Bladder/Bowel Management Guidelines

This document provides guidelines for rating the burden of care as it relates to assistive devices for
bladder and bowel management during a single episode. When determining the overall rating for item
42G, Bladder Management, or item 42H, Bowel Management, consider the number of accidents at the
time of admission or discharge, and determine the level of assistance provided by a helper. For additional
information and exact time frames, see page 32 of The FIM System® Clinical Guide, Version 5.2.
Because these guidelines do not cover every scenario, situations may occur in which the burden of care is
not represented in this document.

Assistive Device: Urinal

• Level 6, Modified Independence: The patient obtains, uses, and empties the urinal without assistance.
• Level 5, Supervision/Setup: A helper places the urinal within reach of the patient, empties it after the
patient uses it, or performs both tasks for the patient.
• Level 4, Minimal Assistance: A helper positions the patient’s penis in the urinal. The patient holds the
urinal in place while using it and then hands it to the helper, who empties the urinal.
• Level 3, Moderate Assistance: A helper positions the patient’s penis in the urinal, and the patient
holds the urinal in place while using it, after which the helper removes and empties the urinal.
• Level 2, Maximal Assistance: A helper positions the patient’s penis in the urinal, holds the urinal in
place, and removes and empties the urinal.
• Level 1, Total Assistance: The patient spills the urinal, and a helper changes the patient’s linen or
clothing.

Assistive Device: Bedpan

• Level 6, Modified Independence: The patient obtains, uses, and empties the bedpan without
assistance.
• Level 5, Supervision/Setup: A helper places the bedpan within reach of the patient, empties it after the
patient uses it, or performs both tasks for the patient.
11/17/11

• Level 4, Minimal Assistance: A helper provides less than 25 percent assistance to position the patient
on the bedpan or remove the bedpan.
• Level 3, Moderate Assistance: A helper positions the bedpan for the patient and holds it in place
while assisting the patient to roll on or off the bedpan.
• Level 2, Maximal Assistance: A helper positions the bedpan for the patient and holds it in place while
assisting the patient to roll on and off the bedpan.
• Level 1, Total Assistance: A helper rolls the patient on his side in a lying position, positions the
bedpan, holds it in place, and assists the patient in rolling on and off the bedpan, or the patient requires
assistance from two helpers to complete the task.

Assistive Device: Intermittent Catheterization

• Level 6, Modified Independence: The patient gathers equipment, performs the self-catheterization
independently, and empties the urine.
• Level 5, Supervision/Setup: A helper sets up the catheterization equipment, supervises the patient
while the patient performs the catheterization, or performs both of these tasks.
• Levels 2–4: The rating will be based on the performance of the procedure and the amount of assistance
the patient requires from a helper.
• Level 1, Total Assistance: A helper performs the entire catheterization procedure.

Uniform Data System

for Medical Rehabilitation
270 Northpointe Parkway, Suite 300
Amherst, New York 14228
tel: 716-817-7800
fax: 716-568-0037 © 2008, 2009, 2011 Uniform Data System for Medical Rehabilitation. FIM, The FIM System, and the UDSmr logo
are trademarks of Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc.
www.udsmr.org
 Bladder/Bowel Management Guidelines
Assistive Device: Indwelling Foley Catheters
• Levels 2–6: See Assistive Device: Intermittent Catheterization.
• Level 1, Total Assistance: A helper cares for the catheter, including emptying the Foley bag.

Assistive Device: Absorbent Pad or Diaper

• Level 6, Modified Independence: The patient retrieves the device, changes it, and disposes of it
independently.
• Level 5, Supervision/Setup: A helper sets up the device, supervises the patient as the patient puts on
or takes off the device (or both), provides verbal cueing, or performs more than one of these tasks.
• Levels 2–4: The rating will depend on the performance of the procedure and the amount of assistance
the patient requires from a helper.
• Level 1, Total Assistance: A helper retrieves the device, changes it, and disposes of it.

Assistive Device: Suppository

• Level 6, Modified Independence: The patient inserts the suppository and performs all aspects of
elimination and cleanup.
• Level 5, Supervision/Setup: A helper cues the patient to insert the suppository.
• Level 4, Minimal Assistance: A helper lubricates and inserts the suppository.
• Levels 2–3: The rating will depend on the performance of the procedure and the amount of assistance
the patient requires from a helper.
• Level 1, Total Assistance: A helper positions the patient, places a pad, lubricates and inserts the
suppository, provides digital stimulation, places the patient on a bedpan, and takes the patient off of the
bedpan.

Assistive Device: Colostomy

• Level 6, Modified Independence: The patient empties the ostomy and cares for all aspects of it.
• Level 5, Supervision/Setup: The patient requires setup assistance or verbal cues.
• Level 4, Minimal Assistance: The patient requires incidental help (e.g., removing wafer).
• Level 3, Moderate Assistance: The patient performs 50 percent to 74 percent of ostomy care.
• Level 2, Maximal Assistance: The patient performs 25 percent to 49 percent of ostomy care.
• Level 1, Total Assistance: The patient performs less than 25 percent of ostomy care.

Accidents
• Level 7: No accidents, no helper, no medication, and no assistive device
• Level 6: No accidents, no helper, may require medication or an assistive device
• Level 5: One accident during the 3-day assessment time frame
• Level 4: Two accidents during the 3-day assessment time frame
• Level 3: Three accidents during the 3-day assessment time frame
• Level 2: Four accidents during the 3-day assessment time frame
• Level 1: Five or more accidents during the 3-day assessment time frame
• For item 42G, Bladder Management, and item 42H, Bowel Management, rate the patient by the
number of times the assistive device leaks or spills, wetting or soiling linens or the patient’s clothing.
Uniform Data System
for Medical Rehabilitation
270 Northpointe Parkway, Suite 300
Amherst, New York 14228
tel: 716-817-7800
fax: 716-568-0037 © 2008, 2009, 2011 Uniform Data System for Medical Rehabilitation. FIM, The FIM System, and the UDSmr logo
are trademarks of Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc.
www.udsmr.org