Learn how home health nurses use the BIMS and PHQ-2/9 during the Start of Care (SOC) visit to screen cognition and mood, improve safety, and meet Medicare compliance.
Introduction: The Mind Matters, Too
In home health, we often focus on wounds, meds, and mobility—but cognition and mood are just as critical. Memory loss, confusion, and depression can derail even the best care plan. That’s why Medicare requires nurses to screen cognition and mood during the Start of Care (SOC) visit using tools like the BIMS (Brief Interview for Mental Status)and PHQ-2/9 (Patient Health Questionnaire).
Done well, these screens don’t just check a compliance box—they uncover hidden risks that impact safety, healing, and quality of life.
The BIMS: Screening Cognition Simply
The Brief Interview for Mental Status (BIMS) is a short, structured way to screen cognition. It assesses:
- Repetition: Can the patient remember three words?
- Temporal Orientation: Can they identify the year, month, and day?
- Recall: Can they repeat back the three words after a short delay?
Scoring:
- 13–15 = Intact cognition
- 8–12 = Moderate impairment
- 0–7 = Severe impairment
👉 This ties closely to functional testing (see Comprehensive Assessment & Functional Testing), since cognition directly impacts mobility and ADL safety.
The PHQ-2/9: Mood Matters
The PHQ-2 is the quick first screen:
- “Over the past two weeks, have you had little interest or pleasure in doing things?”
- “Over the past two weeks, have you felt down, depressed, or hopeless?”
If either is positive, you expand to the PHQ-9, which measures severity of depression and helps guide intervention.
Why it matters:
- Depression impacts medication adherence, nutrition, and participation in care.
- It’s linked to increased hospitalizations and poorer outcomes.
- Early detection means timely referrals and better support.
👉 For more on integrated screening, check out my post on Risk Screens: Falls, Depression, Nutrition, Pain & Skin.
How to Make These Screens Effective
- Normalize them: “We ask these questions to all our patients—it helps us give you the best care.”
- Engage caregivers: They often notice cognitive changes the patient minimizes.
- Document clearly: Scores must align with your care plan and interventions.
- Act on results: Don’t just record—communicate findings to the practitioner for follow-up orders.
👉 For tying findings into the broader plan, see Build the Plan of Care at the Bedside.
Common Pitfalls to Avoid
- Rushing through questions → can under-detect impairment or depression.
- Coding based on assumptions rather than the patient’s answers.
- Forgetting to document caregiver teaching when impairment is identified.
- Not linking findings to OASIS responses (see Essentials & Watch-Outs (OASIS)).
Final Thoughts: The Whole Person Approach
Cognition and mood screens remind us that patients are more than their diagnoses—they’re whole people with emotional and mental health needs that affect their recovery. By taking BIMS and PHQ-2/9 seriously, home health RNs protect patients, strengthen compliance, and build more effective care plans.
✨ Want step-by-step strategies for SOC visits, including cognition and mood screenings?
Check out my RN Home Health SOC Guidebook on Kindle. It’s packed with real-world tips, checklists, and documentation strategies to make SOC visits smoother, faster, and more effective.
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