penkay 1 Report Share Posted May 26, 2010 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. Quote Link to comment Share on other sites More sharing options...
bigchris 1 Report Share Posted June 28, 2010 I saw this article as I was doing research on my own article, specific for activity directors. As I was writing, the Nursing Home association was condicting a class and they had to cancel a good portion of it. Why? CMS is still changing the MDS 3.0 documents and overall program. Needless to say, I put a pause on my article! I have calls in to CMS now but all they say id that yes, we are still making changes that will alter the final draft......so stay tuned folks. Quote Link to comment Share on other sites More sharing options...
bigchris 1 Report Share Posted July 23, 2010 It should be noted that CMS has finally "finished" MDS 3.0 and has information on thier web site. As I collect it , I will relay it to you all. BC I saw this article as I was doing research on my own article, specific for activity directors. As I was writing, the Nursing Home association was condicting a class and they had to cancel a good portion of it. Why? CMS is still changing the MDS 3.0 documents and overall program. Needless to say, I put a pause on my article! I have calls in to CMS now but all they say id that yes, we are still making changes that will alter the final draft......so stay tuned folks. Quote Link to comment Share on other sites More sharing options...
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