MDS RN to resident ratio?

  1. 0
    Hi everyone! Hope we are all going to encompass the October 1st changes without too much turmoil. I am wondering if anyone can give me an idea about a few things. I am relatively new to MDS; 6 months ago I had never heard the term let alone what it meant. I work at a SNF with an average dailt patient census of 35-40. All Medicare for the purpose of my questions. We have an average length of stay of probably 45-60 days, some are only here a week or two for just IV antibiotics, some are here months and months and months with trach care/ massive wounds/ostomies plus IV meds (all in one patient). Lots of PPS assessments! We have PT/OT generally Monday- Friday 8 to 5, Speech tx is a shared role with a related LTAC nearby, Respiratory therapy is 24/7. I am currently the only MDS person, although we are considering adding an MDS assistant (non-licensed) to support me. We do all Electronic charting and MDS, well actually there is a small amount of hard copy that goes into a patient chart. The RNs do the care plans here. I am also an RN but only do MDS, no patient care. With this information in mind what would be considered a doable ratio of patients to MDS RN? We have room to expand and are thinking through the needs. With the changes coming up as of October 1st, I feel as if I will be tied to my desk 100 hours a week just trying to keep up with all the assessments, let alone the EOT Resumes and the every 7 day COT lookbacks etc.

    Also, what exactly can a non-licensed MDS assistant do? I know the person could help with filing and maybe scheduling, but what else?

    Is anyone feeling as overwhelmed as I with the changes?

    I dont post here often but I try to read often and enjoy the board immensely. Plus it has helped a lot with understanding some things in my MDS role, thank all so much!
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  3. 6 Comments so far...

  4. 4
    I don't know if this will help, but here goes. i worked at a 120 bed facility and did mcr assessments. when we got to 35, it was getting hard for me and i had to ask my coworker to help. but then i have never worked in a facility, maybe one, where the other team members did their part of the assessments, at least timely. nor did they do RAPS/CAAS. They did do thier own careplans. That said, i guess it would depend if you just do certain sections.
    an unlicensed person could do data entry and scheduling as you said. how about section A if taught? maybe even enter ADLs, mood or behavior if you just go from print outs off a kiosk. doing the entries/reentries would be a help as well as opening the assessments. printing out, organizing with notes for review, signatures, and to do filing. we have unlicensed people put MD orders in the computer, diagnoses, once taught or given by others and those populate the MDS. But with all the new discharge assessments and now COTs, i believe you need another licensed person, at least part-time if you have the unlicensed person as well, could be an lpn/lvn. all you would have to do is sign as complete, not that it is correct.

    And oh yes, very overwhelmed, especially because i think other disciplines don't have a clue sometimes what all we do and how much.
    crazyforthis, pixie120, montecarlo64, and 1 other like this.
  5. 3
    Yes, I too am feeling overwhelmed.
    Read something about the new changes coming will increase the workload 25% but don't know if that's true or not.
    I am questioning how much longer I can do MDS Work.
    I can't even think about going thru another MDS Audit.
    Thinking about doing Interim MDS Work....that's IF I stay in it....
    Too many Legalities....I'm waiting for all the RAC Audits to start coming....
  6. 3
    I usually have between 15 to 25 PPS (had 28 at one time) and total census of between 65 to 70. When my PPS gets up to around 20, I struggle...They seem to be admitted and leave by the busload & always stay long enough to get a comprehensive care plan. I also do restorative and have over 30 programs, not including B & B assessments and toileting programs. I am suppose to have an assistant 2 or 3 days a week, but she always gets pulled to the floor. She is lucky to keep the B & B assessments caught up.. I get alot of cooperation from the therapy dept, but no cooperation from administration regarding flexibility of my schedule, workload, lack of staff, etc..Between daily PPS meetings, daily staff education regarding charting ADLs and other nursing services, weekly medicare meeting, daily stand up meeting, dining room duty once a week and care plan day with the IDT and family members, I have had it! I actually have been actively seeking employment the past week. I have had an interview with HR and I have a 2nd interview scheduled with the nurse manager and I also have another interview at a 2nd hospital next week.. if neither pans out, I plan to either try home health care or go back to the floor where all I have to worry about is one group of residents, med pass, treatments and charting...I am way ok with that! I pray that if it is God's will, I am directed to another discipline of nursing, as I don't think I can do this much longer (let alone the changes coming in 2 weeks)! I wish good luck to all of us & I am thankful for this forum, as most people do not understand the pressure involved with being a MDS coordinator
  7. 1
    Our facility has a great Restorative CNA who was trained to do all our interviews for section C, and the G section for 0300 to the end. Soc svc. does section D and Q, so the only interview I have to do is the pain interview. She does all the scheduling, as well, and lots of paperwork, since we are 100% paper here. We all do our own data entry. (There are 3 nurses for 300 patients, I do 25 to 40 skilled. If I get over 35 skilled, I run late now. With the new CoT's and lookback changes, there is no doubt there will be almost EXACTLY 25% more work.)
    ST
    Bella'sMyBaby likes this.
  8. 0
    Quote from katoline
    I don't know if this will help, but here goes. i worked at a 120 bed facility and did mcr assessments. when we got to 35, it was getting hard for me and i had to ask my coworker to help. but then i have never worked in a facility, maybe one, where the other team members did their part of the assessments, at least timely. nor did they do RAPS/CAAS. They did do thier own careplans. That said, i guess it would depend if you just do certain sections.
    an unlicensed person could do data entry and scheduling as you said. how about section A if taught? maybe even enter ADLs, mood or behavior if you just go from print outs off a kiosk. doing the entries/reentries would be a help as well as opening the assessments. printing out, organizing with notes for review, signatures, and to do filing. we have unlicensed people put MD orders in the computer, diagnoses, once taught or given by others and those populate the MDS. But with all the new discharge assessments and now COTs, i believe you need another licensed person, at least part-time if you have the unlicensed person as well, could be an lpn/lvn. all you would have to do is sign as complete, not that it is correct.

    And oh yes, very overwhelmed, especially because i think other disciplines don't have a clue sometimes what all we do and how much.
    Kudos for saying that last line, the other disciplines are kinda irritated with nursing, in our building, sort of an us vs them, "just because nursing has to do another assessment....". I think they just don't get that they are also going to have to do assessments in their sections, we don't know yet all that is going to occur, and I get the feeling that some are trying to hide heads in sand, cuz it's gonna be a bumpy ride. We have dedicated MDS nurses 2 for about 75, Medicare about 15-20 average and a couple of HMO's. MDS nurses do the careplans, other's do the quarterly assessments. They are already irritated that we moved up many MDS's to get done by 9/30/11, so we could concentrate for the change. Thank-fully the rehab manager has had extensive training, albiet kinda late in the game, but training none the less, I think therapy is going to be the busiest, and their goals are now changed to attempt to keep rates at the same for the 5d 14 d and 30 day which typically is the same, at least for the "real" rehab clients.
  9. 0
    I just wanted to say that my fist MDS job they went by the book and said it's 24 patients per MDS cordinnator (I don't know where they got that number). When I later was asked to do the same thing at another facility of 88 beds and only 1 MDS nurse I said no. They said but the RNs will be filling out the MDS...so what! You know I'm going to have to check it anyway. My name goes on the final page that means it's me, I'm absolutely responsible for it. When I'm sitting in front of the surveyors answering questions I want to know I have all the current, and correct information.

    Too many hands in the pot makes for big time confusion.


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