaction, or
listening to TV. The resident hears all normal conversational speech and telephone or
group conversation.
•
Code 1, minimal difficulty: Difficulty in some environments (e.g., when a person
speaks softly or the setting is noisy). The resident hears speech at conversational levels
but has difficulty hearing when not in quiet listening conditions or when not in one-on-
one situations. The resident’s hearing is adequate after environmental adjustments are
made, such as reducing background noise by moving to a quiet room or by lowering the
volume on television or radio.
•
Code 2, moderate difficulty: Speaker has to increase volume and speak distinctly.
Although hearing-deficient, the resident compensates when the speaker adjusts tonal
quality and speaks distinctly; or the resident can hear only when the speaker’s face is
clearly visible.
B0200: Hearing (cont.)
•
Code 3, highly impaired: Absence of useful hearing. The resident hears only some
sounds and frequently fails to respond even when the speaker adjusts tonal quality,
speaks distinctly, or is positioned face-to-face. There is no comprehension of
conversational speech, even when the speaker makes maximum adjustments.
Coding Tips
for Special Populations
•
Residents who are unable to respond to a standard hearing assessment due to cognitive
impairment will require alternate assessment methods. The resident can be observed in
their normal environment. Do they respond (e.g., turn their head) when a noise is made at
a normal level? Does the resident seem to respond only to specific noise in a quiet
environment? Assess whether the resident responds only to loud noise or do they not
respond at all.
MDS item matrixAssessment Applicability
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11 relationships5 groups+
Assessment Applicability
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Nursing Home Subsets
Swing Bed Subsets
OBRA Stand Alone Assessments
Program and Policy Use
Item Subset Required Use ISC Skip Patterns
Official CMS source
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Reference details
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