Moving Target

silverbat · Nov 28, 2011

Here is what I do... I schedule my quarterlies and annuals on tues, wed, and thurs. The med A's on mon-Fri. My social services does the b,c,d,e. The activities does f, dietary, k. The rest I obtain from the chart, resident assessment and by talking with staff. Therapy gives me thier minutes. EVERYONE knows when the assessment is due. I don't know why she would need to change ARD's. I try to NEVER change them unless I truly have to. I gues I don't understand why she would be late, if everyone gets her info and she compliles it, completes her assessments and inputs it all in a timely manner. Does she need to have a more experienced MDS work with her, not just bail her out?

PsychNurseWannaBe, BSN, RN · Nov 29, 2011

I put out my grid for the nurses on Monday or Tuesday. The ARD is set to Sunday. It's split between AM and PM. NOCs has to do the sleep assessment portion. I would say that I don't change ARDs but I did have to today but that was an oversight on my part. Resident were put on the schedule after the fact. For our long term residents, we compile the schedules in 3 month increments and adjust if they are sent out, admitted and returned. Therapy will tell us when to put the PPS people on. The PPS people ARDs are not Sunday but what they need to be according to the PPS schedule. I guess technically, the weekend doesn't really participate in the assessments. They are normally done before then. Is she changing ARDs after the weekends have already done assessments and then they have to be redone?

If you give her a schedule, it should be pretty easy for her to just put out the assessments and grid.

silverbat · Nov 29, 2011

psychnurse... you let THERAPY set your ARD's? Therapy and you should work together with the ARD's especially now with the COT's, it takes bothe MDS and Therapy working together to get the best RUGS... i set the date, then we adjust if needed. I look at it daily to watch the COT's.

PsychNurseWannaBe, BSN, RN · Nov 30, 2011

psychnurse... you let THERAPY set your ARD's? Therapy and you should work together with the ARD's especially now with the COT's, it takes bothe MDS and Therapy working together to get the best RUGS... i set the date, then we adjust if needed. I look at it daily to watch the COT's.

When it comes to therapy they monitor RUGS on medicare patients and when they want the ARD to capture their minutes. Their program tells them when they can do things. I have yet to do any COTS, EOT, or any of the new assessments. Makes me nervous but they said their system will alert them.

silverbat · Nov 30, 2011

I have done a couple of COTs, and EOT's happen a few times a month, and they should, I think, as we can't always "time" things to work out. I sit down with therapy daily to go over minutes accruing and their program alerts them, but I am not going to just sit by and let their program alert me.. a program is only as good as t he people inputing information and errors occur. THAT is why I watch it daily. I would be concerned if there were no bumps in the road. I know that CMS wants variations in total minutes and therapy isn;t always good at watching that. I set the ARD's and work with therapy daily, and it works for us. We haven't had any 3 days missed so that is good. We generally run about 25 Med A's.

PsychNurseWannaBe, BSN, RN · Dec 1, 2011

I was getting used to 3.0 until these darn changes. But from what I got from rehab coordinator, rug up or rug down is focused around their next PPS assessment. Does that require a COT if done in the assessment window? I get confused with these new rules. We meet weekly. Therapy projects AR dates and are responsible for hitting their projected minutes. They will even come in on the weekend if someone is on day 2 of missing therapy so the resident doesn't go 3 days.

silverbat · Dec 1, 2011

Mine come in on weekends, too, that helps. Yes, you can have a COT if in Assessment window, you have to use the COT date if within allowed days for that particular assessment. A COT lookback/potential is every 7 days.

PsychNurseWannaBe, BSN, RN · Dec 2, 2011

Mine come in on weekends, too, that helps. Yes, you can have a COT if in Assessment window, you have to use the COT date if within allowed days for that particular assessment. A COT lookback/potential is every 7 days.

In our facility they sent the rehab coordinator to the new training, not us nurse managers who do MDSs... She will ramp up or down WITHOUT COT if in an assessment period. Let's say a 14 PPS is coming up and she is going from high to ultra, she says no COT is due. Her system did not flag it.

Adding: Which I guess makes sense since the COT is to change the RUG level and since a 14 PPS is going to generate a RUG I guess that would be OK so no COT would be needed, right? BUT if we are between a 14 PPS and a 30 PPS and not within the 30 PPS ARD and she can't get her minutes, we would need to COT to create a new RUG right? I can't believe they handed me and my counter part a paper power point for our training versus sending us to the meeting. Oh well...

silverbat · Dec 2, 2011

you are right... if it is between the 14 day and the 30d, etc, there are still COT 7 day lookbacks and if the RUG changes either up OR down, then a COT is required. The bad thing is that if a COT is missed, the only ones that will find it out is the government if you are RAC or DAVE audited, or if there is a review of Med A resident by CMS. THEN you will pay it back! You don't have a dedicated MDS Coordinator? WOW!!!!!!!!!!!!! MDS is a full time job!!!!! especially if there are many A's.

PsychNurseWannaBe, BSN, RN · Dec 3, 2011

Why would we need an MDS coordinator.... we are only 130 bed facility??? (I'm being sarcastic) We have to do the PPS, quarterlies, sig changes, annuals, entry records, discharge MDS, care plans, care conferences... plus run the units. And lucky us... we are starting triple checks. I set up the assignments and assessments, put out the I&Os, bowel and bladders, sleep assessmets, then I have to review all of it and decide if they need a toileting schedule and create yet another document I have to update. I have to monitor psychotropic meds, alarms and restraints, wounds, pain management, falls, provide insurance updates, get auths, the list goes on and on. For example, I finally got to my MDSs today. Which is the last day I could do them. But I am so busy running units and I have to find time to squeeze in the MDS process and everything it entails. Plus I am a certified wound care nurse, so the other units will consult with me so I have to go off and assess wounds.

Our area is really saturated with medicare replacement policies, so they still get rugged according to the PPS schedule, but they go no where close to their 100 days even if it is an unsafe discharge. Totally ****** me off.

There is soooo much more we have to do. All with me and another nurse manager. OK... I think I am done venting. It was a crappy day today. Thanks for all your MDS help. I hope if I have questions, you will help me in the future. I appreciate all your help!! Have a great weekend.

silverbat · Dec 5, 2011

ummmmm can I suggest....... find another job??!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!