What Is a BIMS Score: Tracking Cognitive Impairment in SNFs

In long-term care facilities, like skilled nursing facilities (SNFs), dementia and cognitive impairment can be common. So common, in fact, that a mandatory assessment is required of all residents upon admission. Cognitive decline, or simply knowing the state of a resident’s cognitive abilities, is crucial in providing care for them.

This assessment that produces a BIMS score, known as the BIMS test, is a standardized cognitive assessment tool designed to help understand the mental acuity of residents and categorize them accordingly. These assessments are mandatory upon arrival, in accordance with Centers for Medicare and Medicaid Services (CMS) requirements.

How does the BIMS score make this assessment? What do the BIMS scores mean? How can staff use this information provided by BIMS score to better care for residents? These questions are necessary to understanding how SNFs and BIMS interact. This post will aim to answer these questions around BIMS score and show how long-term care facilities may use the BIMS score to improve resident treatment and operations.

What is a BIMS Cognitive Assessment Tool?

The BIMS score is determined based on a resident’s responses to a set of questions in the Brief Interview for Mental Status. The BIMS score interpretation categorizes scores into groups by cognitive status, signifying severe cognitive impairment to intact cognitive response, helping to understand a resident’s cognitive health. This interview is often conducted by a social worker, though does not need to be, upon admission to a long-term care or skilled nursing facility. The assessment is scored from 0 points to 15, with three levels of impairment suggested by the final score.

Intact

Any score from 13 to 15 points is classified as “Intact”, indicating an intact cognitive response and suggesting that the resident is capable of normal cognition. This resident is likely in need of the least amount of tailored support from the facility staff in relation to memory and cognitive aid.

Moderate to Mild Cognitive Impairment

The “Moderate Impairment” classification suggests that a resident may need extra assistance with daily activities and/or specific tasks and may be in cognitive decline. This is the middle tier interpretation of the BIMS and describes a BIMS score between 8 and 12 on the assessment.

Severe Impairment

The final, and most consequential, of the classifications available in the BIMS interpretation, is “Severe Impairment”, indicating severe cognitive impairment. This indicates that a resident will have significant trouble with cognitive tasks, and will likely need extensive help from the staff to navigate daily life. A BIMS score from 0 to 7 falls into this rank.

BIMS Score Interpretation

While the overall BIMS score provides an analysis of general cognitive function, this cognitive assessment tool also considers each individual answer when assessing the status and future needs of the resident. The BIMS seeks to understand three different types of cognition and how the resident performs in each individual arena.

What are the sections in a BIMS Assessment?

The three areas of a BIMS assessment include immediate recall, temporal orientation, and short-term memory. A resident may score well on the temporal orientation questions, but poorly on the short-term memory and immediate recall sections. These differences should be taken into account when interpreting the resident’s BIMS score.

These insights can provide the staff with specific understanding of the areas in which the patient will need additional assistance. A patient with no temporal orientation impairment will need less assistance with remembering activities, visits, and important dates, for example.

Keep in mind that the test isn’t a diagnostic tool, meaning that there are reasons besides severe cognitive impairment for poor scores on one or more sections of the BIMS assessment test. Hearing impairment is a common one, but language barriers, speech impediments, and more could result in a lower score on the assessment without indicating a legitimate problem with the resident when you assess cognition.

The BIMS score should not be a “one and done” assessment. The BIMS assessment is mandatory upon admission of new residents, but it should also be performed on a regular basis to understand a resident’s cognitive abilities over time. New information should be used to adjust care as the patient’s status progresses, especially when determining if there’s something that could have severe cognitive impact.

What Does the Interview Look Like?

As mentioned, the interview includes a number of questions attempting to assess the resident’s cognitive ability in the areas of immediate recall, temporal orientation, and short-term memory. The BIMS is a brief cognitive assessment tool, similar to other instruments like the MoCA, used to evaluate various cognitive functions and cognitive ability or cognitive impairment. At times subsequent evaluations may be needed after a BIMS assessment to better guage cognitive status and degree of cognitive functioning.

Immediate recall involves the taker’s ability to remember things immediately after they’ve occurred. Temporal orientation is the taker’s ability to understand time, how it moves, and their relation to it. Short-term memory describes the taker’s ability to remember things that happened a short time ago, but not immediately before. This often means revisiting a previous question from earlier in the assessment.

Immediate Recall Element

The immediate recall element includes a series of three words said to the resident, which they are then asked to repeat back. The number of words repeated back, regardless of the order of the response, is the score for this section. If the resident can remember all three words, they will score three. If they can only recall one, the score will be one.

Before moving on to the next section, the test administrator should repeat the words once more with a short descriptor afterwards. For example, if the word is “horse”, the descriptor may be “an animal”.

Temporal Orientation

Next, the administrator will assess the resident’s temporal orientation ability. This will require asking questions about the current year, month, and more. The closer to the correct answer, the higher the score. All of these questions are scored on a scale of zero to three. If the taker knows the correct answer for each question, they will score a three on each, and a nine total for the temporal orientation section.

Short-Term Memory

Finally, the short-term memory section will revisit the list of words from the immediate recall test. Unlike the other two sections, this one is scored from a zero to two for each word. If the taker cannot recall any of the words at all, they score a zero. If they can recall after the cue word, which is the category descriptor the administrator mentioned, they will score a one. And if they can recall each word without aid, their score will be a two.

All of these scores are added together, resulting in the resident’s total score. Remember, the overall score will result in an “Intact”, “Moderate Impairment”, or “Severe Impairment” categorization, but the performance on individual sections is vital to understanding what the resident needs in specialized treatment from the staff.

Applying the Results of the BIMS Assessment

While the BIMS assessment is not a diagnostic tool (and is, in fact, not as accurate as other tests at diagnosing dementia and other memory-related conditions), and in long-term care facilities, it’s used for ensuring all residents are adequately cared for, but for cases of severe impairment, it can be used as a referral for a dementia diagnosis. However, the BIMS has limitations in accurately assessing patients with mild cognitive impairment, necessitating more comprehensive assessment strategies. Depending on the areas of weakness the resident’s scores indicate, a hearing impairment evaluation could also be recommended.

When it comes to applying the scores from the BIMS, evaluate your facility’s capabilities when it comes to providing additional or specialized care for residents. If a resident requires assistance with short-term recall, do you have the tools to assist with those issues?

Will you need to alter your staffing to accommodate any specific needs? Can you adjust your staffing to do so? Do you have the resources to bring in external aid, if needed? Catalogue these needs and determine what you can accomplish to assist residents. If multiple residents have similar needs, it may be possible to combine these resources and provide care as efficiently as possible.

Make the Most of a Resident’s BIMS Score

BIMS scores are a vital tool in helping SNFs and long-term care facilities understand the specifics of a resident’s cognitive functioning, what their cognitive strengths and weaknesses are, and how to best handle their treatment. They’re an important test to discover a resident’s current cognitive status.

But that’s only half the battle. Once the assessment has been administered and the score calibrated, SNFs should take that information and build a specific care plan around the weaknesses discovered during the test. This should be done in conjunction with any official diagnosis, of course, and should ensure that the resident is adequately supported.

It’s best to repeat the test at regular intervals, to determine whether the resident is progressing in any of the areas of cognition accounted for in the test. Any changes should be adjusted as new results are tallied upon further evaluation.

Most of all, BIMS scores should be helpful to long-term care facilities. Having specialized care plans should allow facilities to operate more smoothly—no more taking extra time with a resident who struggles with remembering the schedule. Use these insights to help your staff make the most of their days and provide better care for your residents.