[nratchet]

Originally Posted by RN 4 Life

This can be especially challenging when the therapist do not understand the role they play in reimbursement for the center/facility and completing the MDS.
I would try talking to them first telling them the importance of the information you need, second I would try to determine why it is difficulty for them to provide you an ARD. Could it be they do not plan therapy treatments, could it be insufficient staffing which leads to inconsistent treatment...these are just a few reasons both of which can be worked around. Next I would just set the date for them.
Begin by asking them what level of rehab they believe the resident/patient will need. Then look at the patients MDS calendar and pick a date that allows the therapist to achieve the 5 days and ____ minutes they need. It is good practice to meet with the therapy director daily or at least every other day to determine if the therapist are on schedule to meet the patients rehab minutes. Doing this will allow you to plan ahead and move the ARD if necessary before it is too late.
This may seem like a lot of work but it will save you time in the long run. I hope this helps..check back in and let me know.

I agree. Our medicare coordinator gives the therapist the ARD date and then the therapist then gives her the minutes and lets her know if grace days are needed. By doing it this way, the assessments are done in a timely manner.

[edhcinc]

Hi. You may also try involving your administrator in this issue...especially if he/she understands the many ramifications of this communication.

In most cases, rehab cannot make a decision because of internal departmental inefficiencies--they may not complete evals/Plans of treatment timely or may not have a system in place to quickly look at and compute treatment minutes actually given. Sometimes just asking them to use a calendar to track minutes will work. If rehab uses an electronic system, the minutes are automatically calculated.

Good luck!

[Talino]

RN4Life, nratchet, edhcinc ... Excellent pointers!
You three nailed the most ideal procedure:

1. Always attempt to communicate w/ the therapists and develop rapport.
2. Provide therapists w/ workable ARDs.
3. When all else fails, involve the Administrator.

[CapeCodMermaid]

4. When the administrator is MDS challenged, ask the DNS for help.

[Poppyfield]

I know all about feeling guilty when changing ARD dates. But I always keep in mind, Higher case mix score is job security. Every MDS nurse working in a case mix state has been it your position. It just has to be done, no matter who gripes or complains. Remind everybody it's more work for you too! And, I'm a bit onery, so I just sling crap right back at them. They get the picture and hush up pretty quick!

[Rexie68]

No one really complains about the date changes at my facility, but they do complain about the extra MDS' we end up doing. I get excited about bringing up the CMI, but not everyone does. But when they whine a lot, I just tell them to HUSH, 'cause I do sections BCDGHIJLMOPQRSW, along with the RAPS, and their sections are a whole lot smaller!! Plus, if they're too busy, on vacation, ill, etc....I do their sections. Isn't this job fun? *smile* Who knows what MDS 3.0 will bring......

[edhcinc]

Originally Posted by Rexie68

No one really complains about the date changes at my facility, but they do complain about the extra MDS' we end up doing. I get excited about bringing up the CMI, but not everyone does. But when they whine a lot, I just tell them to HUSH, 'cause I do sections BCDGHIJLMOPQRSW, along with the RAPS, and their sections are a whole lot smaller!! Plus, if they're too busy, on vacation, ill, etc....I do their sections. Isn't this job fun? *smile* Who knows what MDS 3.0 will bring......

Well, it looks like we all will actually have time for fun with the MDS 3.0--truly. Much more straightforward, no required "expert" interpretation needed--and the opportunity to get our heads OUT of the medical record and actually interview and assess the resident! This MDS will truly be a "SOURCE DOCUMENT", as the interview items would never be found in the medical record.
Looks like interesting times ahead!