Care plan/mds questions

[wubby1963 0]

I again am in need of some input first regarding your mds section N, do you all use some or do you have some residents that fall under the category of little or most? Right now I am more or less being told to use the some category. Also again this question has come up that only the residents that rap need activity careplans, what are your feelings on that.

Any and all input is appreciated I was in a meeting for over an hour with our DON, ADON ( who is new) and the Administrator and was told by the new ADON that careplans are only needed when rapping and also that its better to keep all residents at the some category.

 

Suzie in Iowa

[quilterbcathy 0]

Suzie,

I am being told the exact same thing. I'm learning my job out here in California, so things must not be any different anywhere...other than that, I don't know what to tell you, as it is all so new yet to me. There is so much to know... but my DON is being very patient and teaching me... in fact, almost all our dept. heads are new so her hands are FULL with all of us, plus we are in the window for survey now, so we are all pretty nervous about getting our end of the MDS right. She said that MDS' are so complicated that it can take two years to learn all about them. Makes me glad Activities Section N is pretty straightforward and simple, but I've already goofed up a couple of times. So am a little paranoid every time I do my section. One would think it is so simple but it matters when you sign off and date it and what triggers a rap. Yee gads. Last week I didn't even know what a RAP meant. Do you do your MDS's on a computer program?

Cathy

[Pennie 26]

Hi,

The rules have changed as of lately. It use to be that you only write a CP for res. that had a concern/problem. Now that they the State/Feds are using the res. strengths, they are looking for a CP on every res. I like most of you was taught that you needed to CP a res. if they triggered &/or had a problem/concern. Now very, very reliable resources have told me that every res. should have a CP. Also activities should be included in the approaches on other (depts.) approaches. It is a hard to change the way that we (especially the old school professionals) are use to doing things. But now it time for the changes to take place. Every res. is to have a CP. I know that this is a very controversial subject, different views etc. but is it worth taking a chance on?

As far as putting all res. into the "some" category, that will raise a red flag. Not every res. is going to fit into this category. Yes if you put a res. into other categories a trigger will cause a RAP, but it needs to be addressed. You know your res. in the activity area & they are different than the DON sees (deals) with them. So you should put what you know what applies to them. Backup your decision in your progress notes. Remember that you are the AD Professional, trained in this area & it is your name going on the MDS (a legal document) not his/hers. You will be the one to answer to state/feds. if a question was to arise about it.

 

As far as who fills what out on the MDS, section "N" for most of us but I hear pretty soon we will responsible for other sections.

Take note:

The feds. do not care who fills out what section of the MDS as long

as the information is completed by a "qualified professional."

Therefore, facilities can assign whatever sections of the MDS they desire to

whomever the facility thinks is best to complete that section.

 

Surveyors are looking to see that the AD is included in completing areas of

the MDS that relate in any way to quality of life, that would be all of

those sections that you have mentioned. However, most facilities have the

AD complete section N, with perhaps verbal input to the rest. It is up to

the facility policy and procedure and the MDS/care plan team.

 

Whatever section is completed by the AD, he/she should be aware of the

rest of the information recorded on the MDS. It is vital that the AD utilize

this information in formulating the input for activities into the overall

plan of care.

From Pam Sanders, TR/TXC, ACC

Hope this will help you understand better.

[quilterbcathy 0]

Hi, thanks for the information. What scares me is just all of this. I am not yet certified and haven't started school and my administrator says he is waiting for state to finish with survey (they are due any time) to get me started. I thought I read we'd get a deficiency if I wasn't at least enrolled. He probably will "enroll" me just to get by... So I don't have any comfort level with completing the care plans and all else, worried about getting not only everything calendared correctly but carrying out everything (such as activities for the low functioning group). Without really any help...no real training...my administrator when he does approach me wants to know how often I brush the teeth of the therapy dog! That's about it with him! Now he wants me to take two afternoons each week to train with this dog... so something else will have to slip - I think I will put it back to him and in writing - what must I give up in order to spend time with this dog! It is my only planning time. Honestly I think (I know!) they are totally missing the point of AD - I really really believe they see me as the babysitter and are blowing off state... I know better than they but don't have the skills yet as I have said above... I had wonderful training as an Assistant at another facility, I know mostly what I need to do, but to make it all happen with only a 21 yr old immature mostly volunteer (paid for 8 hours/wk but volunteers 2 PM's and one AM so guess what, they don't see the need to pay someone) who doesn't show up half the time and behaves totally inappropriately with residents when she is here...I care darn it! But the state isn't going to see that. I am beginning to wonder if they only have me because of licensing and then will let me go. And I am GOOD at what I do. I was a great assistant and want to do well at this! My DON brushed me off stating that "State won't be looking that hard at Activities charting..." I am documenting these comments, I just have too much pride in what I do to want to be caught in the middle of this! So I guess what I am saying is no matter how much I care and how good I know I can make this, without time and training it won't matter to state and I don't want to get the blame for the program not being on target. Do you see what I mean? I tell them this but they keep blowing it off, except one person, Tuesday I will ask her for a good talk session so hopefully she can help. She stated that I am an integral part of the interdisciplinary team and yes, State will look at me, then mentioned quickly three main things (low functioning...and what else? That's why I need help!) and I told her she is the ONLY one who has told me this and it took her a month to get to me. So much to learn yet with the pressure of state coming! I don't know all my residents like I'd like, just barely having learned names now a month into my job...hardly any time for assessments, learning MDS's but just enough to know what I am doing wrong, don't know HOW to do care plans... HELP! I am drowning! I have to do an outing this week and have no idea what I will need, who is coming on it... it is a SNF so they need LOT'S of help... Sorry to vent but I am really overwhelmed. I am going to tell this person on Tuesday. I want to stay, I love the work, I do it for the residents... but I don't know anymore. I woke at 3 Am this morning and wrote 4 long pages of my worries. Detailed every minute of my day and asked how I can do it all and what else do I need to do to do it right.

Cathy

Edited February 18, 2007 by quilterbcathy

[bigchris 1]

Hello all,

 

 

Can ya'll clarify some items for me, cuz Iam a bit confused...

 

 

1) Is your administrator telling you to falsify records and assess residents higher than they are?

 

2) If so, why?!?! Did they explain?

 

 

3) HAve you explained the new regs to them and that the state surveyors have been EXPLICITLY INSTRUCTED to find flaws in charting re: Activities????

 

Just asking, I didn't wnat to comment without knowing these things.....

 

Be careful....

 

BIGchris

[Pennie 26]

Hi, thanks for the information. What scares me is just all of this. I am not yet certified and haven't started school and my administrator says he is waiting for state to finish with survey (they are due any time) to get me started. I thought I read we'd get a deficiency if I wasn't at least enrolled. He probably will "enroll" me just to get by... So I don't have any comfort level with completing the care plans and all else, worried about getting not only everything calendared correctly but carrying out everything (such as activities for the low functioning group). Without really any help...no real training...my administrator when he does approach me wants to know how often I brush the teeth of the therapy dog! That's about it with him! Now he wants me to take two afternoons each week to train with this dog... so something else will have to slip - I think I will put it back to him and in writing - what must I give up in order to spend time with this dog! It is my only planning time. Honestly I think (I know!) they are totally missing the point of AD - I really really believe they see me as the babysitter and are blowing off state... I know better than they but don't have the skills yet as I have said above... I had wonderful training as an Assistant at another facility, I know mostly what I need to do, but to make it all happen with only a 21 yr old immature mostly volunteer (paid for 8 hours/wk but volunteers 2 PM's and one AM so guess what, they don't see the need to pay someone) who doesn't show up half the time and behaves totally inappropriately with residents when she is here...I care darn it! But the state isn't going to see that. I am beginning to wonder if they only have me because of licensing and then will let me go. And I am GOOD at what I do. I was a great assistant and want to do well at this! My DON brushed me off stating that "State won't be looking that hard at Activities charting..." I am documenting these comments, I just have too much pride in what I do to want to be caught in the middle of this! So I guess what I am saying is no matter how much I care and how good I know I can make this, without time and training it won't matter to state and I don't want to get the blame for the program not being on target. Do you see what I mean? I tell them this but they keep blowing it off, except one person, Tuesday I will ask her for a good talk session so hopefully she can help. She stated that I am an integral part of the interdisciplinary team and yes, State will look at me, then mentioned quickly three main things (low functioning...and what else? That's why I need help!) and I told her she is the ONLY one who has told me this and it took her a month to get to me. So much to learn yet with the pressure of state coming! I don't know all my residents like I'd like, just barely having learned names now a month into my job...hardly any time for assessments, learning MDS's but just enough to know what I am doing wrong, don't know HOW to do care plans... HELP! I am drowning! I have to do an outing this week and have no idea what I will need, who is coming on it... it is a SNF so they need LOT'S of help... Sorry to vent but I am really overwhelmed. I am going to tell this person on Tuesday. I want to stay, I love the work, I do it for the residents... but I don't know anymore. I woke at 3 Am this morning and wrote 4 long pages of my worries. Detailed every minute of my day and asked how I can do it all and what else do I need to do to do it right.

Cathy

Hey Cathy,

My heart goes out to you. I remember having worked with similar dept heads who thought like yours do. They are not giving you & the Ad Dept the respct that it deserves. When they treat you this way it reflects how other staff members treat you. Only you know what you to do but in case you need a little advise start looking for another job. You sound like you would make a great AD, we need all of the good ones we can keep in our profession. After all you are losing sleep over your job, your pride is at stake & it is really not fair to the res. but you can't take that on. I am speaking from expernice! As far as not being certified or qualitified as an AD there are a couple of things here. One the admin will get a deficiency even if you are registered to start the course, they only clear it up once you are finshed with the course. Also you can't sign off on the MDS's unless you are qualitified/certified. So don't do it let somone else do it & take the heat for it like the DON. The admin may be surprised at how state is looking at act. now. (Unless they find a really big problem with another dept, then you may slide by) I am also hearing alot about the FEDS coming in with or right behind state so he should beware.

As far as the dog well you are being used it sounds like but I don't know if you speak with him that it would make any difference, sounds like it won't.

Anyway don't worry about post being to long this is why we are here for advise, venting & siding up with you

Keep us updated & take a step back, breath & take time for yourself, the job is not worth the health risk. The res yes the job no.

Later pennie