MDS 3.0 Discharges

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It seems you can plan all you want, but you will never be prepared enough. How are you all doing your discharges? It's crazy!! I had "3" residents sent to Hospital and Admitted over the weekend. So how do I assign everyone their sections?? How do they assess?? They were admitted friday nite and saturday nite. I can see us doing the whole 'planned' discharge. Can anyone help, please?!?

Specializes in LTC, Psych, Med/Surg.

Good for you! I figure I am going to work until I drop. :icon_roll

Catmom :paw:

P.S. I was thinking that your profile said you were 40 years old but it actually says you have 40 years experience. :o Big difference! LOL

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Specializes in Assessment coordinator.

Congratulations! I have 38 years of experience and will have to work at least 12 more years to retire. The software we use is slow, as well, but speeding up a little by Friday. The discharge MDS info is ridiculous. Took me nearly an hour for one, and that was with dashing most of D and E. Nothing auto populates yet, and I had an MDS rejected by CMS because I put "Care Plan Revised" in the CAA documentation, although the pt was discharged prior to final care planning on all the others. That seems like a ridiculous reason to reject an MDS. So far have had only 16 accepted and 3 rejected due to a software glitch that requires a letter or number in an area where CMS wants dashes.

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TALINO, thank you for your quick responses regarding the 3.0. Considering what the 3.0 manuel says regarding discharge assessments (return anticipated) it allows for the dash on items that cannot be determined. Yes I would consider this for the resident interview but what about the importance of staff interview, ADL coding,pain assessment, orders and visits. I would love to hear your opinion on what items would be absolutely neccessary to code on this type of assessment. If the discharge assessment does not count for rug scores and the manuel is so vauge on what is absolutely neccessary I am afraid it leaves alot of room for error and scrutiny with state. Their opinion of what is important on a discharge assessment and mine may be two different things. And I do feel I could complete most all of the information but do I have to considering the amount of time it takes for a discharge return not anticipated. Especially if some of the questions on this type of assessment have no significant relevance. Thank you in advance for your reply.

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Specializes in ER CCU MICU SICU LTC/SNF.

The assm't for planned discharges is great!

For unplanned discharges, I can only emphatize w/ everyone's antipathy to the process. A brief discharge assm't that can be completed in less than 15 mins capitulating cognition/communication, ADL functions, continence, behavior, etc. that will go w/ the transfer records to allow a receiving facility provide a continuity of care would have been more beneficial to the resident.

IMO, the DC assm't on unplanned hosp'n is but a quality monitoring tool - to scrutinize what may have transpired that precipitated a resident's hospitalization and whether rehospitalizations can be prevented or minimized.

Unfortunately, the regulation is there to stay and mandates us all to comply. Would it be rescinded? I doubt. But, it might be modified. Albeit, I can only keep my fingers crossed.:)

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I had a resident admiited to skilled, was here for 5 days, then d/c to hospital, stayed for 4 days, came back and is leaving monday for another facility. Do I have to do 2 admit tracking, 2 5 day PPS, 1 obra admit and 2 discharge tracking? This is getting ridiculous!

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Specializes in ER CCU MICU SICU LTC/SNF.
I had a resident admiited to skilled, was here for 5 days, then d/c to hospital, stayed for 4 days, came back and is leaving monday for another facility. Do I have to do 2 admit tracking, 2 5 day PPS, 1 obra admit and 2 discharge tracking? This is getting ridiculous!

1st Adm

  • Entry reporting (Admission)
  • Combine PPS 5-day and DC return anticipated. Use day of discharge as ARD.

2nd Adm

  • Entry reporting (Admission)
  • If dc date is in same ARD window, combine PPS Readm/Return assm't and DC return not anticipated. Use day of discharge as ARD.

If less than 14 days, no need to do the OBRA admission.

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Thanks for the information. I think I have been seeing assessments in my sleep! I just couldn't see what to do for the forest of paper on my desk:uhoh3:

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Specializes in medsurg, everything in LTC.

Talino, Can you please point me to where in the manual it says that an admission is not needed if D/C before day 14?

I swear I am so fried that it's probably staring right at me and I just don't se it!

Thanks

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Specializes in ER CCU MICU SICU LTC/SNF.

this rule hasn't changed. the mds 3.0 manual, however, does not provide a detailed explanation.

see rai obra-required assessment summary, p2-15, under column regulatory requirement. it refers to -- 42cfr 483.20 (initial) 42cfr 483.20 (b)(2)(i) (by the 14th day)

483.20(b)(2) when required, a facility must conduct a comprehensive assessment of a resident as follows:

(i) within 14 calendar days after admission, excluding readmissions in which there is no significant change in the resident's physical or mental condition. (for purposes of this section, "readmission" means a return to the facility following a temporary absence for hospitalization for therapeutic leave.)

state operations manual appendix pp p124.

if you still have the mds 2.0 manual, see pp 2-3 to 2-4. the regulation is better defined.

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Specializes in medsurg, everything in LTC.

THANK YOU! as always, your help is much appreciated.

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This whole MDS thing has gone way to far. I think a full assessment upon admission is a good tool but does anyone really believe that the floor nurses have time to read or even will read all that repetative info?? The surveyors aren't even going to have the time. Ridiculous waste of nursing time and paper! Please someone do something!

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A group of us went to the 3.0 training and were informed that we should forget using grace days under 3.0. We understand the start of therapy but our new rehab director is using a grace for every new admission to cover Sundays when ther is no therapy. I have always been told graces are for the patient not the convience of the therapist. Iam so confused anyone have an answer?

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