The GG Functional Items — Home Health Training

The GG items — GG0130 self-care and GG0170 mobility — are the standardised functional items shared across post-acute settings. They feed quality measures and payment, and they are scored on a scale that runs the opposite way from most people's instinct.

Item numbers and the exact assessment window change between OASIS versions. Confirm the current detail against the CMS OASIS Guidance Manual and with your QA team. The conventions below are the part that does not change.

The six-point scale

Read it as how much of the effort did the patient do.

Code	Meaning
06	Independent — no assistance, no supervision, no device set-up by anyone else
05	Setup or clean-up assistance — helper sets up or puts away; patient does the activity
04	Supervision or touching assistance — verbal cueing, steadying, or contact guard
03	Partial / moderate assistance — helper does less than half the effort
02	Substantial / maximal assistance — helper does more than half the effort
01	Dependent — helper does all of it, or two helpers are required

Higher is more independent. This is backwards from most clinical scales, and it is where new clinicians make errors on their first few assessments.

The split between 03 and 02 is half the effort. Not half the time, not how it felt — how much of the work the helper did.

If two helpers are required, the code is 01 Dependent, regardless of how much the patient contributed.

Usual performance, not ability

This is the single most important convention on these items, and the one that separates GG from the M items.

GG asks what the patient actually did, with the assistance that was actually provided — not what they could do on a good day, and not what they might manage if nobody helped.

So:

A patient who can dress herself but whose daughter always does it is scored on what happened
A patient who managed the stairs once on Tuesday, with difficulty, and needs help every other time, is scored on the usual
Safety counts. If the patient can only do it unsafely, that is not independent performance

Compare with the M1800-series items, which ask about ability. The same patient can legitimately score differently on the two. Check which family the item belongs to before answering.

When performance varies

Score the usual — what is true most of the time across the assessment period, not the best attempt and not the worst.

If a patient is steady in the morning and unsafe by evening, the usual is not "steady". Document the variation in your note so the score is explainable.

The activity-not-attempted codes

Use these only when the activity genuinely did not happen. They are not a place to park an item you forgot to assess.

Code	Use when
07	Patient refused
09	Not applicable — the patient did not perform this activity before the current illness or injury
10	Not attempted due to environmental limitations — no stairs in the home, no tub
88	Not attempted due to medical condition or safety concerns

Two things to get right:

09 means not applicable before the current episode. A patient who never climbed stairs because there are none is 09 or 10 depending on the reason. A patient who climbed stairs fine until last month is not 09.
88 needs a reason in your note. "Not attempted due to safety" with nothing else written is exactly what a reviewer asks about.

These codes affect quality measures, so reaching for them because assessing the activity was awkward has consequences beyond the item.

Discharge goals

At SOC and ROC, GG asks for both current performance and a discharge goal for the items your plan will address.

Goals should be realistic and consistent with the rest of the plan of care. A discharge goal of 06 Independent on every item, for a patient who will plausibly reach 04, reads as a form filled in rather than a plan — and the discharge scores will be measured against it. See Writing Measurable Goals.

The self-care items — GG0130

Eating, oral hygiene, toileting hygiene, showering or bathing, upper body dressing, lower body dressing, putting on and taking off footwear, and washing the upper body.

Toileting hygiene is the cleansing and clothing management after using the toilet — not the transfer, which lives in GG0170.

Footwear is its own item and is commonly the lowest score in an otherwise independent patient — reaching the feet is the limiting factor.

The mobility items — GG0170

Bed mobility (rolling, lying to sitting, sitting to lying), transfers (sit to stand, chair or bed-to-chair, toilet, car), walking distances (10 feet, 50 feet with two turns, 150 feet), walking on uneven surfaces, steps (1, 4, 12), picking up an object from the floor, and the wheelchair items.

Walking items are cumulative in difficulty. A patient who cannot walk 50 feet will not score higher at 150 feet.
Car transfer is often coded 10 or 88 — make sure the reason fits.
Wheelchair items apply only if the patient uses one; answer the gateway question honestly.

Observe, do not interview

The most reliable way to get these wrong is to ask.

Patients over-report, families under-report, and both do it sincerely. Where you safely can, watch: watch the sit-to-stand, walk with them to the bathroom, see the transfer.

Where you cannot observe something safely, say so in your note and explain what you based the score on. That is a legitimate assessment; a guess dressed as an observation is not.

Before you submit

Every item scored, with no blanks
Higher number = more independent — check you have not inverted the scale
03 versus 02 decided on half the effort
Two helpers scored as 01
Usual performance, not best or worst
Activity-not-attempted codes used correctly, with a reason in the note
Discharge goals realistic and matching the plan of care
The scores agree with the narrative in your own visit note — see Inconsistencies That Trigger Review