1. RAI and MDS
Chapter 16
Red book

2. 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

3. 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

4. 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)

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

6. 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)

7. 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

8. (3.0) Care Area Assessments

9. 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

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

11. 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

12. 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

13. 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.

14. 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.

15. 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

16. 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

17. 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

18. 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

19. 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

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

21. RAP: Activities
Page 701
Problem
Triggers
Guidelines
RAP key

22. Assessment to Care Plan
Linking Assessment to Individualized Care Plans
Pages
Outline