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W H AT ’ S I N S I D E 2 Inside CMS 9 Q+A 10 Jacksonville Top 10 Reasons 11 Upcoming Workshops 12 New in AANAConnect 15 New C-NEs and RAC-CT®s SPRING 2012 LTC QUARTERLY SPEC IA EDITI L ON April 1 MDS changes: Are you ready? Caralyn Davis, Staff Writer Keeping up with changes has become an almost constant battle for MDS coordinators and interdisciplinary teams (IDTs), and a new round of MDS changes is days away. On April 1, Version 1.08 of the RAI User’s Manual for the MDS 3.0 and Version 1.10.4 of the MDS 3.0 item sets will go into effect. (The updated RAI Manual, the Changed Pages and Change Tables Document, and the accompanying Errata Document can be found on the MDS 3.0 Training Materials webpage. Printable item sets are available on the MDS 3.0 Technical Information webpage.) AANAC’s master teachers offer the following last-minute suggestions for ensuring a smooth transition on April 1 and with any subsequent updates: Check the status of your software. AANAC 400 S. Colorado Blvd., Suite 600 Denver, Colorado 80246 Phone 800.768.1880 Fax 303.758.3588 1 © 2012 AANAC. No part of this publication may be reproduced without written permission from AANAC. The information presented is informative and does not constitute direct legal or regulatory advice. The new rules will be effective for MDSs with an assessment reference date (ARD) of April 1 or later. However, the ARD represents the endpoint of the observation or look-back period. “The typical look-back period is seven days or 14 days,” points out Judy Wilhide Brandt, rn, rac-mt, c-ne, president of Judy Wilhide MDS Consulting in Virginia Beach, VA. “So we need to start opening assessments and working on them (for example, coding interviews) in the days leading up to April 1.” Consequently, updated software needs to be ready to go now, says Brandt. “New software should have been installed, beta-tested, and ready no later than two weeks into March.” continued on page 3 INSIDE CMS Caralyn Davis, Staff Writer Key takeaways From the MDS National Conference While the 2012 MDS National Conference that CMS held in early March was packed to the rafters, many long-term care professionals were unable to attend for a variety of reasons, leaving them feeling like they didn’t know the secret handshake required to enter the executive suite of “MDS World.” However, AANAC is able to throw open the doors of knowledge thanks to Jennifer Pettis, rn, bs, wcc, rac-mt, director of program development at Harmony Healthcare International in Topsfield, MA, and chair of the AANAC Expert Advisory Panel. Pettis attended the conference, gleaning five key takeaways for MDS coordinators, directors of nursing, and other interdisciplinary team (IDT) members: c-ne, 1. Care plans should be built on resident voice. Providers should take heart from the “profound” message on the critical importance of care planning delivered by Karen Schoeneman, technical advisor of the Division of Nursing Homes at CMS, in the keynote, “Looking at the Rules in Our Head: What is Care Planning for?,” suggests Pettis. As recently as 20 years ago, long-term care practice “was really dictated by the rules in your head,” says Pettis. Schoeneman suggested those rules care planning. We should be using the MDS and Care Areas to identify resident choices, and rather than our practice being dictated by all of these rules in our head, it should be dictated by what that resident is telling us is important to them. The RAI process is intended for us to end up with this individualized, person-centered care plan based on the goals of the resident, what their needs are, and what their strengths or limitations or risk factors are—not those institutional rules that sometimes overshadow resident choices.” From an MDS standpoint, Schoeneman’s message boils down to “facilities should take a look at the process of the MDS,” asserts Pettis. “The focus of the MDS process shouldn’t just be the completion of this tool for reimbursement and survey compliance. Strong assessments are embedded into the MDS and the Care Areas. Many times, if we do a good As recently as 20 years ago, long-term care practice “was really dictated by the rules in your head,” says Pettis. revolved around institutional practices, including practices such as ensuring “every resident was up for breakfast” and any resident who wanted to rest could “only take naps at certain times during the day, and they needed to lie on top of the covers.” “Back then I was a nurse’s aide, and it’s not that I was a bad nurse’s aide,” reflects Pettis. “The rules we followed were what our practice at the time told us was right, so that is what we did.” Long-term care is now “heading toward full circle,” Pettis points out. “Karen really challenged us to think about 2 job of using these assessment tools provided by CMS, we can get rid of other layers of paperwork that are burdening interdisciplinary team members because we’ll already have the individualized information we need to serve as the building blocks for the plan of care.” 2. Discharge assessments are getting shorter. MDS coordinators will soon find the workload a little lighter for all discharge assessments, says Pettis. Currently, discharge assessments come in at a whopping 111 questions. However, continued on page 6 A A N AC LT C L E A D E R 3 . 2 0 . 2 012 April 1 MDS changes, continued from page 1 Printing out a hard copy of the discharge assessment will help drive home the changes—and give MDS coordinators a reference to use when checking that their software has the new item set, suggests Brandt. Hand out updated manual sections. Brandt was recently in a facility where the dietitian was using Section K coding instructions from a draft 2009 RAI Manual. “Nobody had given her any updates in more than two years,” she notes. “We tend to forget about dietitians, social workers, and activities staff. However, all team members who code MDS items need to have a current version of the coding instructions.” Similarly, Deb Myhre, rn, c-ne, a consultant with Ankeny, Iowabased Continuum Health Care Services, recently visited a facility that didn’t understand isolation coding because they didn’t have a current Version 1.07 RAI Manual. “Keeping track of the updates can be difficult given all of the changes we’ve had, but MDS coordinators have to be able to go online and make sure team members have current information,” she stresses. rac-mt, If software vendors have scheduled the update to occur on April 1, it may be too late to request earlier implementation this time around. Nevertheless, MDS coordinators should alert the administrator or other appropriate facility decision-maker to ensure the problem is resolved prior to future updates, suggests Brandt. “The software companies have to be responsive to our needs.” Prepare to work on paper. Facilities won’t be able to electronically open assessments with ARDs of April 1 or later until they have the new software. CMS doesn’t offer any wiggle room in setting ARDs timely, so providers should prepare for potential software issues by printing out a batch of blank MDS assessments, says Brandt. “If MDS coordinators need to get the ARDs established and they cannot establish them in the computer, they should be ready to set the ARDs on paper.” Note: Page 2-8 of the RAI Manual states: “The facility is required to set the ARD on the MDS Item Set or in the facility software within the appropriate timeframe of the assessment type being completed.” Review the MDS item sets. Read and discuss the update. The ZIP file of MDS item sets for the April 1 release includes a 12-page document, MDS 3.0 Item Set Change History (aka MDS30_Item_Changes_ v1.10.4.pdf). “This is a handy list of changes to the forms that providers can review,” says Brandt. “This sounds really simple, but a surprising number of people don’t read the updates to the RAI Manual until after a problem occurs,” says Myhre. “When CMS publishes an update, the MDS coordinator sometimes will hand it out to the interdisciplinary One positive change is “how much team and then expect that those team shorter the discharge assessment is going members will do what they want to do to be,” she notes. “Regardless of whether with it. Consequently, manual updates a discharge is unplanned or planned, sometimes sit on the back burner. the discharge assessment is going to be Unfortunately, I’ve seen that happen noticeably shorter. For example, column many times.” 2 in G0110 (ADL assistance) is not there, So not only do IDT members need their and the only item in O0100 (special updated sections of the RAI Manual, treatments, procedures, and programs) is “they have to read it and understand hospice care. CMS listened to providers it, and if they don’t understand about the burden of doing MDSs.” something, they need to ask questions continued on page 4 3 A A N AC LT C L E A D E R 3 . 2 0 . 2 012 April 1 MDS changes, continued from page 3 before implementation occurs,” says Myhre. One way that MDS coordinators can prompt team members to read the manual updates is to schedule a 15-minute segment during a care conference to review section changes. of meeting will keep everyone informed.” (Have questions about the April 1 update? AANAC members have access to help from a wide array of MDS experts via the MDS Connection and LTC Network discussion groups on AANAConnect. ) When CMS issues an RAI Manual update, that might be a good time to find ways to help the team, suggests Myhre. “One of the first things I look at to reduce the MDS burden is the turnaround time—from when the ARD is set to when the assessment is completed.” “The team just needs to sit down and talk about the changes for a few minutes,” she explains. “This is an easy way for MDS coordinators to fulfill their management responsibility and ensure that each person on the team knows what to do with their particular section of the MDS. I’m also a big believer that the whole team should understand what each team member is responsible for, and this type Highlight Section M changes. Section M (skin conditions) includes several revisions. Two that stand out are the re-introduction of skin tears in item M1040G and the addition of moistureassociated skin damage (MASD) in item M1040H, says Brandt. MASD “has to be diagnosed correctly and treated correctly in order to heal. Pressure didn’t cause MASD, so relieving pressure is not going to cure it,” she points out. “With the inclusion of MASD on the MDS, my hope is that MASD will come to the forefront and that clinicians will look with fresh eyes on correctly diagnosing and treating the multifactorial skin issues that our frail elderly typically have.” Use updates as a catalyst for improvement. The burdens of the RAI process frustrate a lot of IDT members. When CMS issues an RAI Manual update, that might be a good time to find ways to help the team, suggests Myhre. “One of the first things I look at to reduce the MDS burden is the turnaround time—from when the ARD is set to when the assessment is completed.” With some exceptions, facilities have 14 days to complete the MDS. (Need details? continued on page 5 A ANAC prouDly reCogNizes Nurse Assessment Coordination Day™ May 8th, 2012. Held in conjunction with National Nursing Home Week™ & National Nurses Week.™ Nurse Assessment Coordination Day is a special day we’ve created to honor you—the picture-perfect champions of resident care, accurate assessment and voice and choice. We invite you to visit our NAC Day web page, coming in early April, to find a variety of AANAC resources, sponsoring partner discounts and much more that show just how much we appreciate the support and care you provide your residents today and every day. We’ll keep adding surprises throughout April—so check back often and see what’s new. COMING SOON! www.aanac.org/NACDay2012 4 A A N AC LT C L E A D E R 3 . 2 0 . 2 012 April 1 MDS changes, continued from page 4 Review Chapter 2 of the RAI Manual.) However, many providers arbitrarily shorten the process. For example, Myhre visited one facility that always set ARDs on Mondays and gave the IDT members two days—Tuesdays and Wednesdays— to get the MDS done so the team could have care conferences on Thursdays of the same week. “People are often resistant to change, but in this type of situation, making better use of the available days to complete the MDS and changing the care conference to a later day so that the team members have adequate time to review their assessments and make good coding decisions can alleviate a lot of frustration,” she points out. Double-check Final Validation Reports. “For the first few transmissions, providers should check their Final Validation Reports with a fine-tooth comb,” advises Brandt. Why? Sometimes software updates result in unintended changes or problems. For example, there always is at least one facility whose software incorporates the wrong RUG grouper—even when an update isn’t supposed to include any SNF PPS changes. “So make sure that you have the right RUG grouper for federal RUGs, and if you are in a state with case mix, make sure that you’re not getting those warnings that say, ‘The RUG we calculated is different from the RUG that you submitted,’” says Brandt. “These are errors that always must be corrected because we cannot bill the wrong RUG.” (Section 5, “Error Messages,” of the MDS 3.0 Provider User’s Guide explains what the error messages mean and offers potential solutions.) ● 5 Tips to fight MDS change fatigue Obtaining staff buy-in for the April 1 RAI Manual update should be relatively simple because “this latest round of changes primarily is a direct result of CMS listening to what we said was wrong,” says Judy Wilhide Brandt, rn, rac-mt, c-ne, president of Judy Wilhide MDS Consulting in Virginia Beach, VA. “As a general rule, these changes clarify the MDS and make it easier and quicker. The major exception is the addition of moisture-associated skin damage in Section M, which is still a very good improvement because it will make our residents’ lives better if we more correctly identify that issue.” Nevertheless, some IDT members likely will be resistant to any change— whether it’s perceived as good or bad—since they’ve already gone through so many updates, says Brandt. “I see MDS change fatigue all the time.” The most important defense against change fatigue is a good attitude, suggests Deb Myhre, rn, c-ne, rac-mt, a consultant with Ankeny, Iowa-based Continuum Health Care Services. “The MDS coordinator must be really positive any time CMS issues an update. That is difficult to do when we’ve had so many changes—and then the changes are changed. However, it’s the MDS coordinator’s responsibility as a manager to be the ‘good cheerleader’ for MDS changes. Everyone knows that when you have a grumpy leader, everyone else is grumpy too. So like any manager, the MDS coordinator needs to portray a positive attitude. The key is to be process-driven. Rather than grumble about individual changes, keep the team focused on what the whole RAI process is for—to have better care planning and improve quality of care and the lives of our residents.” Another good leadership technique is for MDS coordinators to prepare IDT members for a cycle of changes every April and October, says Brandt. “Everyone needs to accept the fact that we are likely to have structural and other substantive changes involving either the MDS or SNF PPS every six months for the foreseeable future.” Also, with any future updates, MDS coordinators should let the IDT members know as soon as they themselves learn about pending changes, suggests Brandt. “Some MDS coordinators say, ‘I’m not going to bring it up until right before the change because there is no sense in worrying about it.’ But forewarned is forearmed. It’s important that the team know what’s going on, even if their particular section doesn’t have any changes. For example, if the changes necessitate a software update, the team members have to plan their work schedules to allow time for the new software to be installed.” It’s also important that MDS coordinators provide IDT members with some perspective. For example, with the April 1 update, a quick glance at the 300plus pages of RAI Manual changes might inspire panic. “However, there are only a few substantive changes,” says Brandt. For example, the changes include multiple instances of replacing “mental retardation” with “intellectual disability” and replacing “entry or reentry” and “admission or reentry” with “admission/entry or reentry.” In addition, there are numerous capitalization changes, for example, replacing “state” with “State.” So any time there is an update, MDS coordinators can calm a lot of fears by looking at the change document and boiling down “what we actually have to do differently,” says Brandt. ● A A N AC LT C L E A D E R 3 . 2 0 . 2 012 Inside CMS, continued from page 2 the April 1 update will cut planned discharge assessments to 89 questions and unplanned discharge assessments to a maximum of 77 questions. Those reductions—almost 20 percent for planned discharges and 31 percent for unplanned discharges—“should impact the time spent on those assessments positively,” she points out. 3. Interviews matter. Nursing facilities that do not complete resident interviews when residents in fact could have participated in the interviews are engaging in a practice that places them at risk for citation during survey, according to Tom Dudley, technical advisor in the Division of Chronic and Postacute Care in the Office of Clinical Standards and Quality, who reiterated comments he made during an earlier Skilled Nursing Facility/Longterm Care Open Door Forum. Why the crackdown? “The interviews on the MDS are central to the whole idea of the resident’s voice driving our practice in long-term care,” says Pettis. “In addition, the interviews are critical for publicly reported data, and they have a tremendous financial impact on facilities.” So facility leadership (e.g., administrators, DONs, or reimbursement directors) should “vet the performance of all staff members who are conducting Chapter 3 of the RAI User’s Manual for the MDS 3.0 provides the basic instructions, interviewing techniques, and suggested language (i.e., the script) for conducting the interviews. In addition, two RAI Manual appendices offer detailed insights on interviewing techniques, as well as cue cards, that allow staff to make the most of resident interviews: Appendix D, “Interviewing To Increase Resident Voice in MDS Assessments,” and Appendix E, “PHQ-9 Scoring Rules and Instruction For BIMS (When Administered In Writing).” (Note: Appendix E includes cue cards for conducting the BIMS in writing. Additional cue cards for other interviews are included in MDS 3.0 Training Aids in the ZIP file, “MDS 3.0 Training AidsSlides-Instructor Guides,” at the MDS 3.0 Training webpage.) Importantly, Appendix D offers methods and techniques to obtain better data from residents who may have impaired cognition. Providers can use the techniques of unfolding or disentangling that are described on pages D-2 – D-3 to break down questions into “digestible chunks,” notes Pettis. “I often liken it to the way that we help residents who have some impaired cognition pick out their clothes. We don't open the closet and say, ‘Here are 40 dresses. What would you like to wear today?’ Instead, we start with a general question: ‘Would you like “No one would let a nurse administer medications before they were sure that the nurse could do it safely and appropriately. Facilities should take a similar approach to ensuring competence for those conducting resident interviews.” resident interviews,” she recommends. “No one would let a nurse administer medications before they were sure that the nurse could do it safely and appropriately. Facilities should take a similar approach to ensuring competence for those conducting resident interviews.” CMS offers a number of resources to help IDT members conduct effective resident interviews, says Pettis. 6 a dress or pants?’ And then we move into specifics: ‘You’d like a dress. I have pink or blue. Which color would you like?’ And then we get even more detailed: ‘Here are two pink dresses. Which one do you want to wear?’ So it’s the same idea that in practice we’ve been doing for years when we care for these residents in day-to-day life. It should be natural for us as clinicians to want to offer that same technique when we are conducting resident interviews.” In addition, the cue cards are key to keeping interviews efficient, says Pettis. “Using the cue cards that CMS offers makes interviews go so much faster, as well as obtaining much better data in my opinion. If you go to the grocery store and are asked to sample and comment on a new product, you will often be given a list of options to choose an answer from. That’s because the list of options speeds the process along for the interviewer. With resident interviews, using the cue cards means you don’t have to repeat the potential answers every single time. The answers are right there in front of the residents, and they are very easily able to point to the response they want to give. Residents aren’t pressured to remember all of the options that the interviewer just told them.” 4. Inactivation rules may force changes in facility practices. John Kane, a health insurance specialist with the Division of Institutional Postacute Care, confirmed that another continued on page 7 A A N AC LT C L E A D E R 3 . 2 0 . 2 012 Inside CMS, continued from page 6 skilled nursing facility prospective payment system update document is forthcoming, says Pettis. (Watch “Need to Know” at AANAC. ) Additionally, a key issue that Kane discussed at the conference was the inactivation of MDS assessments. “The encoding period is an opportunity for providers to take a look at the MDS and say, ‘Is this right?,’” says Pettis. “Providers should institute a solid audit or checklist process to verify everything that is unable to be corrected using the standard modification process, including “Once you have submitted that MDS, it is too late to change these items, so you need to take the time to double-check that what is being submitted on the MDS is what you think it should be.” When an MDS assessment includes an inaccurate event date (e.g., an assessment reference date or a discharge date) or an inaccurate reason for assessment, “providers cannot inactivate that assessment, and then take the same assessment and just correct it and resubmit it,” says Pettis. “When you inactivate an assessment, for all practical purposes that assessment doesn’t exist anymore. You can’t simply fix the problem and re-upload that MDS. You have to create a brand-new assessment, including setting a current ARD. The day that you begin that process of inactivation is the earliest day that you could set the ARD.” ARDs and reasons for assessment. Once you have submitted that MDS, it is too late to change these items, so you need to take the time to double-check that what is being submitted on the MDS is what you think it should be.” 5. Q uality measures will include four survey-only measures. The quality measures (QMs) are coming back to the traditional survey process. Since October 2010, surveyors have been following the instructions in surveyand-certification letter S&C-10-27-NH to replace Tasks 1 – 5C in the traditional survey process as defined in Appendix P, “Survey Protocols for Long-term Care Facilities,” in the State Operations Manual. CMS’ Karen Schoeneman advised conference attendees to “rip up that survey-and-certification letter and go back to Appendix P for the traditional survey process,” says Pettis. (Note: The Quality Indictor Survey, or QIS, process will continue to use Quality of Care and Life Indicators, or QCLIs, to drive the survey process.) The survey QMs will include many of the same QMs that will be publicly reported on Nursing Home Compare. However, CMS deemed some of the publicly reported measures unnecessary to the survey process, particularly the pneumococcal vaccine and influenza vaccine measures. In addition, CMS has This policy has “very serious potential payment implications,” she points out. “There is no question that CMS heard providers at the conference express concerns about that, and they definitely are considering suggestions as to how that could be better handled.” But what can providers do in the meantime? “Make the best possible use of the encoding period,” suggests Pettis. Providers have seven days following the completion of a resident’s MDS assessment to encode the MDS data. (To learn more, see Chapter 5 of the RAI Manual.) At most facilities, IDT members now enter assessment data directly into facility software rather than on a paper MDS, so few providers take advantage of—or even remember—the available seven-day encoding period. continued on page 8 7 A A N AC LT C L E A D E R 3 . 2 0 . 2 012 Inside CMS, continued from page 7 developed four survey-only QMs that have been “recreated from the old QIs [quality indicators],” says Pettis. The four survey measures that won’t be made available to the public are long-stay measures that address these issues: •Falls. The publicly reported QMs include a “fall with major injury” measure. However, the survey measures will include a falls measure that identifies any long-stay resident who has had a fall in the look-back scan, regardless of whether a major injury occurred, says Pettis. •Behavior symptoms affecting others. “Several behaviors will go into this measure and potentially could flag that as an area to be investigated during survey,” notes Pettis. “Providers should make sure everyone is on the same page about how they code behaviors affecting other people. Ask, ‘Are we consistently following the rules?’” •Psychoactive medications, in the absence of psychotic or related conditions. •Anti-anxiety/hypnotic medications. With both of the medication-focused survey QMs “a resident is going to flag when you use these medications, and there is not an appropriate associated condition,” says Pettis. “When an appropriate associated condition is present, the resident will be excluded from that reporting.” Many appropriate associated conditions are diagnosis-based and come from MDS Section I. However, two of these excluding conditions are in Item E0100 (potential indicators of psychosis), specifically E0100A (hallucinations) and E0100B (delusions), notes Pettis. “In most nursing facilities, staff do a good job of capturing hallucinations, which are a sensory perception of something that continued on page 13 A SWEET IDEA AANACareer provides the tools and resources to put members on the path to career success and employers on the fast-track to hiring qualified professionals. Employers—Build your team by using AANACareer to access thousands of LTC professionals through a deep resume database that allows you to search out and contact candidates proactively. Job Seekers—Advance yourself professionally through a redesigned career center that offers expert advice, eNewsletters, Event Connection and email job alerts to notify you about new postings that match your search criteria. Even if you aren’t actively looking for a new job, these are great resources to help make you more career-savvy and marketable in the future. Career success never sounded so sweet; visit 8 A today. A A N AC LT C L E A D E R 3 . 2 0 . 2 012 Q+A Regarding coding respiratory therapy on the MDS, do competencies for lung sounds have to be done by a respiratory therapist or can they be done by a nurse? To capture respiratory therapy on the MDS, treatments must be provided by a respiratory therapist or a trained respiratory nurse, according to Appendix A of the RAI User's Manual. It says that respiratory therapy services are for assessment, treatment, and monitoring of patients with deficiencies or abnormalities of pulmonary function, and that respiratory therapy services include "coughing, deep breathing, heated nebulizers, aerosol treatments, assessing breath sounds and mechanical ventilation, etc." It goes on to say, "A respiratory nurse must be proficient in the modalities listed above either through formal nursing or specific training and may deliver these modalities as allowed that nurse previously was competency tested as a part of his or her nursing program or by a respiratory therapist.) Rena R. Shephard, mha, rn, rac-mt, c-ne ([email protected]) A resident returned from the hospital after having a qualifying stay for Medicare Part A. The readmission date was Feb. 17. We did a Significant Change/5-day assessment with an ARD of Feb. 29 (Day 8). The RUG was Rehab High. The 14-day assessment ARD was March 2 (Day 15), which also was day 7 of COT observation. The RUG score went to Rehab Very High. I told therapy that we would need to do a COT OMRA, because the RUG score increased. Therapy disagrees with me. Which is right? You don’t have to complete a COT OMRA when day 7 of COT observation falls on the ARD of a scheduled assessment, but you have the option and would want to As a former DON, my preference is to have a respiratory therapist provide training, validate return demonstrations, and check key competencies annually. But a nurse with demonstrated competency and experience in these areas can provide the training. under the state Nurse Practice Act and under applicable state laws." Who provides the training is not specified by the regulation. As a former DON, my preference is to have a respiratory therapist provide training, validate return demonstrations, and check key competencies annually. But a nurse with demonstrated competency and experience in these areas can provide the training. (When I've had a nurse do it, when the RUG increases. If you combine the 14-day with the COT then the RV RUG would be retroactive to day 9. So it is in your benefit do complete a COT. Ronald A. Orth, rn, nha, cpc, rac-mt ([email protected]) A resident was admitted Feb. 10. PT started Feb. 15 (day 6), and the resident was seen by PT on Feb. 15 and 16 for a combination of 95 minutes. Next day of service for PT was Feb. 22 (day 13). The resident was seen on consecutive days from Feb. 24 to 27 (days 16 – 18). Without a SOT OMRA, the resident does not classified into a rehab RUG. If I do the SOT with day one being Feb. 15, how would this resident classify into a rehab RUB if only seen twice in that seven day window. Any help is much appreciated. You will not be able to do a SOT OMRA for this resident, because there was not enough therapy provided by the 7th day after the start of therapy to correctly place this resident into a Rehab RUG. The next scheduled assessment will be when you will be able to realize the rehab RUG. Carol Maher, rn-bc, rac- ct ([email protected]) Our Quality Assurance Committee is lacking in focus. I am the chairperson, so I feel responsible to give it meaning. Can you give me suggestions? F520 Quality Assessment and Assurance contains excellence guidance in order to have a successful QAA effort. Give particular attention to the definition of “Quality Deficiencies” that differ from deficiencies cited by the survey team. Quality deficiencies can be related to facility operations and practices that cause negative outcomes, or to enhancing quality of care and improving quality of life. The QAA Committee should decide which areas to investigate based on issues that are meaningful in your setting. The decision on how to proceed can be both corrective and preventive in nature. The regulation requires that the DON, a physician, and at least three continued on page 14 9 A A N AC LT C L E A D E R 3 . 2 0 . 2 012 BETTER TOGETHER—THE 2012 AANAC ANNUAL CONFERENCE You’ve probably noticed that there are all sorts of new and exciting reasons why the 2012 AANAC Annual Conference in Jacksonville, Florida is going to be our best yet. As the deadline for online registration gets closer, we wanted to give you at least 10 additional reasons why you simply can’t afford to miss this event. Read 1 2 3 PRECONFERENCE the information and skills that you need most. PRODUCT THEATERS Get in-person demonstrations of the products and services that have been designed to ease your workload and make your job simpler. 5 THE 2012 AANAC AWARDS Join us as we celebrate our celebrities 6 INCREASED EXHIBIT HOURS You’ll have more time than ever to assessment capabilities to manage and support residents who suffer from skin wounds, chronic pain or dementia. in long-term care with a fantastic evening event complete with food, beverage and an entertaining reception to follow. interact and learn about the newest trends and products right from the source. And maybe even win a prize during our “Exhibit Hall Scavenger Hunt.” 7 NETWORKING WITH THE BEST Join forces with hundreds 8 A VIBRANT CITY With a growing population, a strong economy, and 9 CONNECTED COMMUNITY Meet other attendees before you CONFERENCE April 18 – 20 LEARNING TRACKS New education tracks will help you focus on CLINICAL SESSIONS Learn how to utilize your physical JACKSONVILLE, FL Hyatt Regency Riverfront you more opportunities, choices and chances to get the vital updates and information you need. 4 on for our “Top Ten” reasons to attend. A LONGER CONFERENCE We expanded our conference to offer April 16 – 18 10 of other long-term care leaders, experts and enthusiasts by being a part of this conference. Spend time sharing success stories, and challenges and get insider information from others who have been through similar situations as yourself. diverse cultural and recreational opportunities, Jacksonville distinguishes itself as one of the nation’s most dynamic and progressive cities. even arrive on-site and start putting faces to all the friends you’re going to make, through the AANAConnect online conference community. ONLY ONE CHANCE Since we’ll only have one conference this year, this is your best opportunity to join colleagues to ensure you’re up-todate on the most current regulatory updates, survey preparedness skills, quality control tactics and resident voice and choice issues. SHARE THE FUN, THE KNOWLEDGE AND THE EXPERIENCE WITH OTHER LTC PROS. REGISTER TODAY AT WWW.AANAC.ORG/2012CONFERENCE AANAC 2012 UPCOMING WORKSHOPS TRAINING PARTNER MASTER TEACHER DATES CITY/STATE AANAC RAC-CT Certification Robin L. Hillier Apr 16 – 18 Jacksonville, FL AANAC Medicare University Judy Wilhide Brandt Apr 16 – 18 Jacksonville, FL AANAC C-NE Certification Jennifer Pettis Apr 16 – 18 Jacksonville, FL AANAC RAC-CT Recertification Rena R. Shephard Apr 18 Jacksonville, FL Harmony Healthcare International Jennifer Pettis Mar 27 – 29 Seattle, WA LeadingAge TX Ronald Orth Mar 27 – 29 Austin, TX LeaderStat Lisa Hohlbein Apr 10 – 12 Dallas, TX Pathway Health Services, Inc. Cynthia Perrault Apr 10 – 12 Westmont, IL LeadingAge Iowa Deb Myhre Apr 10 – 12 Des Moines, IA Harmony Healthcare International Jennifer Pettis Apr 10 – 12 New York, NY LeadingAge NY (formerly NYAHSA) Sandy Biggi May 1 – 3 Rochester, NY Harmony Healthcare International Jennifer Pettis May 1 – 3 Windsor, VT LeadingAge New York (formerly NYAHSA) Sandy Biggi May 1 – 3 Rochester, NY Pathway Health Services, Inc. Cynthia Perrault May 8 – 10 Green Bay, WI LeaderStat Lisa Hohlbein May 8 – 10 Detroit, MI LeaderStat Lisa Hohlbein May 15 – 17 Silver Spring, MD Judy Wilhide MDS Consulting Judy Wilhide Brandt May 15 – 17 King of Prussia, PA KHCA—Kansas Health Care Association Becky LaBarge May 16 – 18 Topeka, KS Hill Educational Services, Inc. Carol Hill May 21 – 23 Mobile, AL Pathway Health Services, Inc. Cynthia Perrault May 22 – 24 Spokane, WA Judy Wilhide MDS Consulting Judy Wilhide Brandt May 22 – 24 Boston, MA Duran Consulting Services Sandy Biggi June 4 – 6 Portsmouth, NH Harmony Healthcare International Jennifer Pettis June 4 – 6 Charleston, SC Judy Wilhide MDS Consulting Judy Wilhide Brandt June 5 – 7 Virginia Beach, VA 2012 AANAC ANNUAL CONFERENCE RAC-CT CERTIFICATION WORKSHOPS MEDICARE UNIVERSITY WORKSHOPS The workshop schedule is subject to change and is updated regularly. To see a full AANAC Training Partner workshop schedule, visit aanac.org/workshops 11 A A N AC LT C L E A D E R 3 . 2 0 . 2 012 What’s new in Feeling overwhelmed with the fast-approaching April 1 CMS revisions to the MDS and RAI User’s Manual? So are your peers. Join other AANAC members and the experts in discussing these updates on AANAConnect, your online discussion forum. AANAConnect is the perfect place for you to ask questions, receive clarification, and begin to understand the many updates that will be implemented in just over a week. In case you missed our recent webinar on these April 1 changes hosted by Jennifer Pettis, or Rena Shephard’s email with the detailed highlights, here are a few things you might be interested in discussing on AANAConnect: • Assessment inactivations • Interviews and unplanned discharges • Carrying forward prior interview responses under limited circumstances • Future item set changes/updates • Assessment combinations Active Discussions this week on AANAConnect: LTC Network: Thread Subject: C larify on COT and on Admit/PPS Posted by: Tammy Sp ears . . . After meeting in St. Louis I have become co nfused on COT. I want to know that if I do a 5 day PPS on da y 8 and then I do a COT review on day 15 but also have my 14 day scheduled for tha t day. I am okay so far . Bu t now if therapy tells me they are ramping up the RU G on day 11 or 12 and I still plan to use day 15 but I set ass ess me nt into the computer on day 14 with a 14 day an d a COT because the level is go ing up (and same if I kn ew it was going down). HERE’s where I am confused . . . If I set this assessment with the COT is this conside red EARLY cause it is day 6 of the COT review that I actua lly put the COT for day 7 along wit h the 14 day, and so do I ha ve to take a default for that one day? This is just one part of Tammy’s question. To read the full post, just click on the thread subject above. • Deciding on the ARD for unscheduled assessment after the ARD window closes • Effect of early and late COT ARD on COT observation The April 1 changes will most certainly affect you and/or your team. Make sure you are in-the-know and ready to implement these amendments to ensure you’re proving the best care possible according to the most current rules and regulations. Change is never easy, but going through it with a network of support makes it a whole lot easier. Login to AANAConnect today: connect.aanac.org. 12 n: MDS Connectio ion C and J : Inter views sect ct je ub S d ea hr T Greenwood Posted by: Kathy 12 and I T done 3/8/ ent who had a CO Hi— I have a resid day. This morning interviews yester e th d di d e an ed complet ed (3/9/12). For th l and was admitt ita sp ho r e fo th d to di he went em as he uld you answer th wo , ns io ct w se ie rv w intervie ate NO and inte y or would you st the COT yesterda iated. would be apprec staf f? Any help Thanks!! the of conversation in n generated a lot Carol d an rd ha This conversatio ep rts Rena Sh pe ex r ou w ho e Se read community. clicking on the th this question by news od go tle Maher answered lit a Rena provides r, tte be en Ev e. er’s subject abov tes to the RAI Us m the April upda is the n tio ec that has come fro nn why MDS Co on as re r he ot an swered fast! Manual. Just 3.0 questions an DS M ur yo t ge best place to A A N AC LT C L E A D E R 3 . 2 0 . 2 012 Inside CMS, continued from page 8 What You Need to Know Check out these latest updates from the “Need to Know” section of the AANAC homepage and find the information you need to get the job done right. CASPER Reporting User’s Guide for MDS Providers UPDATED, Including Section on QM Reports MDS 3.0 Provider User’s Guide UPDATED, Including Section 5, Error Messages, for Interpreting Validation Reports Five Star State-Level Cut Point Tables and Staff Time Values Data Set UPDATED doesn’t really exist. However, I’ve found delusions to be one of the most undercoded items on the MDS. Residents who have a delusion, or false, fixed belief, due to memory loss or dementia should still be coded as having a delusion. Take the example of a resident who says, ‘I have to get home. My child is two years old, and she’s home alone.’ Staff members try to reassure that resident, but she remains fixed on that idea that she has a child at home. According to the MDS, that is a delusion and should be captured as such, but many facilities fail to do so.” From a process standpoint, the message for the new QMs is that facilities need to “understand the data underneath each measure,” she suggests. “Look at what sits underneath the exclusions and any other risk adjustments, and understand that the coding for those items is just as important as the coding that actually makes the measure itself flag. And then if you do have residents, for example on psychoactive medications, who flag, it will be worth your time to take that medical record and determine, ‘Are we missing something that would in fact exclude this resident from flagging in that measure?’” (Note: The QMs will be a significant focus in upcoming RAC-CT recertification classes.) Editor’s note: For coding/technical details from the conference, see the article, “CMS National Conference Provides Updates, Clarifications” by AANAC Executive Editor Rena Shephard. ● Reimbursement Tip Ancillary services (e.g. therapy, labs) provided, to a Medicare Part A beneficiary, on the day of discharge are not separately billable to Medicare Part B. These charges should appear on the Part A claim. Ron Orth Treatment of Members Policy AANAC has posted the Treatment of Members Policy on the website. If you need to access it, please click here. FAQ referral Do you have a question you need answered NOW? Members of AANAC can go directly to the experts! Go to the FAQ section of the website. The answer may be right in front of you! 13 A A N AC LT C L E A D E R 3 . 2 0 . 2 012 April 1 MDS changes, continued from page 9 AANAC Board of Directors Carol Siem msn, rn, bc, gnp Chair Ruth Minnema rn, ma, c-ne, rac-ct Vice Chair Carol Maher rn-bc, rac- ct Secretary Peter Arbuthnot aa, ba, rac- ct Treasurer Susan Duong, rn, bsn, nha, rac- ct, c-ne Patrice E Macken, mba, rhia, lnha, rac- ct Gail Harris, rn, bsn, rac- ct, c-ne Joanne Powell nha, rhia Diana Sturdevant ms, gcns-bc AANAC Expert Panel All articles published in LTC Leader are reviewed by a National Editorial Advisory Board to ensure the accuracy of the information we provide. AANAC is pleased to introduce you to our panel of volunteer reviewers who represent the best and the brightest in our field: Jennifer Pettis rn, wcc, rac-mt, c-ne Chair, Harmony Healthcare International Topsfield, MA Betty Frandsen rn, nha, mha, c-ne Nichols, NY Robin L. Hillier cpa, stna, lnha, rac-mt President, RLH Consulting Becky LaBarge rn, rac-mt Vice President, Clinical Reimbursement The Tutera Group other members of the facility staff serve on the committee. You will give added value to your efforts by including representation from nurses’ aides, therapists, staff nurses, social workers, and activities staff, as well as the administrator and the medical director. Assess processes and outcomes, conduct root cause analysis, assure compliance with standards of quality, and use an ongoing interdisciplinary approach to improve delivery of care and resident outcomes. Take copies of F520 to your next meeting to share at the beginning of your discussion so that the committee members understand just how important their roles are. Obtain F520 from the State Operations Manual Appendix PP by visiting http://www.cms.gov/manuals/Downloads/som107ap_pp_guidelines_ltcf.pdf. The regulation is located near the very end of the manual. Betty Frandsen, rn, nha, mha, c-ne ([email protected]) What can we expect from a QIS survey med pass inspection? Survey team nurses or pharmacists conduct this task using the Medication Administration Observation/Drug Storage worksheet, Form CMS-20056. One surveyor is assigned to organize and ensure completion of this task, and also review drug-storage areas. A combined total of at least 50 medication administrations to at least 10 randomly observed residents from different units is included. Surveyors attempt to observe medications by multiple routes, and ask about the routes of administration. Adjustments are made to observations in order to include as many routes of administration as possible. Observations may not all be done in one day. Multiple medication-administration times may be observed for each resident. Refused medications are counted as observable medications, and the surveyor watches to see how the nurse addresses this issue. If any medications are not administered properly, the significance of each error is determined by considering the following elements: resident’s condition, medication category, and frequency of the error. The surveyors assigned the Medication Administration Observation task confer and calculate the error rate as follows: •Combine all surveyor observations into one overall calculation for the facility •Calculate the Medication Administration Error Rate (%) using the following formula: Medication Administration Error Rate (%) = Number of Errors observed divided by Opportunities for Errors (doses given plus doses ordered but not given) multiplied by 100. Deb Myhre rn, c-ne, rac-mt Nurse Consultant, Continuum Health Care Services Ron Orth rn, nha, rac-mt Clinical Reimbursement Solutions, LLC, Milwaukee, WI Andrea Otis-Higgins rn, mlnha , cdona , clnc, rac-mt CEO, Administrator, St. Andre Healthcare Biddeford, ME Rena R. Shephard mha, rn, rac-mt, c-ne AANAC Executive Editor President, RRS Healthcare, Consulting Services, San Diego, CA Judy Wilhide Brandt rn, rac-mt, c-ne Regional MDS/Medicare Consultant President, Judy Wilhide MDS Consulting, Inc. 14 After the overall error rate is determined, the team decides if a citation is appropriate. If the error rate is 5% or greater, they cite F332, Free of Medication Error Rates of 5% or Greater. If any medication error is considered significant, they cite F333, Residents Are Free of Any Significant Medication Errors. You can obtain Form CMS-20056 which is utilized by the surveyors for the medication administration observation from https://www.qtso.com/qisforms.html under the category Mandatory Facility Task Pathway Forms. You can use this form as part of your QAA activities all year long. Betty Frandsen, rn, nha, mha, c-ne ([email protected]) ● A A N AC LT C L E A D E R 3 . 2 0 . 2 012 LOOK AT WHAT YOUR COLLEAGUES HAVE BEEN UP TO! C-NE Recipients January 1 – March 15, 2012 Nancy Adams Cristy Castleberry Sharon Arnold Esther Field Jessica Boe Elaine Brown Edie Galeener Lynn Hild January 1 – March 15, 2012 Jennifer Abela Evelyn Abreu Rochelle Adams Leonilla Addeh Marie Apostol-Andes Joy Aquino Robin Arnicar Candice Arnold Anuradha Adhikari Rhonda Arnold Phebe-Ann Agarin Lacy Axtell Caroline Agbaje Irma Bacchus Benedicta Agbi Kathleen Backer Anne Ahern Ramonietta Bagnol Adam Airington Denise Bailey Nicole Alexander Patricia Bailey Cathy Allen Amy Baker Janene Allen Deanna Baker Julia Alvarez Heather Baker Rhea Amponin Levon Baker Adele Anderson Rochelle Baker Allison Anderson Myrna Baleria Elizabeth Anderson Nancy Banfield Johnson Jane Anderson Susan Anderson Mark Andres Tiffanie Andrews Rhonda Antoine Tanya Banks Susan Bardo Zilphia Barney Marget Barringer Gay Barth Staccey Bascue Pamela Baumann Kimberley Beals Kandice Beard Stacey Beard Neva Bennett Kathleen Bentley Maricel Bernadas Mary Berry LaWanda Bradley Barbara Carstens Tammy Bradley Guenivere Caslangen Ava Braithwaite Ruth Bratton Nancy Briarton Hope Bridges Lydia Britschgi Andrea Brown Gary Brown Jeana Brown Deborah Brumble Cathy Brunetti Marina Bukhrashvili Marianne Bunge Mary Berryman Cherri Burchard Janice Bey Susan Burish Leah Biby Jodie Burroughs Patience Bigbee Pamlia Blackmer Evangeline Cabanban Deborah Blake Beth Cagle Jill Blanchard Evanthe Rockwood Holly Styles Thomas McVay Laura Windle Malissa Nelson Linda Winston Kathleen Rivers John Brown MDS 3.0 RAC-CT® Recipients Christopher Johnson Lacy Castleton Maria Rosario Casuat Blake Cavanagh Ursula Cedeno Danita Chambers Patricia Charlot Ruth Chaza Cheri Childress Youngsuk Cho Rashi Choudhary Carmela Christie Victoria Cisse Jessica Claudio Alecia Clayboin Ann Cockerill Jennifer Young Jana Creamer-Shatkosky Angeline Cuevas Erica Dodd Gail Doetzl Tiffany Cunningham Judith Dogbe Diana Dai Jonette Domingo Riza Damania Judith Donahue Randy Danan Barbara Dornenburg Amanda Danberry Beminda Datuin-Pal Gloria Daughtry Amy Earnest Christina Davis Joan Eastman Stanley Davis Melvina Echols Heather Day Shanna Eckberg Dee Deckard Lori Eckman Patricia Decker Rachael Edmundson Carol Ann Coker Loreta Del Rosario Patricia Call Jacqueline Collins Becky DeLaFuente Craig Blevins Jennifer Cambron Linda Comfort Amelia Deluna Sarah Blevins Lizbeth Caminita Julie Cook Charina DeMille Janet Blough-Black Carolyn Campanella Laura Cook Gloria Dennis Lilibeth Corpuz Rose-Marie Desir David Corriveau Susan DiFate Melinda Cotton Linda Diforte Heidi Courtright Amanda Dillard Rhonda Craig Elizabeth Disch Jessica Boe Ousman Bojang Christine Bowen Frances Bradley Karen Campbell Julie Carlone Diana Carlson Jeffrey Carson Patricia Duffy Emma Duquette Klarisse Chantlle Del Rosario Janet Campbell Nancy Dixon Gail Doan Maria Teresa Cuevas Ann Cohen Karen Boatright Seema Diwan Diane Ehmann Leslie Elliott-Manning Houn Elllis Heidi Engeman Chonna Jossette Enriquez Dee Erickson Jessica Esguerra Lualhati Espina Annette Fairrow Douglas Farley continued on page 16 15 A A N AC LT C L E A D E R 3 . 2 0 . 2 012 First Quarter 2012 RAC-CT Certifications, continued from page 15 Jessica Faulkner Patrice Grindstaff Kathy Inman Beverlyn Larry Tammy McAdam Dawn Ocon Iwona Regula Leonila Fernandez Kathi Grom Cynthia Isenberg Mary Larson Glenda McAuliffe William Odom Kristi Reinberger Genalyn Ferrer Marie Gruber Susan Iwaniuk Patricia Larson Susan McCauley Davnet Okeke Letisia Rendon Linda Fischer Cathy Grundy Karen Jackson Kathy Lashomb Vicki McCullough Miranda Oliphant Susan Revella Kay Flanagan Susan Guzman Tara James Denise Latina Jennifer McCullum Nadine Olness Marquita Reynolds Kimberly Fleming Geraldine Habal Marie Jean-Louis Maureen Lawlor Kristi McDonald Heather Orback Carlos Rhashaun Davis Viven Flores Monterde Patricia Floyd Barbara Folmar Samantha Fortenberry Theresa Forthman Elaine Fox Holly Francis Donna Frank Tammy Franks Jennifer Friddle Rita Frieder Dolores Fritz Sharon Fuller Fran Fullerton Emmanuel Galega Sara Gardner Adoracion Garrote Celeste Garza Ethel Garzon Diane Gayle Rita Gelovani Caryl Gere Jenna Giandalia Christine Gilliland Irene Ginczek Stephanie Giroir Amber Glass Suzanne Glisan Laveta Glover Elaine Gorman Jana Graeber Bernice Graham Stephanie Haines Brandie Jenkins Lindsay Lay Gail McGatlin Kandra Ortez Rachel Halili Carolyn Jessee Alicia LeGrand Tabitha McGill Elizabeth Oryall Carrie Hall Myrlande Jocelyn Evelyne Lemy Lisa McHale Mary Ouellette Robin Hall Nancy Johnson Joyce Lewandowski Kimberly McIver Yvonne Paguio Sonya Hall Tamekia Johnson Kristi Lewis Leona Palmieri Deborah Hamernik Tiffany Johnson Rachel Lewis Dawn McNally-Harris Shanna Hammontree Jesselyn Johnson-James Cherryl Lewis-Berry Ursula Hander Carol Johnston Jayne Lewis-Pitter Jill Hannagan Deanna Jones Shannon Lien Dhanjit Harakh Rachel Jones Tabitha Lindback Theresa Harnage Rashonna Jones Malou Llenos Michelle Harris Stephanie Jones Theodore Llenos Marissa Harrison Trennese Jones Renee Loenen Amy Harrold Marie-Claire Joseph Vicki Lohrman Kathy Hartline Karyn Hartline Kim Hartness Robin Havens Tish Hays Trina Heady Taffy Hembree Robin Hendrix Patty Herndon Lisa Hettich Maryann Hickey Renee Higgins Kitty Hofman Janella Hogan Jill Hogrefe Faye Holbert Christy Howe Joy Hudson Beth Gray Katherine Lynne Hurtt Velda Green Evelyne Huydic Jeri Gregory Onyeka Ibeh Angela Griffin Kathy Ingalls Natalie Griffin Angela Ingle Dorene Judd Shelly Justice Kelley Kalenchuk Deborah Kaplan Felicia Kelley Naomi Kelley Traci Kellum Angela Kemp Amy Kerr Crystal King Katrina King Lyudmila Kletsko Elizabeth Lorenzo KellyAnn Lunghi Jocbee Lusan Karen Lynch Susan Maak Emelinda Macleod Daria Macy Tracie Magee Cheri Magelky Joan Maire JoAnn Malohn Maria Felma Manaig Deborah McSparrin Jean Medina Rebecca Medina Douglas Merow Deborah Merten Cameron Meyer Teresa Middleton Carol Miller Brenda Miller-Huber Patricia Milord Marilyn Mines Debra Minton Marcella Minucci Monica Miranda Tereta Mitchell Venus Molina Amanda Monsivais Robin Moore-McElroy Judy Richards Angela Richmond Jeanette Rios Julie Ritchie Elisa Rivera Adolfo Peter Paras Brenda Rivers Karen Parker Judy Roberts-Velapoldi Lynn Parker Malissa Parks Sarah Robinson Eleanor Parnell Idalina Rocha Anita Patterson Veronica Patterson Barbara Patterson-Paul Cynthia Payne Dean Pearce Remedios Peloton Rosalina Perez Tanesha Perry Ann Phillips Kimberly Pierce Katherine Pilbin Kimberly Pinder Linda Pitzen Dolores Price Eleanor Prince Sandra Rocha-Zapata Laura Rogers Mary Rolle Diana Rollins Sandra Root Diane Ross Lorna Ross Jill Rueckemann Jennifer Russell Valerie Sachse Amy Sanchez Jill Sanders Ranelyn Santos Wendy Satory Kris Sauberzweig Starla Morton Denise Puckett Kimberly Puckett Jane Scarborough Lancaster Gena Klima Sidney Manyiri Brenda Mueller-Jensen May Pura Kelly Knight-Vanscoy Ann Marfia Laurel Schaefer Patricia Mwariri Carolyn Pye Mary Grace Mariano-Alabas Tina Schermer Debra Myers Stacy Quakenbush Colleen Schmidt Susan Nappen Paje Racca Peggy Schneider Michael Nelson Anna Rainey Stacey Schories Paul Netto Danette Ranck Lorraine Schwartz Vicky Newman James Rankin Michelle Schwarz Ruth Newport Jessie Rao Stephanie Scott Mary Newton Deb Rayas Gwendolyn Searcy Debbie Norman Katherine Rayner Timothy Seavey Lauren Obst Katrina Reese Patricia Seidler Kathy Kopp Lisa Korinko Rhodora Krcik Angela Krukowski Loretta Kryger Daniel Krzysik Susan Kuhl Susan Lade Shannon Lambrix Andromeda Marquez-Hulse Juliet Martin Ruth Mask Sandy Mastrangelo Wendy Matousek Mary Mauler Lydia Mba continued on page 17 16 A A N AC LT C L E A D E R 3 . 2 0 . 2 012 First 2012 RAC-CT Certifications, FinalQuarter Rule Changes, continued from page 2 continued from page 16 Janet Sekelsky Theresa Sliez Ann Steinkamp Terrel Tetschner Carol Trumbauer Judith Vogel Tina Shannon Jessica Smith Marcie• Stoup Catherine Valencia eliminatesHeather the distinction between Ana Wilson of $3.87 billion, or 11.1 percent. It is overlap in observation periods between • Provides for the allocation of a Susan Sellers Sligo Tamara assessments. Sterling Darly Thomas Regina Vogt Jackie Wilson therapist’s time for group therapy designed to ensureKarol that payments more The final rule also: Elsa Turney Andrea Serquina Brianna Slone required Doris Stetson Lashonda Thomas Amber Umbreit (defined Lindain Vonfraenkel Wolfe the rule as aDebra single accurately reflect the resources • Clarifies circumstances when SnFs therapist leading four patients in to provide care for the range of SNF Jennifer Seymour Diane Smack Amy Stimpson Lorie Thomas must report breaks of three orMichalina more Umnova Georgiana Walker Janet Wolken a common activity) to ensure that patients, includingAlma thoseSmith requiring more days of therapy. Jennifer Shaffer Valerie Stinson Cynthia Thompson Patty Unpingco Karen Walker Kilee Wolken medicare payments better reflect medically complex care. John Wallis Wolsefer resource utilization andVanessa cost for these Thompsonfurnishing therapy This recalibration removes an facilities regularly Marla Shapiro Laurie Smith Lori Strittmatter Rhonda Frances Ware Kirathat Wood services, and specifically the unintended spike in payments that Thompson services onIdalina a 5- or 7-day basisVan forBuskirk therapist’s appropriately Nancy Sharrow Loretta Smith Lenora Sullivan Kimberlytime is being Brandi Woods occurred in FY 2011 rather than purposes of setting the date for the Van Horncounted Doris Thornburg Roxanne Washington and reimbursed. Dawn Sheppard Mary Smythe Patricia Sullivan Vickie Worden decreasing an otherwise appropriate end of Therapy (eOT) Other medicare Sheri Renee Cynthia Van Sickle Nancy Weljkovic • Discusses the impact of certain Sabrina Sheppard Sonyawith Soboleski Kyle Summers Beverly Wright Required Assessment (OmRA). payment amount. Even the Thornburg provisions of the Affordable Care Lorraine Raquel Welsh Helen Shropshire Sue Sochats Shannon Summers Linda Wright recalibration, the FY 2012 payment • StreamlinesTammy procedures for documenting Thornton Vanderwal Act, Kay andWestbrook announces that proposed rates will be 3.4 percent Georgia Shultz Dorotahigher Sohail than the Brenda Sutherland Dawn Wylie situations involving a brief interruption provisions regarding ownership Sue Thrower Kimberly Jill Weston rates established for FY 2010, the period in therapy, where therapy resumes Theresa Silkwood Jenette Somers Annie Swanson Elna VanMeter disclosure requirements setYambao forth Chingbee Tinio immediately preceding the unintended Ruby Whaley Care Act will be without any change in the patient’s in the Affordable Maricar Simene Angela Spencer Norman Taclob Debra York Paulson Varghese Kathleen Tipton spike in payment levels. RUG-iV classification level. FeliciaatWhite finalized a later date. Elizabeth Simes Sara Spinney Cathi Tampa Cora Young Marie-Francoise Along with recalibrating and updating the • introducesRebecca a new Todd Change of Therapy Karissa White Vaudreuil More information on this SNF PPSZabel final Carol Simpson Michelene Splichal Maria Tang Mary Ernestine Toe those SNF PPS payment rates for FY 2012, this (COT) OmRA to capture Brenda Williams news Laura Verbarg rule and other health care related Natasha Simpson Amanda Spore Shannon Tate Mary Ziegler final rule makes a number of additional changes inJanet a patient’s Toomey therapy status can be found at www.healthcare.gov, a Linda Williams Marise Vignier Samie Singleton SquireSNF PPSMary Tauer Theresa Zielinski that wouldEdwin be sufficient to affect the revisions aimed at Jennie enhancing Towers new web portal made available by the U.S. Nyeka Williams Lorena Villamor patient’s RUG-iV classification and accuracy and integrity. Tifanny Sirichana Alice The Steckrule modifies Betty Taylor Sheila Zion-Self Department of Health and Human Services. ● Danita Traxinger Sanyo Williams payment, even though they may not Dina the patient assessment windows and Jami Skeen Betty Stegall Kelli Taylor Jermaine Zosa Trimbach Villanueva Burgos increase toDavid the level of a significant grace days to minimize duplication and Sharon Celia Slayden Robin Stegenga Ulysses Tayocnog in Nelson clinicalTrujillo status. AANACad_030512 3/6/12 11:04 AM Pagechange 1 MDS Interview Forms RESIDENT INTERVIEWS Assessment Reference Date: Directions: Conduct interview in private setting. Be sure the resident can hear you. A resident with a hearing impairment should be interviewed with their usual communication device/technique. ____/____/_____ A1100. Language Identification Information A. Does the resident need or want an interpreter to communicate with a doctor or health care staff? 0. No 1. Yes Specify in A1100B, Preferred Language 9. Unable to determine B. Preferred language: Hearing, Speech, and Vision SECTION B B0700. Makes Self Understood Enter Code Ability to express ideas and wants, consider both verbal and non-verbal expression 0. Understood 1. Usually understood – difficulty communicating some words or finishing thoughts but is able if prompted or given time 2. Sometimes understood – ability is limited to making concrete requests 3. Rarely/never understood SECTION C C0100. No (resident is rarely/never understood) Yes Continue to C0200, Repetition of Three Words C0200. (06/10) Form # CP3001-C 2. 3. Mood Missed by 1 year Correct Should Resident Mood Interview be Conducted? to conduct interview with all residents month are we–inAttempt right now?” Ask resident: “What Enter Code 0. 1. D0200. (06/10) (06/10) Enter Code is rarely/never B. Able to report correctComplete month Staff Assessment of Resident Mood (PHQ-9-OV) No (resident understood) Missed by >1 month or no answer Yes Continue to0. D0200, Resident Mood Interview (PHQ-9©) 1. Missed by 6 days to 1 month 2. Accurate within 5 days Resident Mood Interview (PHQ-9©) Ask resident: “What day of the week is today?” Say to resident: “Over the havetoyou beencorrect bothered of the following problems?” Enterlast Code2 weeks, C. Able report dayby of any the week 0. 1,Incorrect no answer If symptom is present, enter 1 (yes) in column SymptomorPresence. 1. Correct If yes in column 1, then ask the resident: “About how often have you been bothered by this?” C0400. Recall Read and show the resident a card with the symptom frequency choices. Indicate response in column 2, Symptom Frequency. Enter Code that Enter Score slowly lot more than Reorder From: speaking so a H. Moving orSCORE moving around SUMMARY you have been C0500. usual or of hurting yourself in some way dead, be better off Add scores forthat questions and fill in total score (00 - 15) you wouldC0200–C0400 Thoughts I. 99 Enter if the resident was unable to complete the interview Total score must be between 00 and 27. SCORE 2, Symptom Frequency.3 or more items). TOTAL SEVERITY in Column D0300. for Refer to RAI Version 3.0frequency Manualresponses pages C-1 through C-15 for coding guidelines and time frame for interview completion. is blank Frequency all Interview Enter Conducted By to complete 99 if unable $ Inc. All rights reserved. Reproduced Resident Name SECTION F Form # CP3001-D Enter Code C. Able to Activities recall “bed”or sleeping too much Code C. Enter Trouble falling or staying asleep, Preferences for Customary Routine and 0. No – could not recall D.interview Feelingwith tiredfamily or having little energy If resident is unable to complete, attempt to complete significant 2. member Yes, no or cue requiredother 0. No (resident is rarely/never understood andE.family/significant other not available) Complete Staff Assessment Poor appetite or overeating C0500. SUMMARY SCORE Continue to F0400, Interview for Daily Preferences 1. Yes Enter Score Add scores for questions C0200–C0400 and fill in total score (00 - 15) F. Feeling bad about yourself – or that you are a failure or have let yourself or your family down Enter 99 if the resident was unable to complete the interview Should Interview for Daily and Activity Preferences be Conducted? – Attempt to interview allofresidents able to communicate. 1. Yes, after cueing (“a piece furniture”) F0400. Interview for Daily Preferences LEARN THE STEPS TO SUCCESS! interview (i.e., with permission. pages D-1 through 800-438-8884 Add scores for Enter Score Copyright© Pfizer SECTION F F0300. © 2010 MED-PASS, Inc. Enter Code Ask resident: “Let’s go back to an earlier question. What were those three words that I asked you to repeat?” 1. Symptom Presence 2. Symptom Frequency Directions: Conduct interview in private setting. the resident can 1. Be sure 2. FOR toCUSTOMARY If unable to rememberPREFERENCES a word, give cue (something wear; a color; a piece of furniture) for that word. 0. No (enter 0 in column 2) 0. Never or 1 Day Symptom Symptom hear you. A resident with a hearing impairment should be interviewed Enter with A. Able to ROUTINE recall “sock” AND ACTIVITIES FOR MDS 3.0 Code 1. 2 - 6 Days (several days) 1. Yes (enter0. 0 - 3No in column their usual communication device/technique.Presence Frequency – could2) not recall 2. 7 - 11 Days (half or more of the days) 9. No Response column 2 blank) 1. (leave Yes, after cueing (“something toAssessment wear”) Reference Date: 3. 12 - 14 Days (nearly every day) Enter Scores in Boxes Does resident need or want an interpreter to communicate with the doctor or health careno staff? 2. Yes, cue required _____/_____/_______ □ No □ Yes □ Unable to determine Preferred language: ________________________________________ A. Enter Little or pleasure in“blue” doing things B. Able to recall Code interest 0. Noexpressions)? – could not recall Is the resident able to express ideas and wants (consider both verbal and non-verbal 1.depressed, Yes, after (“a color”) understood Feeling down, or cueing hopeless □ Understood □ Usually understood □B.Sometimes understood □ Rarely/Never 2. Yes, no cue required 800-438-8884 Form # CP3000 Reorder From: D0100. Interviews include: Section C - BIMS Section D - PHQ-9© Section F - Daily/Activity Preferences Section J - Pain Ask resident: “Let’s go back to an earlier question. What were those three words that I asked you to repeat?” things If unable to remember a word, give cue (something to wear; a color; a piece of furniture) for that word. in doing interest or pleasure A. Little A. Able to recall “sock” or hopeless 0. No – could not recall down, depressed, B. Feeling 1. Yes, after cueing (“something totoo wear”) much asleep, or sleeping 2. Yes, noorcue required staying falling C. Trouble B. Able to recall “blue” energy or having tired No – could notlittle recall Feeling D. 0. 1. Yes, after cueing (“a color”) down overeating 2. Yes, noorcue required or your family E. Poor appetite have let yourself are a failure or C. Able to recall “bed” – or that you about yourself watching television Feeling F. 0. restless Nobad – could not recall newspaper or so fidgety or as reading the suchof opposite – being 1. Yes, after cueing (“a piece furniture”) on things, noticed. Or the concentrating G. 2.Trouble Yes, no cue requiredthat other people could have (06/10) © 2010 MED-PASS, Inc. A.and Able to report correct Enter Code ideas Is the resident able to express wants (consider bothyear verbal and non-verbal expressions)? 0. Missed by > 5 years or no answer □ Understood □ Usually understood Sometimes understood □ Rarely/Never understood 1. Missed by 2 - 5 □ years SECTION D INNOVATION: Boxes Enter Code INH 042010 C0300. Temporal Orientation with (orientation to year, month, and day) Does resident need or want an interpreter to communicate the doctor or health care staff? □ No □ Yes □ Unable to determine Preferred _____________________________________________________________ Ask resident: “Please telllanguage: me what year it is right now.” t other and family/significan rarely/never understood No (resident is Preferences Activity Preferences Interview for Daily Continue to F0400, Yes 800-438-8884 1. Form # CP3000 Enter Scores in 0. Daily Preferences in this facility…” Interview for “While you are options and say: the response at all Show resident 4. Not important can’t do or no choice but Coding: 5. Important, or non-responsive 1. Very important important 9. No response Enter 2. Somewhat important Codes in 3. Not very clothes to wear? Boxes choose what is it to you to or things? A. how important personal belongings take care of your sponge bath? is it to you to bed bath, or B. how important a tub bath, shower, choose between is it to you to meals? C. how important available between have snacks is it to you to D. how important own bedtime? about your care? choose your is it to you to involved in discussions friend E. how important close a or have your family is it to you to private? F. how important the phone in be able to use is it to you to keep them safe? G. how important your things to lock to have a place is it to you to H. how important Activity Preferences facility…” Interview for you are in this F0500. and say: “While options the response at all Show resident 4. Not important can’t do or no choice but Coding: 5. Important, or non-responsive 1. Very important Enter important 9. No response 2. Somewhat Codes in important to read? 3. Not very Boxes and magazines newspapers, have books, is it to you to A. how important you like? listen to music is it to you to B. how important such as pets? be around animals is it to you to C. how important the news? keep up with is it to you to D. how important groups of people? do things with is it to you to E. how important activities? your favorite good? is it to you to do the weather is F. how important fresh air when outside to get is it to you to go or practices? G. how important religious services participate in is it to you to important of 4 how H. F0400. problems?” 2 weeks, Missed by 6 days to 1 month “Over the last1. Presence. Say to resident: 1, Symptom bothered by this?” 2. Accurate within 5 days 2, Symptom Frequency. 1 (yes) in column how often have you been response in column present, enter If symptom is resident: “About “What day of the choices. week isIndicate today?” Ask resident: frequency 1, then ask the with the symptom If yes in column Enter Code C. a card Able to report correct day of the week2. Symptom Frequency the resident 1 Day Read and show 0. Never or 0. Presence Incorrect or no answer (several days) 1. Symptom 1. 2 - 6 Days (half or more of the days) 1. Correct 0 in column 2) 2. 2. 7 - 11 Days (nearly every day) 0. No (enter 1. 2) 0 - 3 in column Symptom 3. 12 - 14 Days 2 blank) Recall 1. Yes (enter Symptom C0400. (leave column Frequency Presence 9. No Response MOOD INTERVIEW FOR MDS 3.0 Symptom Title D-9 for coding guidelines and time frame for interview completion. ID # Room # Date Physician G. facility…” Trouble concentrating on things, such as reading the newspaper or watching television Show resident the response options and say: “While you are in this Refer to RAI Version 3.0 Manual pages C-1 through D-9 for coding guidelines and time frame for interview completion. H. Moving or speaking so slowly that other people could have noticed. Or the opposite – being so fidgety or restless Enter Coding: Conducted By Title that you have been moving around5.a lot more than usual Codes in 1. Very important 3. Interview Not very important Important, but can’t do or no choice Boxes 2. Somewhat important 4. Not important at all 9. No response or non-responsive I. Thoughts that you would be better off dead, or of hurting yourself in some way A. how important is it to you to choose what clothes to wear? Resident Name ID # Room # Physician INH 042010R 800-438-8884 resident: “What month are we in right now?” Ask If resident Enter Code No (resident3. Correct Resident Mood Interview Continue to D0200, Yes 0. 1. B. Interview Able to (PHQ-9©) report correct monthby any of the following Resident Mood 0. bothered been Missed by >1 month or no answer have you Preferenc be or significant with family member Activity Preferences Daily and for Daily and complete interview Assessment of Complete Staff Should Interview to complete, attempt to not available) is unable F0300. (PHQ-9-OV) Resident Mood be2Conducted? 1. Missed - 5 years Interviewby Assessment of Mood Complete Staff Should Resident 2. Missedunderstood) by 1 year (PHQ-9©) is rarely/never Enter Code Repetition of Three Words SECTION D SECTION F Temporal Orientation (orientation to year, month, and day) Ask resident: “Please tell me what year it is right now.” A. Able to report correct year with all residents to conduct interview Mood Attempt 0. Missed by > 5 years or –no answer Enter Code D0200. Ask resident: “I am going to say three words for you to remember. Please repeat the words after I have said all three. The words are: sock, blue, and bed. Now tell me the three words.” Number of words repeated after first attempt Enter Code 0. None 1. One 2. Two Directions: Conduct interview in private setting. Be sure the resident can hear 3. Three you. A resident with a hearing impairment should be interviewed with their usual Assessment Reference Date: communication device/technique. After the resident’s first attempt, repeat the words using cues (“sock, something to wear; blue, a color; bed, a piece of furniture”). You may _____/_____/_______ repeat the words up to two more times. Reorder From: (06/10) Form # CP3000 C0300. Enter Code No (resident is rarely/never understood) Complete Staff Assessment Continue to C0200, Repetition of Three Words Yes Brief Interview for Mental Status (BIMS) Repetition of Three Words SECTION D D0100. 0. 1. Should Brief Interview for Mental Status (C0200-C0500) be Conducted? – Attempt to conduct interview with all residents 0. 1. Cognitive Patterns Should Brief Interview for Mental Status (C0200-C0500) be Conducted? – Attempt to conduct interview with all residents Enter Code Ask resident: “I am going to say three words for you to remember. Please repeat the words after I have said all three. The words are: sock, blue, and bed. Now tell me the three words.” RESIDENT Assessment Reference Number of words repeated after first attempt Date: INTERVIEWS ____/____/_____ 0. None with hear you. A resident N TOOL 1. One the resident can device/technique. COLLECTIO setting. Be sure communication MDS 3.0 DATA interview in private 2. Two with their usual Directions: Conduct should be interviewed 3. Three a hearing impairment Activities to communicate. After the resident’s first attempt, repeat the words using cues (“sock, something to wear; blue, a color; bed, a piece of furniture”). You may y Routine and all residents able repeat the words up to two more times. – Attempt to interview es for Customar other Conducted? Enter Code _____/_____/_______ Is the resident able to express ideas and wants (consider both verbal and non-verbal expressions)? □ Understood □ Usually understood □ Sometimes understood □ Rarely/Never understood Brief Interview for Mental Status (BIMS) C0200. Assessment Reference Date: Does resident need or want an interpreter to communicate with the doctor or health care staff? □ No □ Yes □ Unable to determine Preferred language: _____________________________________________________________ Reorder From: C0100. Enter Code Improving care through knowledge SECTION C BIMS INTERVIEW FOR MDS 3.0 Directions: Conduct interview in private setting. Be sure the resident can hear you. A resident with a hearing impairment should be interviewed with their usual communication device/technique. Cognitive Patterns SECTION C Date V\RXUUHKDESURYLGHUZHFDQFKRUHRJUDSKWKHULJKW VWHSVDWWKHULJKWWLPHVR\RXUWHDPVXFFHVVIXOO\ QDYLJDWHVLQGXVWU\FKDQJHVDQGFKDOOHQJHV Observation Forms 7KURXJKHIIHFWLYHFRPPXQLFDWLRQFROODERUDWLRQ DQGSDUWQHUVKLSZHFDQOHDG\RXUWHDPWKURXJKDOO WKHQHZVWHSVZKLOHZHNHHSWKHIRFXVZKHUHLWVKRXOG EH²RQ\RXUUHVLGHQWVDQGWKHLUQHHGV B. C. D. Room # ID # 3 of 4 Physician 800-438-8884 F0500. G. □ Understood □ Usually understood how important is it to you to be able to use the phone in private? H. SECTION how important is it to you to have a place to lock yourJthings toHealth keep themConditions safe? Interview for Activity Preferences Reorder From: C. D. F. MDS 3.0 Observation Tool _____/_____/_______ DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 __________ __________ __________ __________ __________ DAY 7 C0700. Short-Term Memory OK Seems/appears to recall after 5 minutes 0. Memory OK 1. Memory problem C0800. Long-Term Memory OK Seems or appears to recall long past 1. Identify the dates in the 14-day observation period. 2. At the end of each shift, record appropriate response for Symptom Presence using the codes provided. 3. Initial after each shift and enter verifying signature. 4. Summarize findings for MDS. SYMPTOM PRESENCE Check ()all that resident was able to recall. DAY 4 DAY 5 DAY 6 DAY 7 DAY 8 DAY 9 DAY 10 DAY 11 DAY 12 DAY 13 DAY 14 __________ __________ __________ __________ __________ __________ __________ __________ __________ __________ __________ __________ B. Feeling or appearing down, depressed, or hopeless Made decisions regarding tasks of daily life C. Trouble falling or staying asleep, or sleeping too much C1000. Cognitive Skills for Daily Decision Making D. Feeling tired or having little energy 0. Independent – decisions consistent /reasonable 1. Modified independence – some difficulty in new situations only 2. Moderately impaired – decisions poor; cues/supervision required 3. Severely impaired – never/rarely made decisions Form # CP3003 800-438-8884 SIGNATURE SIGNATURE SIGNATURE SIGNATURE INH 060410 17 7 E. Poor appetite or overeating F. Indicating that s/he feels bad about self, is a failure, or has let self or family down concentrating on things, G. Trouble INITIALS SIGNATURE such as reading the newspaper or watching television INITIALS Reorder From: INITIALS INITIALS INITIALS INITIALS Resident Name © 2010 MED-PASS, Inc. INH 060410 © 2010 MED-PASS, Inc. Reorder From: (06/10) 800-438-8884 D. That he/she is in nursing home SIGNATURE H. Moving or speaking so slowly that INITIALS SIGNATURE other people have noticed, or the opposite being so fidgety or restless thatINITIALS s/he has been moving around SIGNATURE a lot more than usual I. States that life isn’t worth living, wishes for death, or attempts to harm self INITIALS INITIALS SIGNATURE SIGNATURE SIGNATURE Room # Physician Improve resident outcomes. Start reducing ADL decline, incontinence, hospitalizations, pain and restraint use in your facility. Physician Title (00–10) Date Numeric Rating Scale Ask resident: “Please rate your worst pain over the last 5 days on a zero to ten scale, with zero being no pain and ten as the worst pain you can imagine.” (Show resident 00–10 pain scale) Room # Physician Enter two-digit response. Enter 99 if unable to answer. Verbal Descriptor Scale Ask resident: “Please rate the intensity of your worst pain over the last 5 days.” (Show resident verbal scale) 1. Mild 2. Moderate 3. Severe 4. Very severe, horrible 9. Unable to answer Why look for certification? Provide care you would want. Your residents will be getting the kind of care that we will all want for ourselves, and shows your commitment to positive outcomes. Refer to RAI Version 3.0 Manual pages J-4 through J-14 for coding guidelines and time frame for interview completion. Interview Conducted By Resident Name Title ID # Room # Date Physician INITIALS SIGNATURE INITIALS INITIALS ID # INH 042010R DAY 3 __________ Z. NONE OF ABOVE are recalled ID # MDS 3.0 Observation Tool _____/_____/_______ C0900. Memory/Recall ABILITY DAY 2 __________ INITIALS A. B. Enter Code Assessment Reference Date: 0. No 1. Yes DAY 1 D0500. Staff Assessment of Resident Mood (PHQ-9-OV©) A. Little interest or pleasure in doing things Why become certified? Date Room # Pain Intensity – Administer ONLY ONE of the following pain intensity questions (A or B) Enter Rating Resident Name SECTION D MOOD 0. Memory OK 1. Memory problem CHARTING CODES MOOD C. Staff names/faces B. Location of own room Interview Conducted By Seems/appears to recall after 5 minutes Directions: SHIFT KEY = ___________ = ___________ = ___________ A. Current season A. Ask resident: “Over the past 5 days, has pain made it hard for you to sleep at night?” Enter Code F0600. Daily and Activity Preferences Primary Respondent 0. No Enter Code 1. (F0400 Yes Indicate primary respondent for Daily and Activity Preferences and F0500). 9. Unable to answer 1. Resident 2. Family or significant other (close friend or other representative) B. Ask resident: “Over the past 5 days, have you limited your day-to-day activities because of pain?” Enter Code 9. Interview could not be completed by resident or family/significant other (”No Response” to 3 or more items) 0. No 1. Yes Refer to RAI Version 3.0 Manual pages F-1 through F-13 for coding guidelines and frame for interview completion. 9. Unable totime answer © 2010 MED-PASS, Inc. Form # CP3002 (06/10) Seems or appears to recall after 5 minutes H. how important is it to you to keep up with the news? J0400. Pain Frequency Ask resident: “How much of the time have you experienced pain or hurting over the last 5 days?” Code how important is it to you to do thingsEnter with groups of people? 1. Almost constantly 2. Frequently how important is it to you to do your favorite activities? 3. Occasionally 4.when Rarely how important is it to you to go outside to get fresh air the weather is good? 9. Unable to answer how important is it to you to participate in religious services J0500. Pain Effect or onpractices? Function J0600. CHARTING CODES __________ AANAC’s Resident Assessment Coordinator Certified designation is the gold standard in LTC professional development. No matter your position or goals, our certification is guaranteed to give the advantage you need for successful assessments and superior resident care. Enter Code 800-438-8884 SECTION C COGNITIVE PATTERNS Assessment Reference Date: DAY 1 __________ INH 042010R 1. Identify the dates in the 7-day observation period. 2. At the end of each shift, record the resident’s status using the charting codes provided for each section. 3. Initial after each shift and enter verifying signature. © 2010 MED-PASS, Inc. Directions: □ Rarely/Never understood Pain Presence Interview Conducted By Title how important is it to you to have books, newspapers, and magazines to read? Ask resident: “Have you had pain or hurting at any time in the last 5 days?” how important is it to you to listen to music you like? 0. No Continue to J0400, Pain Frequency 1. Yes Resident Name ID # how important is it to you to be around animals such as 9. pets? Unable to answer Complete Staff Assessment G. SHIFT KEY □ Sometimes understood Should Pain Assessment Interview be Conducted? Enter Code J0300. A. B. E. COGNITIVE PATTERNS J0200. 0. No (resident is rarely/never understood) Complete Staff Assessment Show resident the response options and say: “While you are in this facility…” Continue to J0300, Pain Presence 1. Yes Coding: Enter 1. Very important 3. Not very important 5. Important, but can’t do or no choice Codes in Pain Assessment Interview 2. Somewhat important 4. Not important at all 9. No response or non-responsive Boxes of 4 = _____________ = _____________ = _____________ © 2010 MED-PASS, Inc. By Resident Name Does resident need or want an interpreter to communicate with the doctor or health care staff? how important is it to you to choose your own bedtime? Refer to RAI Version pages D-1 through D-9 for coding guidelines and_____________________________________________________________ time frame for interview completion. □ No 3.0 □ Manual Yes □ Unable to determine Preferred language: how important is it to you to have yourIsfamily or a close involved in discussions about your care? the resident ablefriend to express ideas and wants (consider both verbal and non-verbal expressions)? INH 042010R Interview Conducted Physician Room # ID # _____/_____/_______ how important is it to you to have snacks available between meals? Reorder From: Inc. Date Title By Resident Name SECTION J TOTAL SEVERITY SCORE Copyright© Pfizer Inc. All rights reserved. Reproduced with permission. E. F. Title 2 D0300. how important is it to you to take care of your personal belongings things? Directions: Conduct interview inor private setting. Be sure the resident can hear PAIN INTERVIEW FOR MDS 3.0 Enter Score AddAscores all afrequency responses in Column 2, Symptom you. residentfor with hearing impairment should be interviewed with Frequency. their usual Total score must be between 00 and 27. how important is it to you to choose communication between a tub device/technique. bath, shower, bed bath, or sponge bath? Assessment Reference Date: Enter 99 if unable to complete interview (i.e., Symptom Frequency is blank for 3 or more items). (06/10) Daily and Activity Form # CP3001-F F0600. Form # CP3001-J (06/10) Respondent Primary and F0500). Preferences Preferences (F0400 Daily and Activity respondent for to 3 or more items) Indicate primary other representative) t other (”No Response” Enter Code (close friend or 1. Resident significant other resident or family/significan completed by 2. Family or could not be interview completion. 9. Interview time frame for guidelines and F-13 for coding pages F-1 through Version 3.0 Manual Date Refer to RAI Inc. © 2010 MED-PASS, Interview Conducted 1 © 2010 MED-PASS, Version 3.0 Manual INH 042010 Refer to RAI Williamson RAC-CT® Certification Stand-Alone Forms 4-Page Data Collection Form MDS 3.0 DATA COLLECTION TOOL SECTION A Enter Code Jamie Vistrand SIGNATURE INITIALS SIGNATURE INITIALS SIGNATURE INITIALS SIGNATURE J. Being short-tempered, easily annoyed INITIALS INITIALS SIGNATURE INITIALS SIGNATURE INITIALS SIGNATURE INITIALS SIGNATURE INITIALS SIGNATURE INITIALS SIGNATURE INITIALS SIGNATURE INITIALS SIGNATURE INITIALS SIGNATURE INITIALS SIGNATURE INITIALS SIGNATURE INITIALS SIGNATURE INITIALS SIGNATURE INITIALS SIGNATURE INITIALS SIGNATURE INITIALS SIGNATURE Create your future. Visit aanac.org and start your certification today. 800-438-8884 www.med-pass.com (keyword: MDS) Resident Name ID # Room # Physician A AA AN N AC AC LT LT C C L LE EA AD DE ER R 38 .. 2 00 2 .. 22 012 011 BUSINESS pARtNERS & PROFESSIONAL buSINESS & DEVELOPMENT PARTNERS CoRpoRAtE SpoNSoRS Diamond Business Partners Diamond Business Partners Platinum Business Partners Platinum Business Cerner Partners Dementia Care Forest Specialists Pharmaceuticals, Inc. eHealth Data Solutions Inc. MeD-PaSS, Forest Laboratories Gold Golden Living Business Partners Harmony Healthcare accu-Med International Services, Inc. MED-PASS aIS Systems Purdue Pharma answers on Demand Gold Business Partners golden living Centers Accu-Med Technology Solutions Professional AIS Inc. keane Care, Inc. 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Kingston Healthcare CompanyHealthcare kingston Company Kissito Healthcare kissito Healthcare Lexington Healthcare lexington Healthcare Lutheran Senior Services Care Company nHS Management llC Pinon Management Paramount Plantation Health Care Company Management Company Pinon Management Plott Healthcare Plantation Management Preferred Company Care Partners Management Preferred GroupPartners Care Management Prestige Healthcare group Regent Care Center Prestige Rockport Healthcare Healthcare Regent ServicesCare Center Communities St. Francis Health Services TRISUN Healthcare Ten Broeck Commons Vanguard Healthcare Trinity Senior Services, LLC ● living Communities TRISun Healthcare Vanguard Healthcare Services, llC ● WE’RE WITH YOU EVERY STEP OF THE WAY. GROW Find out more at aanac.org LEARN SHARE JOIN At every step in your long-term care journey, AANAC has the resources you need to succeed. AANAC | 400 S. Colorado Blvd., Suite 600 | Denver, Colorado 80246 | Phone 800.768.1880 | Fax 303.758.3588 | 400 S.No Colorado Blvd., Suite 600 |may Denver, Colorado 80246 | Phone 800.768.1880 | Faxfrom 303.758.3588 © AANAC 2012 AANAC. part of this publication be reproduced without written permission AANAC. 18 13 The information presented is informative does not constitute direct permission legal or regulatory advice. © 2011 AANAC. No part of this publication may beand reproduced without written from AANAC. The information presented is informative and does not constitute direct legal or regulatory advice.