Help me understand the MDS please

[laurenbella24]

Hi all. I would appreciate any input/help I can have on my problem. I am a social worker, new to a facility (less than a week) and came into a poorly run department ect. No orientation. Anyhow, I learned the way they were doing care plans were call the families due for one and they call back for an appointment. If they didn't call, the care conference doesn't happen. Just to give you an idea the extent of the problem, there were probably 15 care conferences due this week. FOUR called back so 4 were reviewed.

In our meeting today, I explained we have to do them 2 days a week due to the sheer number of people and reminded everyone that even if families/res don't show up the interdisciplinary team still has to meet and REVIEW the care plan. My question is...at my old facility, the policy was at least for admissions to have care conference within 14 days of admission. At regulation is within 21 days. And for LTC every 90 days thereafter. However, the MDS coordinator (who btw, quit and last day was today) stated I "had to be careful with changing the dates because of the VB2....maybe it was VB4" That if that isn't in alignment with the care conference date we can get in trouble or something. What is VB2 or VB4? And what in relation does it impact the care conference dates or vice versa? I don't want us to get tagged, but I think the fact that we aren't having care conferences for 75% of the residents is far worse. Not to mention the fact I haven't been able to locate ANY care plans for one unit. When I asked no one seemed to know. And we WILL get tagged for that. Someone please enlighten me about this VB2/VB4. Thanks.

[Talino]

VB2 is the date an RN Coord certifies that the triggered RAPs (regardless by which discipline) have been addressed and completed.

VB4 is the last permissible date (no later than 7 days after VB2 date) that a care plan be developed based on the triggered RAPs.

According to the CFR 483.20 (K), a care plan must be prepared by an interdisiciplinary team, to the extent possible, the participation of the resident or a family member. In other words, the interdiciplinary team must work together to provide the greatest benefit to the resident. The care plan must also be reviewed periodically and revised by a team of qualified persons after each assessment.

A face-to-face meeting between the interdisciplinary team and/or the resident or responsible person, is NOT a requirement and is left at the facility's discretion. A facility practice, however, must be able to prove that a care plan was developed in acquiescence of the interdisciplinary team, including that of the resident or his/her designee when possible.

It is good to know that a Social Worker is concerned about a facility's care planning process.

[laurenbella24]

Thank you for the clarification! I appreciate it. Yeah, I have YET to find out where the care plans are located for a particular unit. That scares me. The unit manager didn't seem sure either. Couldn't locate them where she thought they were. I feel that while care conferences are tedious, they are important, and if the family does come its a good opportunity to get everyone in the same room to address their care/concerns. I definitely see some major residents rights issues. I don't think the residents were ever invited to a care plan conference. It doesn't matter if they are confused, I send them a letter anyway, along with family member. That way I know I gave them a chance to be involved in their care and plan of care. Some people may resent the fact that I'm changing things, but I feel that we'll certainly get tagged if we don't. And the last survey we had a LOT of tags I hear.

[Nascar nurse, ASN, RN]

I would be absolutely sick if I was not able to locate a single careplan for an entire unit. Are these on computer and can be regenerated easily, or will this have to be started from scratch.

I do not envy you! I think I would seriously consider different employment, especially if no one else seems real concerned that this is a problem.