RAI and MDS Chapter 16 Red book

2.0 -> 3.0 In 2010, the Centers for Medicare & Medicaid Services updated the MDS from version 2.0 to version 3.0. Your book was published in 2010. To maintain consistency, the lecture will follow the text, but incorporate new terminology where applicable http://www.mcknights.com/what-mds-30-will-mean-for-nursing-home-providers/article/180179/

RAI Three components related to treatment: MDS (Minimum Data Set) – test questions Triggers – scores that indicate the need for further assessment in one or more of the 18 areas of more in-depth assessment (CATs in 3.0) RAPS (Resident Assessment Protocols) – Assessment protocols that provide guidelines for the further assessment indicated by the triggers Care Area Assessments (CAAs) in 3.0

Additional Components In addition to the 3 main components just described, there are 3 components used to improve the management of nursing homes and determine payment for the services provided. Quality Indicators (QI) Resource Utilization Groups (RUGS) Prospective Payment System (PPS)

Minimum Data Set MDS A set of standardized, interdisciplinary assessments Initial Update Discharge Summary Example of formatting on Table 16.1, page 681

Triggers Scores (or patterns of scores) that have been identified to have specific meanings In order to help decide if the resident currently assessed will also experience the same health or quality of life concern as those with similar patterns previously, a more detailed assessment looking at only the triggered areas of concern is done. The more detailed assessment is called a RAP (Care Area Assessment)

Resident Assessment Protocols (2.0) 18 areas identified as potentially needing further assessment Used for newly admitted residents, when a resident has a change in health status, and for the annual MDS assessment Not used each time the MDS is filled out by the treatment team It is not required for the quarterly updates unless the resident has experienced a significant change in status

(3.0) Care Area Assessments https://nrrs.ne.gov/mds/pdf/Care-Assessment-Planning.pdf

Resource Utilization Guidelines RUGS (RUG-IV now) Part of the scoring and summary component of the RAI Treatment team received a printout summarizing the resident’s scores on the RAI, which includes placement of the client into one of the seven treatment groups, or categories – a case mix Placement is based on a combination of diagnosis, services already being provided by staff, and level of functional ability

Seven RUG categories (2.0) Rehabilitation Extensive services Special care Clinically complex Impaired cognition Behavior problem Reduced physical function

RUGS- IV 8 Major RUG Classifications (3.0) Rehab Plus Extensive Services Rehabilitation Extensive Services Special Care High Special Care Low Clinically Complex Behavioral Symptoms and Cognitive Performance Reduced Physical Function

Prospective Payment System PPS Method the US government uses to reimburse the nursing homes for the services provided. Based on how the MDS is filled out. NEED to make sure you accurately record your resident’s needs and strengths

Quality Indicators Potential problems related to healthcare services or quality of life that are identified through the MDS Using data from past MDS scores, the RAI software identifies resident whose scores are similar to other residents who have had problems in the past. While all residents have treatment objectives identified through the RAI process, all resident show are identified through the QI process will have additional treatment objectives based on the QI data.

Quality Measures Nursing home quality measures have four intended purposes: To give you information about the quality of care at nursing homes in order to help you choose a nursing home for yourself or others; To give you information about the care at nursing homes where you or family members already live; To give you information to facilitate your discussions with the nursing home staff regarding the quality of care; and To give data to the nursing home to help them in their quality improvement efforts. The nursing home quality measures come from resident assessment data that nursing homes routinely collect on the residents at specified intervals during their stay. These measures assess the resident's physical and clinical conditions and abilities, as well as preferences and life care wishes. These assessment data have been converted to develop quality measures that give consumers another source of information that shows how well nursing homes are caring for their resident's physical and clinical needs.

Short Stay Quality Measures < 100 days Percent of Residents who Self-Report Moderate to Severe Pain (Short Stay) Percent of Residents with Pressure Ulcers that are New or Worsened (Short Stay) Percent of Residents Who Were Assessed and Appropriately Given the Seasonal Influenza Vaccine (Short Stay) Percent of Residents Assessed and Appropriately Given the Pneumococcal Vaccine (Short Stay) Percent of Short-Stay Residents Who Newly Received an Antipsychotic Medication

Long Stay Quality Measures Percent of Residents Experiencing One or More Falls with Major Injury (Long Stay) Percent of Residents who Self-Report Moderate to Severe Pain (Long Stay) Percent of High-Risk Residents with Pressure Ulcers (Long Stay) Percent of Residents Assessed and Appropriately Given the Seasonal Influenza Vaccine (Long Stay) Percent of Residents Assessed and Appropriately Given the Pneumococcal Vaccine (Long Stay) Percent of Residents with a Urinary Tract Infection (Long Stay) Percent of Low-Risk Residents Who Lose Control of Their Bowels or Bladder (Long Stay) Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder (Long Stay) Percent of Residents Who Were Physically Restrained (Long Stay) Percent of Residents Whose Need for Help with Activities of Daily Living Has Increased (Long Stay) Percent of Residents Who Lose Too Much Weight (Long Stay) Percent of Residents Who Have Depressive Symptoms (Long Stay) Percent of Long-Stay Residents Who Received An Antipsychotic Medication

Let’s look at the MDS! Section AC. Customary Routine Figure 16.1, page 688 Section B. Cognitive Patterns Figure 16.2, page 690 Section N. Activity Pursuit Patterns Figure 16.3, page 692 Section T. Supplement items for MDS 2.0 in case mix and quality demonstration states Figure 16.4, page 694

Let’s look at the RAPS! Table 16.2 (page 687) lists the 18 RAPS The triggers and their definitions should provide facility staff with information to better understand the underlying cause of a problem

Steps of the RAP process Step 1 – Identifying need for further resident assessment by triggering RAP conditions Step 2 – Assessment of the resident whose condition triggered RAPS Steps 3 & 4 – Decision making and documentation of the RAP findings Step 5 – Development or revision of the care plan

RAP: Psychosocial Well-being Page 699 Problem Triggers Guidelines RAP key

RAP: Activities Page 701 Problem Triggers Guidelines RAP key

Assessment to Care Plan Linking Assessment to Individualized Care Plans Pages 704-706 Outline