The Centers for Medicare and Medicaid Services' (CMS) tool for facilitating care management in nursing homes is called the Minimum Data Set (MDS), a core set of screening and assessment elements that is part of a Resident Assessment Instrument (RAI). The RAI provides a comprehensive and standardized assessment of each long-term care facility resident's functional capabilities and helps staff to identify health problems. This assessment is performed on every resident in a Medicare and/or Medicaid-certified long-term care facility. In this series, we examine seven areas of care.
Mood distress is a serious condition that is under-diagnosed and undertreated in nursing homes and can lead to death. MDS 3.0 seeks to reduce the morbidity caused by mood disorders.
Depression can be associated with:
- psychological and physical distress (e.g., poor adjustment to the nursing home, loss of independence, chronic illness, increased sensitivity to pain)
- decreased participation in therapy and activities (e.g., caused by isolation)
- decreased functional status (e.g., resistance to daily care, decreased desire to participate in activities of daily living [ADLs]
- poorer outcomes (e.g., decreased appetite, decreased cognitive status)
The goal is to find causes and contributing factors for symptoms, identify interventions (treatment, personal support, or environmental modifications) and ensure resident safety.
The level of cognitive ability among nursing home residents helps determine a proper care plan and therefore contributes to their quality of care and quality of life. In the past understanding cognitive patterns was done by simply observing residents and making notes of what was observed. Much has changed under MDS 3.0.
Nursing facilities must now determine whether the Brief Interview for Mental Status (BIMS) can be conducted with residents by a social worker. This provides a much better indicator of a resident’s cognitive ability.
The Centers for Medicare and Medicaid Services (CMS) is committed to reducing unnecessary physical restraint in nursing homes and ensuring that residents are free of physical restraints unless deemed necessary and appropriate as permitted by regulation. Proper interpretation of the physical restraint definition is necessary to understand if nursing homes are accurately assessing devices as physical restraints and meeting the federal requirement for restraint use.
While a restraint-free environment is not a federal requirement, the use of restraints should be the exception, not the rule according to CMS.
Falls are a leading cause of injury, morbidity, and mortality in older adults. MDS 3.0 guidelines looks to help providers minimize fall risk while treating fall injuries with the goal of achieving the best quality of life for residents.
A previous fall, especially a recent fall, recurrent falls, and falls with significant injury are the most important predictors of risk for future falls and injurious falls. Persons with a history of falling may limit activities because of a fear of falling and should be evaluated for reversible causes of falling.
Providers need to determine the potential need for further assessment and intervention, including evaluation of the resident’s need for rehabilitation or assistive devices. And the physical environment and staffing needs for residents who are at risk for falls need to be evaluated as well.
Skin conditions, such as pressure ulcers, are a big concern in both nursing and assisted living facilities. MDS 3.0 updates protocols for pressure ulcers, wounds, or lesions so that facilities can recognize and evaluate each resident’s risk factors and identify and evaluate all areas at risk of constant pressure.
Pain can cause suffering for nursing home residents and can result in inactivity, social withdrawal, depression, and functional decline. That is why effective pain management is so important in improving the quality of life for residents.
MDS 3.0 regulations around pain management seek to assess the presence of pain, pain frequency, effect on function, intensity, management and control.
The goal of any pain management program should be to achieve a consistent level of comfort for the resident while maintaining as much function as possible.
Improved management of chronic pain can significantly reduce disability in older adults. Pain in aging adults has historically been poorly reported, recognized and managed. There has been a lack of identifying pain as a real problem in the elderly, particularly in long term care facilities and patients with Alzheimer's or other dementias.