II.    Impaired Mobility - means that the resident is physically limited in his or her ability to leave the home. The rating should reflect the present physical environment in the building where the resident lives and should be based on the resident lying awake on his/her bed. The resident is rated according to how easily he or she can leave, given the presence of physical barriers that hinder movement (such as stairs), the resident's ability to get out of bed or chairs he or she normally uses, and so forth. The resident should be given credit for being able to use devices that aid movement (for example, wheelchairs, walkers, crutches, and leg braces). However, the rater may give credit for such devices only if they are always available for an emergency evacuation.

The resident should be rated on his or her ability to use the most accessible route out of the home. For example, a resident who is "self-starting" when he uses the back door, but who "needs limited assistance" to get out the front door would be rated as "self-starting".

The rater should test the resident when he/she is under the influence of any routine medication that slows the resident's movement.

When the resident needs physical assistance to make a timely evacuation, the amount of assistance required is based on the categories defined below. Physical assistance mans that the staff member must use some strength to assist the resident. Guiding or directing the resident by giving gentle pushes or leading by the hand is not considered physical assistance.

(a) Self-Starting - means that the resident is physically able to start and complete an evacuation without physical assistance.

(b) Slow - means that the resident prepares himself or herself to leave and travels to the exit (or an area of refuge) at a speed significantly slower than normal. Specifically, the resident is rated "slow" if he/she cannot prepare him- or herself to leave, and then travel from his/her bedroom to the exit (or area of refuge) within a period of 90 seconds.

(c) Needs Limited Assistance - means that the resident may require some initial or brief intermittent assistance, but can accomplish most of the evacuation without assistance. (The total time required to physically assist the resident should not exceed the amount of time typically required in the examples listed below.)  The following are a few examples of capabilities that fall within this category:

The resident would be physically able to start and complete an evacuation, except that:

(1) The resident needs help to get into a wheelchair, or

(2) The resident needs help to descend stairs in the building, or

(3) The resident needs help to get out of bed, or

(4) The resident needs help to hope a door.

(d) Needs Full Assistance or Very Slow - means that the resident needs "full assistance" or is "very slow" as defined in this section.

Needs full assistance . The resident needs full assistance if either:

(1) the resident may require physical assistance from a staff member during most of the resident's evacuation or

(2) the total time required to physically assist the resident is equal to or greater than the time required in the examples below.

The following are a few examples of capabilities that fall within this category:

(1) The resident may need to be carried from the building.

(2) The resident needs help to get into a wheelchair and must be wheeled out of the building.

(3)The resident needs help to get into leg braces and needs help to descend steps.

Very slow . The resident is rated very slow if the time necessary for the resident to prepare him- or herself to leave, and then travel from his/her bedroom to the exit, is so long that the staff cannot permit the resident to evacuate unassisted. Specifically, the resident is rated very slow if he/she cannot prepare him- or herself to leave, and then travel to the exit (or area of refuge), in 150 seconds.

III. Impaired Consciousness - means that the resident could experience a partial or total loss of consciousness in a fire emergency.  Unless there is specific evidence that loss of consciousness may occur during a fire emergency, the resident should be rated as "no significant risk."

Specific evidence means that the resident has experienced some temporary impairment of consciousness of short duration (seconds or minutes) six or more times during the three months preceding the rating of the resident. Regardless of frequency, if there is specific evidence that loss of consciousness may be caused by the stress of a fire emergency, the resident should be rated as having impaired consciousness. An episode of partial loss of consciousness should be counted only if the impairment was severe enough to significantly interfere with the resident's ability to protect himself or herself.  Do not count episodes where the loss of consciousness was the result of a temporary medical problem (e.g., a severe infection).

(a) No Significant Risk - means that the resident is not subject to loss of consciousness or that the resident has had fewer than six episodes of consciousness loss (partial and total) during the three months preceding the ratings.

(b) Partially Impaired - means that the resident has had at least six episodes of consciousness loss in the last three months, and that the most severe of these episodes was only a partial loss of consciousness; that is, the resident would still be able to participate somewhat in his or her own evacuation.

Examples of specific evidence that a resident should be rated in this category include loss of consciousness result from mild (partial or petit mal) seizures, dizzy spells, intoxication, or any other partially incapacitating impairment of consciousness.

(c) Totally Impaired - means that the resident has had at least six episodes of consciousness loss in the last three months, and that the most severe of these episodes was a total or severely incapacitating loss of consciousness; that is, the resident would require the full assistance of at least one staff member to get out of the building.

Examples of specific evidence that a resident should be rated in this category include losses of consciousness resulting from severe (generalized or grand mal) seizures, fainting spells, intoxication, or other total or severely incapacitating loss of consciousness.