One of the most gratifying parts of my job is seeing seniors become more independent when they work with our therapists.  But the benefits go beyond our patients who live in senior living settings, because having more independent senior living residents means fewer demands on caregivers.  During this time when finding quality caregivers is so challenging, we believe an alternative is to reduce the acuity of residents and, as a result, reduce the number of caregivers needed each shift.

In the senior living settings where our services are available, residents who take advantage of our programs see an impressive increase in independence with both transfers and ADLs.  We recently published a report examining the outcomes achieved through therapy services in IL,AL and MC populations.  The results were an impressive 31.6% improvement in independence with transfers and a 19.6% in improvement in independence with ADLs.  These outcomes were quantified by studying the Barthel Index and other clinically reliable tools incorporated into therapy evaluations, treatments and discharges

The Barthel Scale/Index (BI) may be one of the most important metrics a senior living provider should be familiar with, but often is not.  It’s an ordinal scale used to measure performance in activities of daily living (ADL). Ten variables describing ADL and mobility are scored, a higher number being a reflection of greater ability to function independently. Time taken and physical assistance required to perform each item are used in determining the assigned value of each item. The Barthel Index measures the degree of assistance required by an individual on 10 items of mobility and self care ADL.

The BI combines a self-report by the resident and direct observation by the therapist.

The 10 personal activities included in the BI are: feeding, personal toileting, bathing, dressing and undressing, getting on and off a toilet, controlling bladder, controlling bowel, moving from wheelchair to bed and returning, walking on level surface (or propelling a wheelchair if unable to walk) and ascending and descending stairs.

The BI is considered a very reliable test to administer.  Five studies of the MBI reported excellent internal consistency: one study of the MBI reported excellent test-retest reliability; one study of the MBI and 4 studies of BI reported excellent inter-rater reliability; and 1 study of the BI reported adequate inter-rater reliability.

As a predictive tool the the MBI predicted instrumental ADL performance at 6-months post-stroke: likelihood a patient will regain continence following stroke; risk for falls in patients with stroke; functional recovery following stroke; and acute care hospital length following stroke.

In conclusion, we feel the Barthel Index is an essential tool when we partner with senior living providers.  It lets us monitor and adjust the effectiveness of our therapy for achieving greater independence for the seniors we help, and reducing staffing demands for caregivers at the residence.