MDS and Hospice Team

[Susan.B]

I work in hospice and do a lot of education on regulatory and operational issues. I am preparing a presentation on the MDS 3.0 for hospice staff members. Content will include MDS background and history, multiple functions of the MDS, the key (and, from my perspective, very challenging) role of the MDS nurse and the primary changes from 2.0 to 3.0.

Reading your comments on 3.0 has been very helpful - and I feel your pain. I hope it gets smoother and some changes will be made.

I would appreciate your input on the following questions (and if you have comments beyond the questions I would love to hear that as well). I find that workshop participants are always very interested in ways that they can do better in their partnerships with long term care folks, especially those that have never worked in the LTC setting.

1. If there information that the hospice team can provide to assist in the MDS process?

2. What is it and in what form would you like to receive it?

3. In what other ways can the hospice team can helpful?

Hospice doesn't yet have anything that equates to the MDS or OASIS. However, our new Conditions of Participation (implemented in 2008) are written to support a comprehensive assessment process - so our day is clearly coming. I am hoping that I will have retired before then!

[katoline]

I guess it would depend on how long the hospice nurse is there each day. Most of the documentation would have to be provides by SNF staff, but if something is said or occurs during your visit it would be usefull to give examples. CMS and Myers and Stauffer are always looking for examples say for not being able to make sound decisions because the resident chose to wear two pairs of pants and no shirt or non sensical speech such as answering questions appropriately, then talking about something totally off the subject. If someone gives you an assessment and points out parts and highlights what I am talking about, that would be a great start. Examples of delusions and hallucinations, feeling bad about themself all of these things frequently occur, but often the nurse doesn't have time to chart them, forgets or they become routine. And giving your ideas for the CAAs and careplans that we still have to do would be of great help as well. thanks for asking! we have a new hospice resident and maybe we should get together as you suggest.

[lupo23]

I would be very interested in your MDS for Hospice presentation. Would you be willing to share it? Lu

[susanthomas1954]

And with the 3.0 changes, make sure the facility MDS coordinator gets a copy of what you give the business office. Every time an LTC patient enrolls in hospice, we have to do a new comprehensive assessment, even if, in our humble opinions there has been no change in condition. Same with dis enrolling. Enrolling because the family wants to, then deciding next week to disenroll because mom "really needs one last blood transfusion" and then enrolling again the day after the transfusion elicits three full assessments.

ST

[catnip3]

It would also be very helpful if the Hospice agency can provide the MD-signed certifications of terminal illness as soon as they are updated. Too often I have had to call multiple times for them. They are needed so we can answer the question in Section J appropriately regarding terminal illness.

[tewdles, RN]

I have never had LTC ask me or my agency for CTI!

[Talino]

it would also be very helpful if the hospice agency can provide the md-signed certifications of terminal illness as soon as they are updated. too often i have had to call multiple times for them. they are needed so we can answer the question in section j appropriately regarding terminal illness.

one prerequisite of receiving "hospice benefits" is that "the primary physician and the hospice medical director certify that the patient is terminally ill and have 6 months or less to live if the illness runs its normal course." a resident who is already in a "hospice program" and continues to receive it would have met that requirement. therefore, the facility physician's doc'n stating "terminally ill, hospice care" during his periodic visits should be sufficient to answer yes to j1400.

i have never had ltc ask me or my agency for cti!

most likely, the hospice agency had already fulfilled this requirement--

a written certification must be on file in the hospice patient's record prior to submission of a claim to the medicare contractor

medicare benefit policy manual - hospice services