RAI and MDS 2.0 and 3.0 HPR 451

What is the RAI? The Resident Assessment Instrument is a computerized interdisciplinary assessment and care planning process used in long-term care settings (settings where CMS is monitoring services funded through Medicare and/or Medicaid) Three components make up the RAI: Minimum Data Set (MDS) – test questions Triggers -scores or results that indicate the need for further assessment Resident Assessment Protocols (RAPs) – assessment protocols that provide guidelines for further assessments that are indicated by the Triggers

MDS Standardized instruments (same for all; reliability and validity; broad and general) Used at various times (initial/intake, updating periodically, discharge if applicable) 20 + sections, completed by members of interdisciplinary team Sections labeled with letter and title and have one or more subcategories Function to identify “Triggers”…..

MDS cont’d For TR/RT, the residents at greatest activity risk include: “Residents who have indicated a desire for additional activity choices; “Cognitively intact, distressed residents who may benefit from and enriched activity program, and cognitively deficient, distressed residents whose activity levels should be evaluated, and “Highly involved residents whose health may be in jeopardy because of their failure to slow down

Triggers Specific scores or patterns/combinations of scores that have been determined to have meaning (based on prior experience) More detailed assessment following trigger determines whether or not current client’s score should be of concern

Resident Assessment Protocols The more detailed assessment following a result that is a “trigger” 18 areas are identified that may need further assessment

Resident Assessment Protocols cont’d Team conducts a RAP review after triggers are identified RAPs and guidelines are reviewed for the following: Complications and risk factors Clinical and causal factors The need for referrals The need for a revised plan of care OR for further assessment RAP review is summarized into a narrative, ‘focus statement,’ or format preferred by facility

Outcomes Based RAI tends to be outcomes specific (the assessed needs of the Client related to his/her leisure will be met) rather than occupation specific (clients will receive x hours of recreational therapy or leisure education)

Benefits of the RAI process Clients respond to individualized care Staff communication has improved (interdisciplinary nature of process) Client and family involvement in care have increased Documentation has become clearer (consistent, using same starting point, etc.)

Completing the RAI Review of client’s record Communication with client; observation of client Communication with direct care staff from all shifts Communication with other licensed professionals, therapists Communication with MD Communication with client’s family

RAI – Sections of interest to TR/RT MDS 2.0 – Not used after 9/30/10 Section AC: Customary Routine Section B: Cognitive patterns Section N: Activity Pursuit Patterns Section T: Supplement items (Special treatments and procedures section includes recreational therapy) Must be CTRS, have doc orders w/ frequency, duration and scope of tx

MDS 3.0 – Effective Oct 1, 2010 RT in Section O – Special Treatments, Procedures, and Programs (with OT, ST, PT) Total minutes – record total # of minutes this therapy was administered to the resident in the last 7 days Days – record # of days this therapy was administered for at least 15 minutes a day in the last 7 days

MDS 3.0 – Section F Preferences for Customary Routine and Activities Need not be CTRS to complete Nursing may complete at your facility

RAP Example “Little Time – Chronic Health Problems” (Proceed with Care Plan) Nature of condition Resident has had little time involved in activities, group or independent Causal, Complications and Risk Factors Resident has had a long debilitating illness of ___ which causes him to tire easily during activity programs. Resident needs much encouragement, frequent rest periods during programs, and modified activity program interventions to ensure positive recreational experiences Need for Referral None Reasons for deciding to care plan The Recreation Therapist will proceed with a care plan to promote optimal participation within the resident’s current abilities

RAP Example 2 “Little Time – Increased Activity Levels” (Do Not Proceed with Care Plan) Nature of condition Even though the resident has the physical strength and endurance to participate in activity programs, the resident chooses to spend little time engaging in available leisure opportunities Causal, Complications and Risk Factors The resident has stated a history of participation in a very structured routine lifestyle. The resident and family members have disclosed that the resident is happiest when very predictable daily events occur, and the resident is not rushed into various activity programs Need for Referral None Reasons for deciding to care plan In respecting the resident’s established, unhurried lifestyle, the Recreation Therapist will not proceed with a care plan for the triggered statement. Activity related documentation will be entered for interdisciplinary social and cognitive opportunities. Any resident’s desire for change in activity participation will be noted and documented properly.