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CMS MDS 3.0 RAI Manual v1.20.1 is the governed baseline currently attached to this lookup item.
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Urinary Toileting Program
Item Rationale
Matrix review
6 matrix group(s) are already attached for review on this item.
Answer coverage
4 governed answer row(s) are attached for this item.
Answer Codes
Code 0
No
if for any reason the resident did not undergo a toileting trial. This includes residents who are continent of urine with or without toilet...
Code 1
Yes
for residents who underwent a trial of an individualized, resident-centered toileting program at least once since the most recent admission...
Code 2
Completely dry (continent)
if the resident becomes completely continent of urine, with no episodes of urinary incontinence during the toileting trial. (For residents...
Code 9
Unable to determine
if records cannot be obtained to determine if a trial toileting program has been attempted. If code 9, skip H0200B and go to H0200C, Curren...
What this item is
Item Rationale
When to use it
Use this item when the facility is completing content tied to Section H and needs to stay anchored to v1.20.1.
Reminders
- Current source status: Published.
- Item locator: Manual page H-3
- CMS exact locator: Manual page H-3
- This item has 4 governed answer row(s) attached.
Source awareness
This page is grounded in CMS MDS 3.0 RAI Manual v1.20.1. Review the exact text and locators before treating the item as final reference content.
Source & Review
Manual
CMS MDS 3.0 RAI Manual v1.20.1
Status
Published
Effective start
2025-10-01
Item locator
Manual page H-3
CMS exact locator
Manual page H-3
Full CMS Text
Item Rationale
Health-related Quality of Life
An individualized, resident-centered toileting program may decrease or prevent urinary incontinence, minimizing or avoiding the negative consequences of incontinence. Determining the type of urinary incontinence can allow staff to provide more individualized programming or interventions to enhance the resident’s quality of life and functional status. Many incontinent residents (including those with dementia) respond to a toileting program, especially during the day.
Planning for Care
The steps toward ensuring that the resident receives appropriate treatment and services to restore as much bladder function as possible are — determining if the resident is currently experiencing some level of incontinence or is at risk of developing urinary incontinence; — completing an accurate, thorough assessment of factors that may predispose the resident to having urinary incontinence; and — implementing appropriate, individualized interventions and modifying them as appropriate. If the toileting program or bladder retraining leads to a decrease or resolution of incontinence, the program should be maintained. Research has shown that one quarter to one third of residents will have a decrease or resolution of incontinence in response to a toileting program. If incontinence is not decreased or resolved with a toileting trial, consider whether other reversible or treatable causes are present. Residents may need to be referred to practitioners who specialize in diagnosing and treating conditions that affect bladder function. Residents who do not respond to a toileting trial and for whom other reversible or treatable causes are not found should receive supportive management (such as checking the resident for incontinence and changing their brief if needed and providing good skin care).
Steps for Assessment: H0200A, Trial of a
Toileting Program The look-back period for this item is since the most recent admission/entry or reentry or since urinary incontinence was first noted within the facility.
1. Review the medical record for evidence of a trial of an
individualized, resident-centered toileting program. A toileting trial should include observations of at least 3 days of toileting patterns with prompting to toilet and of recording results in a bladder record or voiding diary. Toileting programs may have different names, e.g., habit training/scheduled voiding, bladder rehabilitation/bladder retraining.
2. Review records of voiding patterns (such as frequency,
volume, duration, nighttime or daytime, quality of stream) over several days for those who are experiencing incontinence.
3. Voiding records help detect urinary patterns or intervals
between incontinence episodes and facilitate providing care to avoid or reduce the frequency of episodes.
4. Simply tracking continence status using a bladder record or
voiding diary should not be considered a trial of an individualized, resident-centered toileting program.
5. Residents should be reevaluated whenever there is a change
in cognition, physical ability, or urinary tract function. Nursing home staff must use clinical judgment to determine when it is appropriate to reevaluate a resident’s ability to participate in a toileting trial or, if the toileting trial was unsuccessful, the need for a trial of a different toileting program.
DEFINITIONS
BLADDER REHABILITATION/ BLADDER RETRAINING A behavioral technique that requires the resident to resist or inhibit the sensation of urgency (the strong desire to urinate), to postpone or delay voiding, and to urinate according to a timetable rather than to the urge to void. PROMPTED VOIDING Prompted voiding includes (1) regular monitoring with encouragement to report continence status, (2) using a schedule and prompting the resident to toilet, and (3) praise and positive feedback when the resident is continent and attempts to toilet. HABIT TRAINING/ SCHEDULED VOIDING A behavior technique that calls for scheduled toileting at regular intervals on a planned basis to match the resident’s voiding habits or needs. CHECK AND CHANGE Involves checking the resident’s dry/wet status at regular intervals and using incontinence devices and products. Steps for Assessment: H0200B, Response to Trial Toileting Program
1. Review the resident’s responses as recorded during the toileting trial, noting any change in
the number of incontinence episodes or degree of wetness the resident experiences. Steps for Assessment: H0200C, Current Toileting Program or Trial
1. Review the medical record for evidence of a toileting program being used to manage
incontinence during the 7-day look-back period. Note the number of days during the look- back period that the toileting program was implemented or carried out.
2. Look for documentation in the medical record showing that the following three requirements
have been met: implementation of an individualized, resident-specific toileting program that was based on an assessment of the resident’s unique voiding pattern; evidence that the individualized program was communicated to staff and the resident (as appropriate) verbally and through a care plan, flow records, and a written report; and notations of the resident’s response to the toileting program and subsequent evaluations, as needed.
3. Guidance for developing a toileting program may be obtained from sources found in
Appendix C. Coding Instructions H0200A, Toileting Program Trial
Code 0, no: if for any reason the resident did not undergo a toileting trial. This includes
residents who are continent of urine with or without toileting assistance, or who use a permanent catheter or ostomy, as well as residents who prefer not to participate in a trial. Skip to Urinary Continence item (H0300).
Code 1, yes: for residents who underwent a trial of an individualized, resident-centered
toileting program at least once since the most recent admission/entry or reentry or since urinary incontinence was first noted within the facility.
Code 9, unable to determine: if records cannot be obtained to determine if a trial
toileting program has been attempted. If code 9, skip H0200B and go to H0200C, Current Toileting Program or Trial. Coding Instructions H0200B, Toileting Program Trial Response
Code 0, no improvement: if the frequency of resident’s urinary incontinence did not
decrease during the toileting trial.
Code 1, decreased wetness: if the resident’s urinary incontinence frequency
decreased, but the resident remained incontinent. There is no quantitative definition of improvement. However, the improvement should be clinically meaningful—for example, having at least one less incontinent void per day than before the toileting program was implemented.
Code 2, completely dry (continent): if the resident becomes completely continent
of urine, with no episodes of urinary incontinence during the toileting trial. (For residents who have undergone more than one toileting program trial during their stay, use the most recent trial to complete this item.) Code 9, unable to determine or trial in progress: if the response to the toileting trial cannot be determined because information cannot be found or because the trial is still in progress. Coding Instructions H0200C, Current Toileting Program
Code 0, no: if an individualized resident-centered toileting program (i.e., prompted
voiding, scheduled toileting, or bladder training) is used less than 4 days of the 7-day look-back period to manage the resident’s urinary continence.
Code 1, yes: for residents who are being managed, during 4 or more days of the 7-day
look-back period, with some type of systematic toileting program (i.e., bladder rehabilitation/bladder retraining, prompted voiding, habit training/scheduled voiding). Some residents prefer to not be awakened to toilet. If that resident, however, is on a toileting program during the day, code “yes.” Coding Tips for H0200A–C Toileting (or trial toileting) programs refer to a specific approach that is organized, planned, documented, monitored, and evaluated that is consistent with the nursing home’s policies and procedures and current standards of practice. A toileting program does not refer to — simply tracking continence status, — changing pads or wet garments, and — random assistance with toileting or hygiene. For a resident currently undergoing a trial of a toileting program, — H0200A would be coded 1, yes, — H0200B would be coded 9, unable to determine or trial in progress, and — H0200C would be coded 1, yes.
Examples
1. Resident H has a diagnosis of advanced Alzheimer’s disease. They are dependent on the staff
for their ADLs, do not have the cognitive ability to void in the toilet or other appropriate receptacle, and are totally incontinent. Their voiding assessment/diary indicates no pattern to their incontinence. Their care plan states that due to their total incontinence, staff should follow the facility standard policy for incontinence, which is to check and change every 2 hours while awake and apply a superabsorbent brief at bedtime so as not to disturb their sleep.
Coding: H0200A would be coded as 0, no. H0200B and H0200C would be skipped.
Rationale: Based on this resident’s voiding assessment/diary, there was no pattern to
their incontinence. Therefore, H0200A would be coded as 0, no. Due to total incontinence a toileting program is not appropriate for this resident. Since H0200A is coded 0, no, skip to H0300, Urinary Continence.
2. Resident M., who has a diagnosis of congestive heart failure (CHF) and a history of left-sided
hemiplegia from a previous stroke, has had an increase in urinary incontinence. The team has assessed them for a reversible cause of the incontinence and has evaluated their voiding pattern using a voiding assessment/diary. After completing the assessment, it was determined that incontinence episodes could be reduced. A plan was developed and implemented that called for toileting every hour for 4 hours after receiving their 8 a.m. diuretic, then every 3 hours until bedtime at 9 p.m. The team has communicated this approach to the resident and the care team and has placed these interventions in the care plan. The team will reevaluate the resident’s response to the plan after 1 month and adjust as needed.
Coding: H0200A would be coded as 1, yes.
H0200B would be coded as 9, unable to determine or trial in progress. H0200C would be coded as 1, current toileting program or trial.
Rationale: Based on this resident’s voiding assessment/diary, it was determined that
this resident could benefit from a toileting program. Therefore H0200A is coded as 1, yes. Based on the assessment it was determined that incontinence episodes could be reduced, therefore H0200B is coded as 9, unable to determine or trial in progress. An individualized plan has been developed, implemented, and communicated to the resident and staff, therefore H0200C is coded as 1, current toileting program or trial.
Matrix Applicability
Nursing Home Subsets
NC - Comprehensive
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
NQ - Quarterly
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
NP - PPS 5 Day
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
Swing Bed Subsets
SP - PPS 5 Day
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
Program and Policy Use
PDPM
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
Shared NH/SB Subsets
IPA - Interim Payment
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
OBRA Stand Alone Assessments
OBRA Admission A=01, B=99, F=99, G=^, H=0
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
OBRA Quarterly A=02, B=99, F=99, G=^, H=0
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
OBRA Annual / Sig Chg A=03, B=99, F=99, G=^, H=0 A= 04, B=99, F=99, G=^, H=0
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
Item Subset Required Use ISC Skip Patterns
PDPM (A0310B = 01 or 08)
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4