A question about the MDS

[MQ Edna]

I am currently working at a skilled facility where I don't have access to the MDS. They are not on the charts. The only info on this subject that I can find says that the MDS must be "readily available". I work an off shift and like to look to the MDS to compare my assessment data with what has been noted previously. Is it legit for the MDS to be unavailable to the staff nurses? Is it proper for the MDSs to be kept locked up in the assessment nurse's office?

[stevie b]

The MDS as well as the raps and the care plan are to be available 24/7. Ther is a state/federal regulation that says so, and noncompliance carries a hefty defficiancy fine. Also, charting in ltc should support the care plan, so how can you do this if its not there? I would question my DON as to why?

[MQ Edna]

But shouldn't the MDS be in the chart? I thought that they were supposed to be there for fifteen months. And as a matter of fact, the care plans are with the MDSs somewhere and the staff nurses don't have any input! This is a fifty bed skilled facility part of a chain owned by a group of lawyers. And there are only four nurses employed there and the rest are agency.

[mamabear]

Somebody please tell me what MDS is. I've seen it in ads, journal articles, etc., but I don't have a clue to what it means. I've worked exclusively in psych and have never come across the term. I appreciate it.

[Fran-RN]

The MDS or Minimum Data Set is part of the RAI or Resident Assessment Instrument that was mandated by OBRA "87, It is a comprehensive interdisciplinary assessment tool that is used in long term care to create a Care Plan and is also used by Medicare and in some states by medicaid for payment determination. Every part of resident care is supposed to flow from this assessment. It is also used for Quality Indicators, which state and federal government and private consumer groups are using to measure the care at long term care facilities. So, It is imperative that it be available to every one. A good MDS coordinator is worth their weight in gold, as the MDS impacts all areas of the facility.

[WriteStuff]

Nebby Nurse,

What State do you work in? Does your facility use an MDS Coordinator? Is the MDS computerized.....in other words, is it on the computer, as opposed to a hard copy? Do your resident charts have a section for "Assessments" - which is where the final, printed copy of the MDS should be found, each time there is one completed. At our facility, our MDS process is all computerized and technically only the MDS Nurse has access to the information until the assessment is completed and printed and placed in the chart. But ONLY because the other Staff are not familiar with the program. Frankly speaking, I've been doing MDS for seven years and I've NEVER had another Staff person (Licensed) either independently want to, or request to read the MDS! The Care Plan, yes, but never the MDS. I'm just curious I guess.......why do you want to read the MDS? Maybe I can take your curiosity and sprinkle it on our Staff so they will read the MDS? LOL

I can't imagine what it would be like to be working for a facility is that owned and operated by LAWYERS. Ugh. Have you asked your MDS Coordinator "why" the MDS is not accessible, especially if it's NOT being kept in the resident's charts? Medicare Fraud is alive and well these days and it makes one feel suspicious if these Government mandated assessments are being "hidden" from view. Let us know more.

Bonnie C., RN

[MQ Edna]

Actually I started looking at MDSs when I was employed at my last staff nurse position when I worked the night shift and had a little down time. I was curious that some of the residents were in the skilled facility with seemingly nothing wrong with them other than old age. After familiarizing myself with the coding, I observed that several of these residents were coded as being total care, incont., dementia agitiation with innacurate supporting data from the CNA's and staff. In fact, the assesment nurse or whomever was filling in the ADL flow sheets and other documents to jive with the MDS. The physician on this particular unit always completed his progress notes with "requires 24 hour ADLs". Based on what I perceived to be inaccuracies, I went to the DON and told her that perhaps I didn't really understand the MDS but could she explain... Well after informing me that I didn't really understand the complicated process I later heard they were terrified I'd bust them for medicare fraud. The next thing you know, significant change forms began to appear like magic and the coding began to portray an accurate picture. Since I left the place, I still find the same types of residents in other facilities and being "nebby" I can't help but wonder how medicare or the HMO is willing to pay me to cater to these individuals and their families when I much prefer to take care of the sick. I live in PA. and again, I thought a hard copy of the MDS was to be in the patient chart for fifteen months. Hey, thanks for the replies.

[NRSKarenRN, BSN, RN]

Check out the website below for MDS information.

From: Centers for Medicare and Medicaid Services (CMS)

Long Term Care Resident Assessment Instrument

RAI Version 2.0 Questions and Answer

QUESTION 3 - 10: Must a facility maintain both the hand written and computer-generated MDS forms on the resident's clinical record? If not, which is preferred?

July 2001 5

CMM MDS 2.0 Q & A Addendum 2 Not every facility prints computer generated resident assessment records. In some facilities, the records are manually completed. There is no requirement to maintain two copies of the form in the resident's record. Either a hand written or a computer-generated form is equally acceptable. It is required that the record be completed, signed and dated within the regulatory timeframes, and maintained for 15 months in the resident's active record. If changes are made after completion, those changes must be made to the electronic record, and indicated on the form using standard medical records procedure. It may also be appropriate to update the resident's care plan, based on the revised assessment record. Resident assessment forms must accurately reflect the resident's status, and agree with the record that is submitted to the CMS standard system at the State. For additional information, refer to Resident Assessment Requirements for Long Term Care Facilities in the Code of Federal Regulation

http://www.carecomputer.com/html/news/mds20/mdsqa3.pdfs at 42 CFR 483.20.

[MQ Edna]

Thanks Karen. Correct me if I'm wrong but aren't they saying that either a handwritten or computer generated form must be on the chart?

[NRSKarenRN, BSN, RN]

CORRECT!

[MQ Edna]

Now where to go from here...

[NRSKarenRN, BSN, RN]

How badly do you want to stay in your currnet job?