10/15/2026

Survey Tip of the Week: Range of Motion Decline

A decline in a resident’s range of motion (ROM) or mobility may result in a citation under F688 when the facility fails to demonstrate that appropriate assessments, interventions, and services were provided to prevent an avoidable decline. Changes identified through the Minimum Data Set (MDS), including a decline in functional range of motion, may prompt surveyors to further investigate whether the facility provided necessary care and services.

For residents admitted without a limited ROM, surveyors will evaluate whether the facility provided services and/or treatment to prevent reduction in ROM? For residents admitted with a limited ROM and/or mobility, surveyors will evaluate whether appropriate treatment, services, and equipment were provided to improve or maintain function and prevent further avoidable decline. These interventions must be based on the comprehensive assessment, person-centered care plan, resident preferences, and professional standards of practice.

For a decline to be considered unavoidable, documentation must reflect the attempts made by the facility to implement the care plan and revise interventions to address the changing needs of the resident.

The Long-Term Care Survey Process instructs surveyors to ask the resident and/or resident representative the following:

• What limitations in ROM or contractures are present, how long have they existed, and what interventions are being provided? Has ROM, mobility, or positioning improved or declined?
• Were you involved in developing your care plan, does it reflect your preferences and choices, and is it being implemented as written?
• Are prescribed splints, braces, and other adaptive or assistive devices provided and used appropriately? When are they applied, what instructions were provided, and are there any related skin concerns? If so, how are these addressed?
• Do you experience pain or discomfort during exercises, treatments, transfers, or positioning? Are you comfortable in bed or while seated? How are concerns addressed?
• Are you encouraged and able to participate in exercises, mobility, and positioning? What assistance, instructions, or modifications are provided when needed? Are you given sufficient time without being rushed or having staff unnecessarily complete tasks for you?
• If receiving PT/OT, were treatment goals and interventions discussed, including the type, frequency, and duration of services? Do they reflect your preferences and choices?
• Is needed positioning assistance and equipment provided, and does it meet your needs for comfort, safety, and proper alignment? How are unmet needs addressed?
• If you declined interventions, why, and did staff discuss or attempt alternatives?

Facilities should routinely review changes in ROM and mobility, ensure interventions are consistently implemented, and maintain documentation demonstrating efforts to prevent avoidable declines. Refer to the Positioning, Mobility & Range of Motion critical element pathway for additional insight into the surveyor’s investigative process.