Archive for 'MDS Minute'

MDS Section Q: Compliant Return to Community

Posted on 03. Jul, 2014 by .


Consider these 7 questions and know that your resident’s individual rights come first.

Coding a resident’s desire to return to community in Section Q of the MDS does not have to be challenging. Your concern for the facility’s liability, particularly for follow-up care is rightful. Get pointers to ensure a smooth transition:

Here’s a case study that explains what you should be doing:

A blind woman elderly woman, Mrs Smith, lived with her parents until she was married, and then with her husband until he passed away. About five years back, she moved to a nursing home since she was always horrified to live alone. 100 percent of the time she uses a wheel chair. Despite being earlier scared to live by herself, she responded yes to an item Q0500B — Return to Community on her annual MDS assessment. She said that she very much wanted to leave the facility to live independently. She doesn’t have any appointed legal representative. (more…)

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CMS to Conduct Additional MDS 3.0 Training in August

Posted on 06. Jun, 2010 by .


The August training will include MDS 3.0 updates. 

Folks who didn’t get to go to CMS’ April MDS 3.0 training in Baltimore will have another shot at receiving in person training before the new instrument debuts on Oct. 1.

People should “get their nickels and quarters together,” said CMS’ Thomas Dudley during the June 3  SNF/LTC Open Door Forum,  as a way of introducing the training destination: Las Vegas, Aug. 9 through Aug. 13. 

The purpose of the training, added CMS’ Sheila Lambowitz, is to include people on the West Coast who may have been unable to attend the Baltimore training event.

Not Just a Replay


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CMS Shares RUG-IV Payment Plans for Oct. 1, 2010

Posted on 27. May, 2010 by .


CMS to pay RUG-IV rates for the MDS 3.0 with retroactive payment adjustments.

CMS recently provided a heads up on its plans for managing the legislated RUG-IV delay. In a May 24 update for SNF providers, the Centers for Medicare & Medicaid Services noted that the Patient Protection and Affordable Care Act delays RUG-IV until FY 2012, which starts Oct. 1, 2011. The legislative provision, however, requires CMS to implement two RUG-IV features: the limits on concurrent rehab therapy and elimination of the hospital lookback for payment purposes.

CMS Plans to Apply Interim Payments 


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Study Connects Elderly People’s Falls with Blood Pressure and Flow

Posted on 21. May, 2010 by .


Seniors with blocked arteries fall an average of 1.5 times a year.

There could be a significant link between high blood pressure, slow blood flow in the brain, and incidence of falls in elderly people, according to a study published by the Institute for Aging Research of Hebrew SeniorLife. The purpose of the study was to determine causes of falls in older adults in order to develop new ways to prevent falls from occurring.

Researchers looked into 420 people over the age of 65 enrolled in the MOBILIZE Boston Study (Maintenance of Balance, Independent Living, Intellect and Zest in the Elderly), a long-term cohort study based at the Institute for Aging Research. For 24 months, participants were subjected to several breathing exercises and walking speed tests before their blood flow was measured.

The results revealed that seniors with the smallest blood flow changes fell an average of 1.5 times per year, and had the slowest walking speeds. Those with the highest rate averaged less than one fall a year.

“Our findings show that low vasoreactivity, a measure of blood flow in the brain, is associated with slow gait and the development of falls in elderly people,” neurologist Farzaneh Sorond, MD,  a scientist at the Institute for Aging Research and lead author of the study, said in a press release. He noted that altered blood flow in the brain becomes a more significant concern as people age.

Check Out These Findings


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LTC Planning Starts With Knowing the Bottom Line, Options

Posted on 14. May, 2010 by .


Preparing for future long-term care is a conversation everyone should have.

Thinking through long-term care costs and coverage should be part and parcel of all retirement planning.  In fact, one financial counselor notes that you either talk long term care (LTC) to clients or risk seeing them lose their savings in the blink of an eye. That’s the advice John W. Wheeler Jr., vice president of Water Tower Financial Partners LLC, imparted at the Retirement Income Summit in Chicago, addressing primarily financial and insurance advisers, according to a report by Investment News.

Financial people usually avoid discussing LTC with their clients because the idea of nursing homes and LTC facilities carries a negative connotation. But that’s a mistake. “We have to get emotion in the mix,” Wheeler was quoted as saying in the article.

Noting that more people will reach their 100th birthdays in the future, an article in The State cautions people to consider their retirement carefully, including the potentially devastating expenses of a long-term condition, such as Alzheimer’s.

“With the cost of long-term care approaching $100,000 per year, few retirees’ portfolios can withstand the hit of several years in such a care facility,” said Bryan Clintsman, a certified financial planner in Southlake, Texas, in the article. “One of the saddest things I see is a married couple who enters retirement at age 65, then one of them comes down with something really cruel like Alzheimer’s, spends the next five years in a facility draining their retirement assets, then dies, leaving the surviving spouse to live on almost nothing for the rest of their retirement.”

Know the Options (more…)

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Ramp Up for the MDS 3.0 Interviews Now — Here’s How

Posted on 08. May, 2010 by .


Tips help residents participate more fully.

The MDS 3.0 resident interviews will play a pivotal assessment role once the instrument goes live on Oct. 1. And now’s the time for your team to get a solid grip on the interviews and process.

The MDS 3.0 RAI User’s Manual  spells out how to select residents for the sections requiring interviews (pain, cognition, mood, preferences for customary routine and activities, and return to community/overall goals).

 “Based on the guidelines,” the only time you do an interview is when you’ve coded the resident as sometimes understood — “and if an interpreter is needed, one’s present,” says Marilyn Mines, RN, RAC-CT, BC, manager of clinical services for FR&R Healthcare Consulting in Deerfield, Ill.

The MDS 3.0 RAI User’s Manual includes instructions for each section’s interviews.

Key point: Staff doing interviews will have to help the resident to stay focused by narrowing their choices for answering while also helping them express their choices, says Rena Shephard, MHA, RN, RAC-MT, C-NE, president and CEO of RRS Healthcare Consulting in San Diego. The goal is to elicit the information intended by the items, she notes.

Read on … For additional tips, including ones from a SNF provider,  that will help you get the best interviews possible, read the rest of this article in MDS Alert, Vol. 8, No. 3, available online immediately when you subscribe.

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Tap the MDS 3.0’s Heightened Risk Prediction Powers

Posted on 30. Apr, 2010 by .


Coding for falls and behaviors can give you an edge in heading off problems.

The MDS 3.0 allows you to distill a more accurate resident risk profile to head off problems from admission on. Check out these five key assessment areas to take your care planning and trouble shooting to a new level.

1. Fall-related injuries. The MDS 3.0 captures the level of fallrelated injury (see page 42 of MDS Alert, Vol. 8, No. 4), so CMS will have more information about the facility’s fall outcomes, says Christine Twombly, RNC, RACCT, a consultant with Reingruber & Co. in St. Petersburg, Fla. She’s not certain facilities always track the types of injuries and their severity as part of their quality assurance efforts. The MDS 3.0, however, “will encourage them to do so in order to code that section accurately,”Twombly points out.

Analyzing fall-related injuries may help you review not only compliance with certain fall-related interventions, but also their effectiveness, Twombly notes. Examples include use of hip pads, fall mats by the bed, and rehab therapy aimed at improving balance and teaching people how to fall in a way that helps prevent injuries.

Injuries may be more common or worse in people with certain conditions. “For example,” says consultant Jane Belt, MS, RN, RAC-MT, “a diagnosis of osteoporosis certainly makes a resident more vulnerable to fracture with any kind of fall.” The resident on anti-coagulation therapy has a heightened risk of serious injury due to bleeding.

Check out this key point …


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Be Prepared to Do Discharge MDS Assessments When the MDS 3.0 Goes Live

Posted on 16. Apr, 2010 by .


Find out what CMS may be able to tell based on this assessment.

Unless CMS makes a change before the MDS 3.0 rolls out on Oct. 1, your team will be doing MDS discharge assessments that make the current discharge tracking requirements seem like a breeze. The extra work will also provide additional information potentially to CMS and to surveyors.

The MDS 3.0 RAI manual requires doing the MDS assessments for residents being discharged regardless of whether they are expected to return, says Rena Shephard, MHA, RN, RAC-MT, C-NE, founding chair and executive of Nurse Assessment Coordinators and president and CEO of RRS Healthcare Consulting Services in San Diego. By contrast, the MDS 2.0 requires a few items to track resident discharges, she notes. That’s one thing “that has folks a little stirred up due to the time it takes to do the additional MDS assessment. I keep hoping that [the time requirement] will balance out because the MDS 3.0 as it was tested took less time to do than the MDS 2.0.”

So what’s behind the discharge assessment requirement? (more…)

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MDS: Promote Optimal Bed Mobility With These 2 Enablers

Posted on 22. Mar, 2010 by .


A small rail or trapeze could get the patient or resident moving.

Looking for ways to help prevent pressure ulcers, lift mood, and improve quality of life to boot? Give residents the tools to be as independent as possible with their bed mobility.

For example, you can provide a one-eighth rail that hooks on the side of the bed to help residents reposition in bed or to get in and out of bed, says Cheryl Field, MSN, RN,CRRN, healthcare specialist with PointRight Inc. in Lexington, Mass.

Tip: If a resident’s mattress is soft, “he might need a small siderail to assist him [with bed mobility] due to the … mattress surface tension,”says Field. That’s because the soft mattress may make it difficult for him to push down with his hands on the soft surface to position himself. If so, “you’ll notice that the person has an easier time getting off a padded table in the rehab gym,” says Field. (In that case, you might also check into providing the resident a firmer mattress.)

Litmus test:When using any device attached to the side of the bed, “always assess” whether the person can use it to improve his or her independence, advises Field. And determine whether the device acts as a restraint, which might be the case if it blocks the person’s vision so he can’t see the hallway when he’s resting, she says. “That could act [as a psychological restraint] if the person can’t see people as they come by and begins to feel socially isolated.”

Also “if someone is afraid of a device and doesn’t use it, he or she could choose to remain still in the bed,” Field adds.

But “if the person emotionally feels better getting out of bed with a tiny rail next to him,” which he uses when transferring, then it’s not a restraint, says Field. You have to continue to do this assessment over time, as the resident’s condition and abilities could change.

Evaluate Whether a Trapeze Could Be the Answer

A resident with sufficient strength may be able to use a trapeze to position himself in bed. You can also “put up a trapeze to help someone develop upper body strength,” Field says. For example, “someone with a spinal cord injury has to have huge upper body strength.”

Keep in mind: “The size of the trapeze affects different muscles,” Field notes.

A smaller trapeze will work on shoulder muscles but not so much the person’s back, she adds. And since “there are different types of trapezes, it’s a good idea to have a physical therapist help the team think through which one is best for the resident given the underlying limitations in range of motion in his or her back or shoulders,” Field counsels.

Pressure-ulcer prevention tip:

Make sure the resident with a trapeze on their bed can use it “without dragging himself across the bed surface,” advises Carol White, RN, MS, ANPC, GNPC, DNP, CLNC, principal of NationalHI Inc. in Huntington, Ind. If the person has had the trapeze for some time, he may have deteriorated and not be able to use it safely and effectively, she cautions. And “this puts him at higher risk for a shear injury.”

AUDIO TRAINING EVENT: Sync your therapy and nursing documentation with MDS 3.0.

© MDS Alert.

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Keep the Spotlight on Quality Assurance During the MDS 3.0 QI/QM ‘Blackout’

Posted on 08. Mar, 2010 by .


Consider using these 2 CMS survey forms to manually track quality issues.

Once the MDS 3.0 goes live, nursing facilities and surveyors will move into a temporary “blackout” phase where they won’t have access to the quality indicators/measures reports. And now is the time for your team to start thinking through options for how to make do without those automated QI/QM reports flagging quality-of-care concerns and residents in need of more in-depth review.

In a nutshell: The Centers for Medicare & Medicaid Services will take down the QI/QM reports for a “number of months” after MDS 3.0 implementation because there won’t be enough residents in a particular nursing facility with MDS 3.0 assessments to populate the reports for some time, confirmed the agency’s Karen Schoeneman, in a CMS Webinar on the MDS 3.0.

The bottom line: Facilities will have to find a way to track their clinical issues during that time, says Sue LaBelle, RN, MSN, a healthcare specialistwith PointRight Inc. in Lexington, Mass. “Internally, facilities should be able to track prevalence-based measures, such as falls, pressure ulcers, infections, etc.,” LaBelle says.

Tap the CMS 802 and CMS 672 … (more…)

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