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MDS 3.0 Assessment Process for Social Workers

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					MDS 3.0 Assessment Process
            for
      Social Workers
         OKHASA
          2011
   First you need to Understand the
                Process
• The new Assessment Process is very different
  and requires many new tasks and
  documentation.
• Look at the data set format – yes I said data
  set format – no more MDS “forms”
• Newly organized data formats, definitions and
  look back periods
• New rules impact everyone
• New data and new uses of the data
• Definitions that will impact many members of
  the IDT
• Many new assessment assignments – both for
  assessment and care planning tasks
• Look at the need for training, resources and
  skills for the social service department.
• What does it take to get the assessment tasks
  done?
  TAKE A LOOK AT THE DATA SET

  PAY ATTENTION TO THE RED AND GREEN
  ITEMS – HIGH IMPACT DATA FOR PAYMENT
  AND CARE PLANNING.
• DO NOT ASSUME – READ THE MANUAL –
  MANY NEW PROCESSES AND DEFINITIONS
• BE CAREFUL BECAUSE SURVEYORS ARE
  LOOKING AT NEW DATA NOW
   LOOK AT THE MANUAL FOR THE
     SECTIONS YOU ARE CODING
• POLICIES AND PROCEEDURES
• PAY ATTENTION TO THE STEPS FOR THE
  ASSESSMENT – IT IS IMPORTANT
• DEFINITIONS ARE IMPORTANT AND WILL
  INFLUENCE THE DATA OUTCOMES
• NUMERICAL DEFINITIONS – THIS IS NEW –
  VERY DANGEROUS – EVERYONE IS IDENTIFIED
  BY A NUMERICAL SCORE
                Section B
• Combination of assessment tasks from the
  2.0 process.
• B-700 – most important code as it could
  influence the interview activity. – code
  carefully.
• Vision test and visual appliances – very
  important
• Combine clinical and social service tasks
                   Section C
• Technically not an interview – it is a test – very
  structured.
• Brief Interview for Mental Status
• One page assessment – 34 pages of directions
  in the manual
• Read the Steps for Assessment – be certain
  that training is focused on RAI manual
  resources.
• Appendix D and Appendix E
• The BIMS test is not only very scripted it
  needs to be introduced consistently – See the
  Steps for the Assessment section C of the RAI
  Manual.
• If the elder does not answer certain questions
  then a small amount of help can be given per
  the instructions in the RAI Manual and
  Appendix E .
• Before you do the BIMS read Appendix D
            Scoring the BIMS
• Write the elder’s answers on the work sheet
  and then score after the test is completed.
• No family or significant others are to be
  present
• Be certain the elder is comfortable and can
  see and hear you. Use ampflication device if
  necessary
• If elder can not speak use special test in
  Appendix E of the RAI Manual
• BIMS Test is done on all assessments and
  scores each test with a number.
• The IDT must consider the BIMS scores as they
  plan and conduct utilization review meetings.
• Can be completed by any staff member with
  training and proper documentaiton
• On admission doing the first BIMS close to the
  admission date assesses the elder’s ability as a
  base line.
• VERY IMPORTANT – ALL BIMS TESTS SHOULD
  BE DONE THE SAME AND SCORED THE SAME
  SO THE SCORES ARE ACCURATE AND
  RELATIVE. THESE SCORES WILL BE USED BY
  MANY OUTSIDE SOURCES TO EVALUATE THE
  RESIDENT AND YOUR FACILITY POPULATION.
  REMEMBER EVERY RESIDENT GETS A
  NUMERICAL SCORE FOR EACH MDS
  ASSESSMENT.
     Section D – Mood Interview
• This must be done on the ARD or the day
  before the ARD
• Read the Steps for the Assessment in the RAI
  Manual
• Introductory statement is very important and
  the scoring of the intensity or frequency of the
  issues must be done carefully
• Ask the questions in order
• 14 day look back on all cases
• Do not explain items –let elder answer what
  they think the items mean
• Record the resident’s response –
• Score the Mood Severity Score from the
  frequency of the indicators
• Refer to scoring guides in Appendix E of the
  RAI Manual – very important
• This interview is very converstaional
• Use the VIVE DVD produced for CMS for
  training
• Write the elder’s responses on the interview
  record and score after the interview is
  completed.
• Use the scoring rules and examples in
  Appendix E
• Record of the interview, date of the interview
  and the person doing the interview should be
  kept in the medical record as substaniation of
  compliance with the RAI process.
• Score of the Mood interview of 10 or higher
  can impact payment levels for Nursing
  Categories and could be part of fiscal audit.
                  Section E
• Behavior coding and outcomes
• This is a redesigined section with many
  outcome codes included
• Read the manual carefully and note the
  definitions and time lines carefully
• Tracking of behaviors is very specific during
  the ARP = be sure to use definitions in the RAI
  manual
• If you code behaviors you must answer
  outcome questions.
• Be careful – What is the meaning of
  “Significant” to your team. Outcome answers
  will be very important to the surveyors.
• Refusal of Care – New Item – 10 pages of
  instructions in the manual with examples.
  This includes all care – therapy, physician visits
  , treatments etc.
• Wandering – Very dangerous code – What is
  your definition. Best definition – “
  Locomotion with no rational discernable
  purpose” Do not over code !!!!!
• Outcome coding for wandering behavior –
  code carefully and be sure clinical staff are
  aware of codes.
• Surveyors will monitor these codes at all
  surveys – take action to be sure elders are
  safe.
• Behaviors that occur in therapy or at activities
  are included here – need for excellent
  communication. Code from 24 - 7
                 Section Q
• All new coding –
• Manual instructions and Intent statements are
  very important
• Coding examples are important to read to see
  what CMS is looking for
• Mini interview on admission – identify the
  goal of the elder - needs to be documented
• Return to the community – high impact – read
  instructions and follow the guidance in the
  manual.
                Care Planning
• Which areas of the planning are you
  responsible for?
• First Step is to look at the red trigger items in
  your coding sections.
• Look at triggers in the other sections.
• Read the concepts and Care Planning Process
  guidelines in chapter 4 of the RAI Manual
• Read the guidance and triggers for the CAA
  areas you are responsible for.
        Care Area Assessments
• Appendix C of the RAI Manual
• You need hard copies of these documents to
  review
• Now we have 20 CAAs – two new areas on
  Pain and Return to the Community
• Look at what is triggered – Work the CAA –
  Document the result of the CAA with a
  proceed or not proceed to care planning
  statement.
• Locate the documentation in the record in
  column 4 of Section V of the MDS
• When your section of the care plan is
  completed then check column B of Section V.
• Sequencing is very important
• Documentation is very important
• You must sign for the areas of the assessment
  you complete in Section Z on all assessments
  and complete CAA documentation on all
  comprehensive assessments.
• Many parts of this process are new !!!!!
              Chapter 4
Very important – spend the time to read it
carefully – surveyors have been training on
the CAA process and the documentation
requirements. The entire IDT should read it
and talk about the changes in the
requirements. Make copies of the CAAs from
Appendix C of all the areas you are care
planning for – Many new items
      Timelines for Assessments
• Many have changed
• The timelines for transmission have also
  changed and are going to impact your need to
  have the sections completed in a shorter time.
• More assessments will need to be done – big
  problem start and stop of therapy and the
  discharge return anticipated and reentry
  forms. This is a big change to the process and
  impacts everyone.
• You need to check with the MDS manager in
  your facility to discuss all the things that have
  changed with the MDS 3.0.
• The BIMS and Mood Severity Scores will be
  part of the case review now. Monitor the
  scores throughout the stay. This includes the
  Utilization Review meeting.
                       Summary
• Look at the total scope of the MDS 3.0 Change to your
  practice as a Social Worker
• Read the RAI Manual for the sections you are responsible for
  and the care planning process that is involved.
• The interviews need to be completed on the schedule in the
  RAI Manual and documented in the medical record.
• Instructions are in the Steps for the Assessment section of the
  manual.
• BIMS and Mood Interview create a numerical score for each
  resident and become part of the resident and faciltiy data
  base. Score carefully and communicate scores with
  appropriate meetings and departments.
                        AND
  Section Q is all new
• Read instructions and CAAs content. – There is a lot
  of important new information. Surveyors will be
  evaluating the care planning and documentation
  process.
• Discuss discharge planning and the resident’s
  awareness and goals with the IDT and the Utilization
  Review meeting.
• The MDS 3.0 has more new than old information –
  you must be aware !!
QUESTIONS ?????

				
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