glm777

With the new 3.0, should we still be coding leaking around a catheter as an incontinence episode? I don't see that stated anywhere in the RAI manual.

So the person doing the BIMS and PHQ would be signing the MDS prior to the ARD. If they have other sections of the MDS to complete as well, then they would be signing the MDS twice, correct? Once before the ARD for the interviews and again for the completion of items after the ARD (Section A, E, etc) What about the pain interview - does that need to be done before the ARD as well? And where can I find the "MDS 3.0 Track Changes for the RAI manual ". Thank you for the info.

I just keep thinking - Could they have possibly made this MDS any more confusing?? For us and for the resident. I consider myself an intelligent person, I've been an MDS Coordinator for 20 years, I graduated top of my class and I have to have the RAI manual glued to my hip with every MDS I do! I actually had to copy the manual for section C and tape it to my computer because I still can't GET it. Code this for that but only if this is that but isn't this and that other thing isn't that. Then, code the other thing this way but only if it's the other way first and last and.... at this point all I'm seeing is "blah, blah, blah"! Why does it have to be so darn complicated!!? And I don't know about the rest of you but my building has many, many dementia residents. They may be coded as "sometimes understood" because they can ask to go to bed or tell us what they'd like for a snack...but start asking them 20 questions about how important things are and forget it. Their eyes glaze over - I've had residents actually fall asleep while doing the interview. Most of them cannot answer those questions! Those questions are a far stretch from "do you want oreos or chocolate chip cookies tonight". I've heard more swear words from cute little old ladies who are sick and tired of answering "these stupid questions" than I ever thought possible! In case you can't tell, I still HATE 3.0. The only reason I'm sticking it out out is I've been in it so long and my back can't take working the floor at this point in my life.

Can someone tell me where in the RAI manual it states to complete the BIMS and PHQ-9 interviews on the ARD rather than after the ARD like the rest of the MDS? My SW completes the interviews and other sections of the MDS. She does all of the interviews when she completes the rest of the MDS - usually 2 or 3 days after the ARD. Otherwise, she would have to go to the MDS twice - once to complete the interviews then a second time to complete the other sections of the MDS (A,E and Q). This is way too much runnig back and forth with 180+ beds! Thanks so much!

the one that makes me the craziest: the resident used a pencil to "itch" under his cast! Don't they mean "scratch" under his cast????

The one thing I have learned about people who always turn the problem around onto someone else's shoulder is that they do it because they think they can get away with it. You need to sit down ASAP with your boss and set her straight. Be professional but firm. Let her know that you will not be accepting the concequences of her bad judgement. Get a copy of your new job description - if there isn't one (I've had this happen to me) then set a deadline as to when one will be available and until then have a plan as to what you feel your job duties should be. I have found over and over again that if you call someone on their bad behavior they back down and respect you more for it. Again, keep your tone and words professional and if you feel you need it - bring a witness with you. I have done this in the past as well. You can just say "so that everyone is on the same page and there are no misunderstandings, I would like to bring ________ with me to this meeting. I want to be sure that you and I are hearing each other and a third person can clear up any miscommunications before they get too far". Above all remember this - you have a license to protect. Do not accept an assignment or responsibility that you feel you cannot safely handle. Your boss likely isnt going to stick up for you if something happens and she isn't going to feed your kids if you lose your license!

Our resident has a feeding tube that is not used for feeding or nutrition at this time. The resident eats well PO and the tube is only flushed every shift. Our RD thinks we should be coding the tube in K0500B. The manual kind of contradicts itself - the definition of a feeding tube states: "presence of any type of tube that CAN deliver food..." but further on, the manual says that you should code in K0500 "any and all nutrition and hydration received...provided they were administered for nutrition or hydration" The tube is flushed soley to maintain it's patency. Should I code it in K0500B?

"The D/C Assessments are a Nightmare. We can't keep up." LOL! Don't get me started on the D/C assessments!!! Again, what is the point other than data gathering for the federal government? Free labor for the government is what it is all about in my opinion! I think at this point we should be able to collect federal benefits! 99% of our residents are d/c'ed home with services. These services go into the home on day 1 and do their own eval. They don't need my info from my facility to help them provide care - it would be like getting a resident from another facility and not doing an assessment of my own because the facility they came from sent us their assessment! Who would accept that? So our d/c assessment is not in any way helpful to the resident after d/c. I've been at my facility for over 10 years and can count on one hand the number of times we have EVER sent in an assessment late. Now - I think 50% of our d/c assessments are submitted late! We can't keep up either. It's either we do the d/c assessments or we do the MDS for residents that are still in the facility - we can't keep up with both. I wish the folks who dreamed this craziness up would have an open forum so we nurses who actually DO the work could voice our opinions. I'm loading up on tomatoes just in case!

I require my disciplines to have their section of the MDS done within 3 days of the ARD, then I allow another 4 days for the CAAs to be completed. What I find is the longer you give them, the longer they take. With the regulation of completion due within 14 days of the ARD, by giving them such a short time period, it alows me some "wiggle room" in case they are late. If I waited the 14 days then they would still be late and we would be out of compliance.

I still think the 3.0 is cumbersome. I think it definitely could have been simplified. The number of skip patterns make it difficult for some of our staff members to follow. Also, the amount of room it takes in the chart is ridiculous. I still feel like only about 50% of the form actually assists us in providing appropriate care for our residents - the other 50% is simply data gathering for the government. I don't like the CAAs and I especially don't like what triggers them. If reading is not important to a resident - why does that trigger a CAA? Some folks just don't like to read. It seems to me that the government has set it's own criteria about what should and should not be important to a resident and any deviation needs further investigation! I could see if the resident enjoyed reading and could not d/t vision or limited access to books but if he doesn't like to read - what is the issue???? I love to read - my husband hates it! And things like triggering an incontinence CAA because a CONTINENT resdient needs help to the toilet is ludicrous! More writing to explain a "problem" that isn't a problem! Oh well, sorry that turned into a rave but I'm still not a fan - at all.

Can someone help me out here? The Psychosocial CAA triggers whenever the resident states in section F0500f (daily activity preferences) that it is "not very important" to do their favorite activities. This is the resident's answer - not staff. How can I care plan this? If it's not important to the resident to do his favorite activites - why do WE have to MAKE it a problem? I HATE this new MDS!!!!!!!!!!!!!!!!!!!!!!!11:eek:

Has anyone taken any of the new 3.0 certification courses from AANAC? I've been certified for a few years now and am hoping that maybe going through some of those courses might clarify some things for me. I'm just afraid that I'll only get more confused!! I'm thinking maybe get a month or 2 under my belt first, actually working with the new process, then trying to take the 3.0 courses. Any suggestions/advice?

yes - the lovely updates. Of course, our company, being so ready to jump on this new process, got us our manuals in June. So between then and now I have highlighted, made margin notes, etc (on my own time) in my manual. I took it to all the trainings and kept great notes in it. So of course I was slightly peeved to find that there have been so many updates that it is easier to just replace the entire manual!!! I am NOT going to read through it again! I'm done with this craziness. I think it is time to look into other options.

We are a 175 bed facility with an average medicare census of 25. There are 2 full time MDS nurses that complete all the MDSes for the facility. This is so not do-able with the new 3.0!

You have got to be kidding me!! I just finished my first D/c return not anticipated and I am fuming! took me 1 3/4 HOURS to complete it! For someone who has gone home! Thankfully we had just done a 30 day assessment 4 days prior and I took a lot of info from that. How is it that the powers that be came up with such a labor intensive process?? Did anyone who had input into this new process actually WORK in a nursing home? Did they actually try to DO the new MDS in a real, true NH environment? I work in a 180 bed facility with 8 d/c and 6 admissions between OCt 1 and Oct 4. Not to mention the medicare census 0f 26 with the SOT, EOT, 5,14,30,60,90 day assessments due. Plus this week we had 6 annuals, 2 significant changes and 11 quarterlies - all needing the 3.0. So....by the end of next week I will have approx 1400 pages of assessment to do, not to mention 16 sets of CAAs!! There is only me and one other full time person to do all this. We've been advertising for a 20 hour person (whooppee) but no takers yet - who want this job now?? WHAT WERE THEY THINKING????????