Those who work in the Nursing Home industry are very aware of the importance of accurately capturing ADLs (Activities of Daily Living) data on dependency, rehabilitation therapy minutes provided, and skilled nursing services, just to name a few areas, when completing scheduled MDS 3.0 assessments for Medicare and Medicaid reimbursement purposes. There are a host of organizations that offer services to nursing facilities to assist with reimbursement, including preparing a facility for a RAC or other reimbursement audit. While reimbursement is important, it is also essential to have an accurately completed MDS 3.0 assessment so that an individualized plan of care can be developed and implemented for the nursing home resident.
If a facility’s clinical staff completes an MDS accurately, correctly applies the CAA (Care Assessment Area) process, then develops and implements an individualized comprehensive care plan that is periodically evaluated by the nursing home’s Interdisciplinary Team with the input of the resident and/or their designated representative, then the facility has a sound system in place.
In fact, a truly comprehensive care plan goes beyond addressing only the triggered CAAs. It acknowledges all of the resident-specific problems, strengths and needs – it paints a picture of who the resident is. Regardless of whether the nursing home develops a comprehensive care plan or has implemented a standard of care system that facilitates care planning by exception (documenting only the resident-specific items in the care plan beyond the standard of care), the MDS 3.0 will still provide a wealth of information.
Therefore, the importance of the accuracy of the MDS 3.0 document needs to extend beyond establishing reimbursement for a given time period. This assessment tool gives a nursing home a great deal of information regarding so many aspects of an individual resident that should be acknowledged in developing a plan of care for that resident. The MDS process currently incorporates resident interviews to obtain information on a resident’s mental status, mood state, preferences for customary routine and activities, and pain - all significant factors that affect Quality of Life and Quality of Care.
For example, the interview for preferences for customary routine and activities can be a rich source of information to individualize a plan of care based on resident choice and likes/dislikes. In fact, the assessment’s directive for this specific interview is to attempt to complete the interview with a family member or significant other if the resident is unable to be interviewed, providing more thorough data.
This interview provides the nursing home with pertinent information regarding “Mr. Smith’s” prior life and his expectations of how he would like his life to be when in the nursing home. With this type of information available regarding past lifestyle and current preferences, the nursing home staff should find it difficult to ignore the individuality of the resident, resulting in a good quality of life for a happy, satisfied resident.
A different perspective on the resident is obtained from interviewing the clinical staff responsible for the resident’s care, leisure needs, etc. These interviews to obtain information need to include staff from all shifts, as a true picture of the resident cannot be captured if the clinicians responsible for any portion of the MDS only speak with daytime caregivers.
Quality of Life and Quality of Care concerns are highlighted when the MDS is accurately completed, and the information from these assessments is essential in developing a plan of care. When a nursing home is surveyed, the data from MDS assessments is utilized in determining which care areas should be assessed by the State survey team. This data is utilized to provide information on the Quality Measures for CMS’S CASPER reporting system. Some of the measures include excessive weight loss, falls with a major injury, use of physical restraints, pain, and new or worsening pressure ulcers.
An inaccurate MDS assessment can result in inaccurate Quality Measure information. Clinical staff members responsible for completing the MDS assessment need to be well-trained and knowledgeable in accurate completion of this assessment, as well as in identification of potentially problematic areas that might not trigger on an MDS but should be recognized when developing an individualized plan of care.
All staff involved in the completion of MDS assessments and the associated development of an individualized, comprehensive care plan need to understand that the information found in the MDS is a key component in the fabric of a nursing home resident’s life. While reimbursement is a great incentive for proper completion of an MDS assessment, recognition also needs to be given to the value that accurate MDS information plays in the quality of daily life and care for nursing home residents.