Assessment help please

[crazyforthis]

I'm sure this has been asked before, even more than once... Mr X admits to a SNF bed on 1/5/12, he then is discharged from the SNF bed on 1/20/12 and admitted same day to a Hospice bed here in the same facility. He expires on 1/21/12 on Hospice with a one day los. He is self pay for all.

What assessments do I do for his dc from SNF? He had Cancer and mostly refused PT/OT on SNF, had lots of RT, had TPN and IV ABX. Doc says should have been hospice all along but patient/family was not ready to accept that yet.

In our facility we do not 'tranfer' patients for level of care changes, we discharge and admit.

Thank you :)

[Talino]

Entry - 1/5/12

Initial Admission assm't - completed no later than 1/18

Death in Facility - 1/21

The facility's practice to discharge/admit during care level changes has no effect.

[andy3k]

In addition to Talino's suggestions, I add: "A SCSA is required to be performed when a terminally ill resident enrolls in a hospice program (Medicare Hospice or other structured hospice) and remains a resident at the nursing home." RAI Manual pg 2-21

[silverbat]

I would not do a sig change until I had done an admission assessment, becuse that is due first. So I would have done what talino suggested.

[susanthomas1954]

The COC required for a hospice admit has up to ten days look back. If he died the second day no COC needed.

[andy3k]

The admission is completed on 1/18 so an SCSA for a 1/20 hospice admit is appropriate since it will be completed after the admission. An SCSA is required for a hospice admit. Unless there is a caveat I missed, you can't ignore a required assessment. The ARD cannot, of course, be set later than the date of discharge since the date of discharge is the last date of observation. "If a resident dies prior to the completion deadline for the assessment, completion of the assessment is not required. Whatever portions of the RAI that have been completed must be maintained in the resident’s medical record.3 In closing the record, the nursing home should note why the RAI was not completed." (RAI page 2-18) It does not say you ignore the assessment, it says you do not continue the completion of it assessment.

So the SCSA would have an ARD of 1/20 or 1/21, would not be completed, and any data collected would be placed in the record along with a note that says it was not completed due to death in facility. The SCSA might not have much more than an ARD but it must exist or the RAI Manual is not being followed.

Is there a hole in my logic?

[Talino]

Is there a hole in my logic?

Maybe a tiny one Andy...

The Sig. Change ARD can be set "up to 14 calendar days after determination that significant change in resident's status occurred (determination date + 14 calendar days)" RAI p2-15

Since the resident already expired on day 2, the Sig. Change cannot be obliged.