penkay

MDS 3.0 update 2010/02/08 A Closer Look at the MDS 3.0: News and Overview for Activity and Recreation Professionals By Kimberly Grandal, CTRS, ACC/EDU February 8, 2010 The MDS 3.0 implementation date is scheduled for October 1, 2010. CMS highly recommends that everyone should hold back from training until after the "Train-the-Trainer" sessions have been completed. The Train-The-Trainer sessions are scheduled for the spring of 2010. Although its still too early to start training the staff on how to complete the MDS 3.0, its important to keep abreast of any MDS 3.0 news. The RAI User Manual is available for download. Its not too early to start reviewing these materials and familiarize yourself with the new terminology, form design and layout, and the process. This way you will be more prepared to ask questions when you are presented with specific training opportunities. Ive begun reading various components of the RAI Version 3.0 Manual. The following is a summary of what I have gathered to date. Advantages of the MDS 3.0 A 5-year CMS Nursing Home MDS 3.0 Validation Study suggests that the MDS 3.0 has many advantages such as: Increased residents voice Increased clinical relevance for assessment Increased accuracy, both validity and reliability Increased clarity and efficiency 45% reduction in the average time for completion Supports the movement of items toward future electronic formats Downloads The CMS website has the MDS 3.0 materials, forms, timetables, RAI User Manual, etc. available for download. Visit http://www.cms.hhs.gov/NursingHomeQualityInits/25_NHQIMDS30.asp To download the MDS 3.0 RAI user manual scroll down the page and click on MDS 3.0 RAI Manual Jan 2010. The section for Customary Routine and Activities is called section F and is located in the Chapter 3 file folder. The section which refers to Recreation Therapy can be found in section 0, Special Treatments and Procedures. You can also download sections F and O at www.recreativeresources.com/MDS3.0.htm Other items to download on the CMS website include: o MDS 3.0 Item Subsets A file that contains the various subsets of the MDS 3.0 assessment and tracking document such as admission, quarterly, annual, significant change, discharge, etc. o MDS 3.0 Item Matrix - This document identifies the items required for each type of assessment along with how the item is used (e.g. QMs, QIs, CATs, RUG-IV, or RUG-III). o MDS 3.0 Data Submission Specifications - Detailed data submission specifications for MDS 3.0. o MDS 3.0 CATs Specifications - This document provides Care Area Trigger (CAT) specifications for the MDS 3.0 items used in triggering the Care Area, the conditions for triggering, and Visual Basic code for triggering. Education CMS provided a webcast, entitled, MDS 3.0: Part 1- An Introduction, on December 17, 2009. You can view this archived webcast for free at http://surveyortraining.cms.hhs.gov/pubs/VideoInformation.aspx?cid=1074 This webcast was the first of a three part series focused on providing information about the MDS 3.0. The other webcasts in the series include: o 2nd Part: Coding the MDS 3.0 (late spring/early summer, 2010) o 3rd Part: CMS Programs impacted by the MDS 3.0 (summer, 2010 Resident Assessment Instrument Overview The Resident Assessment Instrument (RAI) version 3.0 is no different than the 2.0 version in that it is a structured, standardized approach for applying a problem identification process in nursing homes. Completion of the RAI includes: assessment, decision making, care planning, care plan implementation and evaluation. Care Area Assessment The Care Area Assessment (CAA) process provides guidance on how to focus on problems, concerns or important issues that are identified in the comprehensive and MDS assessment. There are 20 CAA-s which include: 01. Delirium 02. Cognitive Loss/Dementia 03. Visual Function 04. Communication 05. ADL Function/Rehabilitation Potential 06. Urinary Incontinence and Indwelling Catheter 07. Psychosocial well-being 08. Mood State 09. Behavioral Symptoms 10. Activities 11. Falls 12. Nutritional Status 13. Feeding Tube 14. Dehydration/Fluid Maintenance 15. Dental Care 16. Pressure Ulcer 17. Psychotropic Drug Use 18. Physical Restraints 19. Pain 20. Return to Community Referral The MDS 3.0 identifies the actual or potential problem areas and the CAA process provides for further assessment. Care Area Triggers (CATs) replaced the MDS 2.0 Resident Assessment Protocol (RAPs). The triggers identify those who have or are at risk for developing various functional problems in any of the 20 CAAs and directs staff to evaluate further. The Care Area Resources is a list of resources that may be helpful in performing the assessment of a triggered care area. The Care Area Summary (Section V of the MDS 3.0), provides a location for documentation of the care areas that have triggered from the MDS and the decisions made during the CAA process regarding whether or not to proceed with care planning. Just as with the MDS 2.0, further documentation for each triggered CAA is required. Documentation for each triggered CAA should describe: The nature of the issue, concern or condition Causes and contributing factors Complications related to the specific care area Risk factors Need for referral or further evaluation by appropriate health care professionals What research, resources or assessment tools were utilized There are four types of triggers which can change how the CAA is reviewed: Potential Problems Broad Screening Triggers Prevention of Problems Rehabilitation Potential In terms of activities, the purpose of the CAA is to identify strategies to assist the resident in increasing their involvement in meaningful activities that have been of interest to them in the past and to help them find new or adapted activities of interest to accommodate their current level of functioning. The CAA for activities is triggered when there are indications that the resident may have a decrease in involvement in social activities. The information from the assessment should be used to identify residents who may be uneasy in social relationships and activities. In addition, assessment information is to identify resident interests and identify possible causes or risk factors. Chapter 4 of the CMS RAI Version Manual also addresses care planning. Tips for care planning are provided. The manual indicates six general care planning areas: Functional status Rehabilitation/Restorative Nursing Health Maintenance Discharge Potential Medications Daily Care Needed When residents trigger for activities, the CMS RAI Version 3.0 manual states that the focus of the care plan should be to address the underlying cause(s) and the development of the inclusion of activity programs customized to the residents interests and his or her abilities. Activities should focus on helping the resident fulfill his/her wishes, use cognitive skills and provide enjoyment as well opportunities for socialization with others. Preferences for Customary Routine and Activities (Section F) A section with significant revisions is the Preferences for Customary Routine and Activities. The customary routine staff assessment is replaced by the MDS 3.0 Preference Assessment Tool. Residents are to be interviewed for their activity interests and routine preferences. The RAI Version 3.0 Manual suggests various ways for the interviewer to phrase the questions, probe for clarification of residents responses and to utilize adaptive techniques such as cue cards, an interpreter, opportunity to write out answers, etc. The residents are to rate the level of importance by using the following codes: 1. Very important 2. Somewhat important 3. Not very important 4. Not important at all 5. Important, but cant do or no choice (meaning the resident finds it important but feel he/she cannot do that at this time because of health or because of nursing home resources or scheduling. 9. No response or non-responsive (resident, family or significant other refuses to answer or doesnt know, if the resident does not respond to the question, or provides a nonsensical response. A nonsensical response is defined as, any unrelated, incomprehensible or incoherent response that is not informative with respect to the item being rated. When coding the activity preferences interview, no look back is provided. The resident is to respond to their current preferences while in the facility. Family members and significant others may be the primary respondent to the interview questions if the resident is unable to do so. In this case, the family member or significant other may have to consider past preferences if they are unsure of current preferences and the resident is unable to communicate. There is a series of questions that relates to the residents preferences for daily routine such as bathing, bedtime, clothing, etc. The questions relating to activities include: How important is it to you to have books, newspapers, and magazines to read? How important is it to you to listen to music you like? How important is it to you to be around animals such as pets? How important is it to you to keep up with the news? How important is it to you to do things with groups of people? How important is it to you to do your favorite activities? How important is it to you to go outside to get fresh air when the weather is good? How important is it to you to participate in religious services or practices? For residents who cannot answer the questions and a family member or significant other is not available to answer on behalf of the resident, a staff assessment of activities and daily preferences is conducted. Staff is instructed to observe the residents response during activity programs. A variety of routine and activity preferences are listed and staff is to check off each item as it applies in the last 7 days. The items listed are as follows: A. Choosing clothes to wear B. Caring for personal belongings C. Receiving tub bath D. Receiving shower E. Receiving bed bath F. Receiving sponge bath G. Snacks between meals H. Staying up past 8:00 p.m. I. Family of significant other involvement in care discussions J. Use of phone in private K. Place to lock personal belongings L. Reading books, newspapers, or magazines M. Listening to music N. Being around animals such as pets O. Keeping up with the news P. Doing things with groups of people Q. Participating in favorite activities R. Spending time away from the nursing home S. Spending time outdoors T. Participating in religious activities or practices Z. None of the above In a sample of individuals that completed the revised Preferences for Customary Routine and Activities (Section F), findings indicated that: 81% rated the interview items as more useful for care planning 80% found that the interview changed their impression of residents wants 1% felt that some residents who responded didnt really understand the items More likely to report that post-acute residents appreciated being asked Special Treatments and Therapies (Section O) The RAI Version 3.0 Manual states that recreational therapy is not a skilled service according to the Social Security Act however, for purposes of the MDS, providers should record services for recreational therapy when the conditions for the provision of recreation therapy are as follows: The physician orders recreation therapy that provides therapeutic stimulation beyond the general activity program; The physicians order must include a statement of frequency, duration and scope of treatment; The services must be directly and specifically related to an active written treatment plan that is based on an initial evaluation performed by a therapeutic recreation specialist; The services are required and provided by a state licensed or nationally certified therapeutic recreation specialist or therapeutic recreation assistant who is under the direct supervision of a therapeutic recreation specialist; and The services must be reasonable and necessary for the residents condition. The assessor records the number of days and the minutes that recreation therapy was administered over the 7 day look back period. Sessions must be at least 15 minutes in length. The RAI Version 3.0 Manual states that therapy logs are not a MDS requirement but is standard of good clinical practice by all therapy professionals. Its also important to note that when two clinicians work together, which may be common with a recreational therapist and an occupational therapist, the clinicians must split the time between the two disciplines. Music Therapy is included under Recreational Therapy as well. Recommendations Visit the CMS website regularly using the link I provided above. Download and print the items that are available on the CMS website and put it in a binder. Read the RAI User Manual and review all MDS 3.0 materials. Write down your questions as you read the manual. Have these questions available during formal training sessions. Please share what you have learned with others. You can email me and I will post news and information at http://www.recreativeresources.com/MDS3.0.htm as I receive it. I will also address MDS 3.0 issues on my Facebook group page at www.tiny.cc/ReCreativeResourcesonFacebook Kim Grandal ACC/EDU, is the Executive Director of Re-Creative Resources, Inc (www.recreativeresources.com), and serves as a government relations liason to NCCAP. Kim has given her permission for Activity Directors Network to post this article and we thank her.

Activity Directors...Shah Noorani would like you to bring your residents to herFirst Annual Bingo Tournament at Grace Care Center at NorthPointe Blvd. Grace Care Center 11830 NorthPointe Blvd Tomball TX 77377 is having a Bingo Tournament on June 18th 2pm. Would you like to bring your Residents to Tournament? Please RSVP to Shah Noorani:Phone No: 281-205-9448 Cell:713-478-9337Thanks.Shah Noorani - Activity Director.

You could also have a raffel -- fix up something related to Father's Day or July Fourth & sell raffel ticket -- hold a craft show at the facility, sell booth spaces to the community & advertise this in the paper, local stores, signs in the neighbor hood etc.. --- ask family members, staff, volunteers & residents to donate items & hold a garage sale at the facility -- you might ask the place that has the equipment you want if they will donate it or what is the lowest price they will sell it to the facility for. Best of luck

I would tell the clothing store that you place the info in your monthly newsletter. Telling the families & residents about their services & when they will be visiting the facility. Make an activity around it or at least count the residents that attend this & be sure to chart it.

Do You Remember All the girls had ugly gym uniforms? It took three minutes for the TV to warm up? Nobody owned a purebred dog? When a quarter was a decent allowance? You'd reach into a muddy gutter for a penny? Your Mom wore nylons that came in two pieces? You got your windshield cleaned, oil checked, and gas pumped, without asking, all for free, every time? And you didn't pay for air? And, you got trading stamps to boot? Laundry detergent had free glasses, dishes or towels hidden inside the box? It was considered a great privilege to be taken out to dinner at a real restaurant with your parents? They threatened to keep kids back a grade if they failed. . and they did it! When a 57 Chevy was everyone's dream car...to cruise, peel out, lay rubber or watch submarine races, and people went steady? No one ever asked where the car keys were because they were always in the car, in the ignition, and the doors were never locked? Lying on your back in the grass with your friends? and saying things like, 'That cloud looks like a... '? Playing baseball with no adults to help kids with the rules of the game? Stuff from the store came without safety caps and hermetic seals because no one had yet tried to poison a perfect stranger? And with all our progress, don't you just wish, just once, you could slip back in time and savor the slower pace, and share it with the children of today. When being sent to the principal's office was nothing compared to the fate that awaited the student at home? Basically we were in fear for our lives, but it wasn't because of drive-by shootings, drugs, gangs, etc. Our parents and grandparents were a much bigger threat! But we survived because their love was greater than the threat. . .as well as summers filled with bike rides, Hula Hoops, and visits to the pool, and eating Kool-Aid powder with sugar. Didn't that feel good, just to go back and say, 'Yeah, I remember that'? I am sharing this with you today because it ended with a Double Dog Dare to pass it on. To remember what a Double Dog Dare is, read on. And remember that the perfect age is somewhere between old enough to know better and too young to care. Send this on to someone who can still remember Howdy Doody and The Peanut Gallery, the Lone Ranger, The Shadow knows, Nellie Bell , Roy and Dale, Trigger and Buttermilk. How Many Of These Do You Remember? Candy cigarettes Wax Coke-shaped bottles with colored sugar water inside. Soda pop machines that dispensed glass bottles. Coffee shops with Table Side Jukeboxes. Blackjack, Clove and Teaberry chewing gum. Home milk delivery in glass bottles with cardboard stoppers. Newsreels before the movie. Telephone numbers with a word prefix...( Yukon 2-601). Party lines. Peashooters. Howdy Doody. Hi-Fi's & 45 RPM records. 78 RPM records! Green Stamps. Mimeograph paper. The Fort Apache Play Set. Do You Remember a Time When.. Decisions were made by going 'eeny-meeny-miney-moe'? Mistakes were corrected by simply exclaiming, 'Do Over!'? 'Race issue' meant arguing about who ran the fastest? Catching The Fireflies Could Happily Occupy An Entire Evening? It wasn't odd to have two or three 'Best Friends'? Having a Weapon in School meant being caught with a Slingshot? Saturday morning cartoons weren't 30-minute commercials for action figures? 'Oly-oly-oxen-free' made perfect sense? Spinning around, getting dizzy, and falling down was cause for giggles? The Worst Embarrassment was being picked last for a team? War was a card game? Baseball cards in the spokes transformed any bike into a motorcycle? Taking drugs meant orange - flavored chewable aspirin? Water balloons were the ultimate weapon? If you can remember most or all of these, Then You Have Lived!!!!!!! Change this into an activity for your residents who may need a break from their 'Grown-Up' Life . . I Double-Dog-Dare-Ya!

Hi Bennie There is a really good networking group in houston. they have guest speakers sometimes & other times they just meet & share. There is always a lunch & they meet once a month. The meeting places vary from omth to month as ADs take turns hosting it at their facility or they get a local resturant to let them do it there etc. Contact Donna Martin (she is one of the founders for this group) her email address is martindonna@hotmail.com Let us know what happens & if you start your own group you can post it here monthly. HappyThanksgiving Pennie

Hi Becky It is all really hard to figure out! First off you need to take MEPAP (part 1) of the course. That will get you "Qualitified" to work in the long term care setting. This is all you need to have to meet the Fedral Guidelines FTAG 249 -- Now if you want to go on become "Certified" then you will need to take the second part of the MEPAP course. You will also have someother requirements to become certified as set by NCCAP.org If you go to their site & look at the ADC & levels of certification for AD's you will see 4 tracks. You choose the track based upon your education level. Say you have no college then look at track 4 & you will need do everything that is under that track to get certified. The good thing is once you have done everything you will only have to renew every 2 years with CEU's. It seems like it is overwhelming but if you take it 1 step at a time you can get it done. Once you take the MEPAP part 1 you have 5 years to fulfill all the requirement to getting certified. You may also what to check your facility policy & procedure to see what they require. This is what I found for Alaska state regs; 07 AAC 012.285. Activity Program. A nursing facility must provide an activity program that is available to all residents and encourages each resident to attain and maintain function at the highest practicable level. The program must address the intellectual, social, spiritual, creative, cultural, and physical needs, capabilities, and interests of each resident. Also, the program must encourage self-determination and well-being of the residents. If a physician finds a resident as medically able to participate in an activity program, that finding and any conditions of the resident's participation or contra-indications to that participation must be noted in the resident's record at the nursing facility. The activity program coordinator, with an interdisciplinary team, shall develop the resident's individual activity program. The activity program coordinator shall consult as necessary with an occupational or recreational therapist, unless the activity program coordinator meets the requirements of 42 C.F.R. 483.15(f)(2), revised as of October 1, 1991. I hope this helps you out. Good luck Pennie

URGENT: Health Care Reform Bill to Slash at Least $44 Billion in Medicare Payments to Skilled Nursing Facilities Yesterday, HR 3200, America's Affordable Health Choices Act of 2009, was introduced in the US House of Representatives. The bill contains detrimental cuts to Medicare payments for Skilled Nursing Facilities which amount to at least $44.9 billion in cuts for Medicare Payments to SNFs alone. This staggering number doesn't account for the $16 billion in regulatory cuts being proposed by the Centers for Medicare and Medicaid Services (CMS) by August The moment to take action is NOW. We ask that you weigh in with your U.S. Representative and let him/her know that cuts of this magnitude are simply unsustainable. Tell your Representative that cuts to Medicare will have a negative impact on nursing homes and will create a ripple effect - putting at risk the quality of care to the frail, elderly and disabled and the loss of tens of thousands of jobs for long term care providers across the country. We must put a stop to these egregious cuts before it's too late. Congress has made health care reform a priority this year and intends to pass a bill as early as August. Your voice needs to be heard on this vital issue. You can take action today by sending a letter to your U.S. House Representative and tell them to OPPOSE Medicare payment cuts to SNFs contained within HR 3200, America's Affordable Health Choices Act of 2009. Please go to this link: http://capwiz.com/ahca/issues/alert/?alertid=13738636 enter your zip code follow directions from there

CMS releases updates to quality of life F-tags Contemporary Long-Term Care Weekly, June 18, 2009 The Centers for Medicare & Medicaid Services (CMS) recently released several revisions to its Quality of Life F-tags. The revisions under the State Operations Manual, Appendix PP, Guidance for Surveyors went into effect on June 12, 2009. The following F-tags were revised: F172 Access and Visitation Rights F175 Married Couples F241 Dignity F242 Self-Determination and Participation F246 Accommodation of Needs F247 Notice Before Room or Roommate Change F252 Safe, Clean, Comfortable and Homelike Environment F256 Adequate and Comfortable Lighting F371 Sanitary Conditions F461 Resident Rooms F463 Resident Call System In addition to the revisions, CMS deleted F255, Private Closet Space, and moved the regulatory language to F461, Resident Rooms. Go to the link below & once there click on the CMS'Tramsmittal 48 it willopen up as a pdf file (adobe) http://www.cms.hhs.gov/transmittals/downloads/R48SOMA.pdf

Be sure that you document in your Resident Council mins. why you have bingo 3 or more times a week. This way when state comes in you are covered. -- What I mean is that when I tried to cut back on bingo @ at facility (that had it often) the residents get very upset. This was voiced very loudly to me. When state came in they wanted to know why so much bingo etc. I showed them the Resident Council mins & avoided a lot of problems, since it was in the mins & it was a demand/request by the residents. Truth be told the residents would play bingo everyday of the week if I would allow it! It does get to be out of hand at times, residents get bossy, demanding, fighting over cards etc.. So I had to finally take it off of the calendar for a month. They had plenty of warnings that if they didn't stop behaving like children (verbally & in resident council) that it would be taken away. The social worker was asked to speak to all of the residents as well. So it did get removed & the next month it was placed back on the calendar & they acted like adults, went much smoother. I have alway had men as well as women attend, but the men usually enjoyed the Pokeno better that regular bingo. As far as prizes -- once a month was played for 25 cents & black-out was for a dollar -- the rest of the time we used play money & I had a bingo cart -- on the cart I had chips, candy, figurines, $1 store items (some of the items were donated by various folks & rest bought by act dept, set up a account with the folks that fill you vending machine or talk to the dietary manger about her vendors) Like some of you I had the problem of residents saving their bucks & cashing them all at once - so a new rule was put into effect the money expired after 30 days (we started Xeroxing our money every month ie. March was green for St Patty's Day, Feb was pink for Valentines etc. It takes some time & standing behind the change but in the end it works out & is accepted. Good Luck & hope this helps some of you.

Hi Big Chris Over the years I was always told that every resident has to have a CP -- This was hard for me to grasp as not every resident had a concern -- Now they say to use a residents strengths to write a CP -- This has made it easier for most of us -- Maybe a sample of 1 CP for a resdeint who is OOR, active, engaged, content but not over doing it something along these lines you fill in the rest of what type of resident it might be Many thanks for all you input & help to us.

Hi Probably this will vary from state to state as well as facilitiy to facility -- I have always done as the other AD from GA said that we did Pretty Nails, we were lucky enough to have a Beauty Shop in the facility so res., got their hair done there. The Men had a chance to get theirs done there or once a month when the barb came in. -- As far as ADL's & taking to restroom this should be the CNA's job. You are not trained to lift residents nor to do their ADL's, if you dropped a res or hurt them this could turn out to be nasty law suit! I have hired assistance who were CNA's this has always back fired on me. Because when they (nursing) were short handed (which is usually always) they would pull her/him from activities to work the floor. You have a salary budget for your dept for you & your assistance(s). Nursing has theirs so let them get their own help (hire more CNA's) using their budget. Stand up for your dept if possible, activities is just as important as nursing & we don't want residents or other staff to start seeing us as nursing. Ok off of this ban wagon it just gripes me when they think we do so little or less important thatn other depts. Of course we must help each other (team work) out but with in reason.