After 2 months..what do you think of the MDS 3.0?

[Nascar nurse]

Now that we've all had a chance to get used to the 3.0 what do ya'll think? I hate the bulk of the whole thing and our corporation's software program is sooooo slow it's painful most days, but.. surprisingly I think I like the 3.0.

For the most part, our interviews are going fairly well. We've had several residents that I didn't think would even be able to participate with interviews do surprisingly well at at least making an attempt to follow along and answer questions (even if their answers were off the wall).

For the most part the questions themselves are more relevant and we've lost some of the "dumb" questions...I mean who really cares if someone took 14 vs 15 meds in a 7 day period.

What do you all think?

[GRACERN47]

can you tell me what your med A census runs on average? we have three of us in a 200 bed facility, two doing medicare and one doing med A. we are running ragged!!

We are a 173 bed facility and we have 3 full time RNs and 1 part time. We have part A, B managed care and medicaid. I do all the PPS with a low of about 12 up to a high of about 27. One full timer does all the medicaid and the other does the managed care. The part timer fills in wherever needed. We are also responsible for the ICD 9 codes and all mail outs involving care plan invites, follow up letters etc.. And yes I know what you mean. We are just holding ours heads above water.

[Bella'sMyBaby]

There are two of us in our full 120 bed facility.

We run appx. 15-20+ Med A at any time.

However, Med A is Nothing compared to the Managed Care Mess we have to deal with....Some Managed Care have to be treated like Med A, others don't.

Managed Care requires Pre-Authorization & continuous updates.....constant phone calls, can never get through to the proper dept, playing phone tag all day, faxing records, denials, cuts, etc. etc. Hate Managed Care.

[GRACERN47]

So true, with the managed care that leave before the 14 th day, you are actually doing a whole assessement with this new crazy, ridiculous discharge assessment. We have had as many as 10 discharges on a weekend and with the Med A your doing two assessments.

[NurseMomDori]

With the short time period, can't you just use the same information...as your lookback period is nearly the same? Take this in a common sense format. Who looks at the info, who uses it for anything worthwhile? I am not saying to falsify info at all, I am saying to simplify and use the same info for both assessments.

[rukiddingme]

the one problem we have encountered in our facility is the question which asks "have you thought about harming yourself/thoughts you would be better off dead" WHY DIDN"T THEY SEPARATE THESE TWO QUESTIONS????? Many of my residents answer yes theyf eel they would be better off dead ("I am ready to go"....I have had a good life.....I am tired>>>want to be with spouse, etc,etc,) but deny any thoughts of hastening their demise. however, if either section is answered "YES" you must answer a 1 which leads to the notification section.

We've instructed the person doing this interview to 'clarify' the resident's answer to that question - she writes a clarification note about what the resident has said, and signs it. This note goes into the file where we keep all our tracking & back-up information (after the social service person gets a copy of it).

We also are printing the MDS with multiple pages on each sheet. Either just double sided, or two pages on each side of the paper. This makes less pieces of paper, and easier to staple with a standard stapler.

Census is around 100, and there is 2 of us, full-time. We're also doing alot of dashes in the discharges, since most of ours are not planned. The planned ones are usually Medicare, and get tired of answering the interview questions, so at times, they will refuse to 'do it again'.

I think it's a waste of time on anyone whom is discharged unplanned.

[catnip3]

3.0 has resulted in MAJOR changes in our facility, and I am so disheartened. We are a facility of over 180 beds. Prior to 3.0, we had 4 RNACs- 1 full time, and 3 at 32 hours a week. I had been an RNAC for 10 years. We were responsible for the entire RAI process including updating the care plans, and the system worked well and we had great state and UMR surveys. Corporate, despite the increased work burden, cut us to 2 RNACs- one full time and one 32 hours. I lost my RNAC position and am now an "assessment nurse". This change has been so difficult for me. I have gone from a specialized position that I did quite well, to a fragmented position that consists of what feels like cast-off duties that other nurses used to do, like weekly diabetic foot assessments and all the admissions (FUN when 4 come in one day). I'm responsible for a few sections of the MDS- I'm quite tired of looking at teeth and dentures! I have 98 residents on caseload now and I have a hard time keeping up with what is going on with all of them. My heart is broken because everything is so fragmented between the disciplines. The care plans I was so proud of are now in a shambles. I badly miss the old process, but I must "embrace change". Sigh. I hope it gets better in time (though it hasn't after 3 1/2 months).

[Bella'sMyBaby]

3.0 has resulted in MAJOR changes in our facility, and I am so disheartened. We are a facility of over 180 beds. Prior to 3.0, we had 4 RNACs- 1 full time, and 3 at 32 hours a week. I had been an RNAC for 10 years. We were responsible for the entire RAI process including updating the care plans, and the system worked well and we had great state and UMR surveys. Corporate, despite the increased work burden, cut us to 2 RNACs- one full time and one 32 hours. I lost my RNAC position and am now an "assessment nurse". This change has been so difficult for me. I have gone from a specialized position that I did quite well, to a fragmented position that consists of what feels like cast-off duties that other nurses used to do, like weekly diabetic foot assessments and all the admissions (FUN when 4 come in one day). I'm responsible for a few sections of the MDS- I'm quite tired of looking at teeth and dentures! I have 98 residents on caseload now and I have a hard time keeping up with what is going on with all of them. My heart is broken because everything is so fragmented between the disciplines. The care plans I was so proud of are now in a shambles. I badly miss the old process, but I must "embrace change". Sigh. I hope it gets better in time (though it hasn't after 3 1/2 months).

"Corporate" people who cut your staff, probably got a "Bonus" for this.

My previous Company, ran out the other other MDS Coordinator, who was only Part-Time & did ALL the Restorative as well. It's probably time to start sending your Resume out.

[GRACERN47]

Boy, talk about a way to get "cites" ! You poor thing ! If it wasn't broken, why fix it. No way would I work under those conditions. It's not fair to the patient nor the staff. I am sure with your experience you will be able to find another job. In my area the job offers come weekly from head hunters, with excellent salary offers. The nurses I hear of are getting out of this mess. I am lucky my company is very understanding and have bent over backwards to help us out. Good luck !

[evalesco]

i don't have a problem with the 3.0 if we can completely cut out the discharge assessment. this is going to sound very bad, but......when i see a resident had died in the facility, i feel relief knowing i don't have to do a d/c assessment!

here was a cute christmas poem sent to me...............

twas the night before christmas - another year had flown by

mds 3.0 landed with new regs from on high.

the interviews conducted again and again

and our heads are still spinning - when will it sink in?

is it blue - is it red, a sock or a shoe?

did she miss it by one year? or could it be two?

and me with my coding - the rates to uphold

were they omras or short stays or trackers to load?

do i schedule an extra assessment today?

or wait til tomorrow - what rug rate will pay?

and on to the software my fingers did fly

i know i can learn this - at least i will try.

the adl index is lower - oh no!

there are holes in poc adl’s as big as my toe!

but wait - is that resident smiling at me?

she really likes sharing her dreams i can see.

i think this might be worth it to see that sweet smile

and i think i'll stick with it - at least for a while!!!

don't know if anyone already posted it. i have been too busy to look due to trying to complete discharge assessments.

[susanthomas1954]

In work in a 220 bed facility, with one other full time MDS co-ordinator. We run about 25 skilled pts., but the goal is 35. I do case mgmt, and all the skilled MDS. My co-worker does all the OBRA assmts. He is just over 3 weeks behind, and I am running at day 14 for close on all mine, late only with discharge return not anticipated.

About 40 skilled admits a month. Between the two of us, we have over 140 open MDS's as of today. Corporate descended on our building this week and the Corporate director of re-imbursement demanded that our administrator get me some help. I could have used some help a couple of months ago when I had time to train someone. Now, hiring someone to help will put me so far behind I will probably quit.

And I like the work. There's just too much of it. (8+ hrs of meetings a week, and all the care plans.)

Seriously....140 open MDS's.

ST

[Bella'sMyBaby]

Just in the last few weeks, I've noticed a significant increase in the number of MDS job openings around the Country. Corporations/Facilities need to wake up & start LISTENING to their MDS Coordinators.....or there will be none left.....

[susanthomas1954]

I noticed that, too. In our community of about a million people, it used to be when one of us would quit our job, we did a cake walk shuffle, and all switched facilities. Keeps things fresh and new, but now positions are going unfilled long enough to make you think long and hard about walking in on a mess. I really want to work in a smaller facility, but a couple of them have been without an MDS coordinator for months, and I don't want to walk in on that. I ABSOLUTELY would not want to walk in to my own job even a week after it had been unfilled.

On another note: What would you think about working for or with an agency that did nothing but catch up buildings on late MDs's, if that agency did nothing but MDS, no transmitting, no QI's, and only skeleton care plans? How would you feel about having that kind of help in your department?