Admission assessment

[glm777, BSN, RN]

If a new resident goes out to the hospital on day 2 (DRA) and does not return until day 17, is an admission assessment required by day 14?

We were recently told by our consultant that even if a resident is here only a day or 2, if they are here on day 14, an admission assessment is required so we are doing admission assessments with only a few days of information.

Prior to this info - we did not do the admission, if the resident went out before day 14, until after the resident returned - then we completed it within 14 days of the resident's return.

But what about if they are not here on day 14 but return after that - when is the admission assessment due?

I look forward to the responses.

[HyzenthlayLPN]

From the RAI:

If a resident goes to the hospital and returns during the 14-day assessment period and most of the initial assessment was completed prior to the hospitalization, then the facility may wish to continue with the original assessment, provided the resident did not have a significant change in status. In this case, the Assessment Reference Date remains the same and the Admission comprehensive assessment must be completed by day 14 counting from the original date of admission. Otherwise the assessment should be reinitiated with a new Assessment Reference Date and completed within 14 days after readmission from the hospital. The portion of the resident's assessment that was previously completed should be stored on the resident's record with a notation that the assessment was reinitiated because the resident was hospitalized.

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/downloads/MDS20rai1202ch2.pdf

[glm777, BSN, RN]

Thank you for your response. However the latest version of the RAI manual is 3.0 - this is from 2.0 and I can't find in the current RAI anywhere that says specifically what to do if the resident has NOT had an admission assessment.

Here is a similar paragraph from RAI 3.0:

If a resident had an OBRA Admission assessment completed and then goes to the hospital (discharge return anticipated and returns within 30 days) and returns during an assessment period and most of the assessment was completed prior to the hospitalization,then the nursing home may wish to continue with the original assessment, provided the resident does not meet the criteria for a SCSA. In this case, the ARD remains the same and the assessment must be completed by the completion dates required of the assessment type based on the time frame in which the assessment was started. Otherwise, the assessment should be reinitiated with a new ARD and completed within 14 days after re-entry from the hospital.

Am I missing something??? I don't see where it explains what to do if the resident goes out during the initial admission assessment period.

[HyzenthlayLPN]

Otherwise, the assessment should be reinitiated with a new ARD and completed within 14 days after re-entry from the hospital.

Am I missing something??? I don't see where it explains what to do if the resident goes out during the initial admission assessment period.

I apologize for not noticing I was reading RAI 2.0 rather than 3.0 (although I think 2.0 is much more clear on this issue). The wording in 3.0 is confusing because in my understanding, it says the same thing.

Otherwise, you would have to combine an Admission with a DRA and then probably do an Sig Change upon return because your "comprehensive" Admission assessment was anything but comprehensive due to limited data...

[Talino]

A few changes in verbiage but the same context.

In a nutshell, when a resident is discharged on or before day 14th of stay, you are not required to complete the Adm MDS whether you already set an ARD or not.

Otherwise, the assessment should be reinitiated with a new ARD

and completed within 14 days after re-entry from the hospital.

When resident returns, you will again have a new 14 days to complete the Adm MDS.

Whatever you've been doing, you did it right. If a consultant insist on his/her assumption, simply reply - "I must be misinterpreting the RAI instruction on page so and so. I will definitely check with our State RAI coordinator."

[glm777, BSN, RN]

Thank you all so much for your help. I now have something to reference when questioned.