glm777

A resident had a seizure, fell, lost consciousness and received a laceration to his scalp. How would you code this in section J? His fall was related to a medical event - not a trip or loss of balance. Also, a major injury is described as a "closed head injury with alteration in consciousness". His head CT scan at the hospital was negative. All feedback appreciated!

My new SW has been attempting to do section C with almost every resident. She codes "yes" the interview should be conducted unless of course the resident is non verbal or 100% confused and unable to respond to even the most basic care need questions. . But sometimes we find during section C interview that the resident cannot respond to that level of conversation, so she codes " refused to answer or non sensical answer" and moves on to the staff interview. Then she codes section D as "no" interview should not be conducted. Is that acceptable - yes to section C but no to section D? She feels that if the resident cannot repeat three words , he certainly won't be able to respond to the more involved questions in section D. Just looking for the opinions of others.

I just realized a resident came off of Med A (remained in facility) on 11/10/22 and I never completed the end of PPS stay MDS. Should I do it now and will there be any financial ramifications? Thanks!

Resident admitted in March with supposedly 100 days of Medicare available. Set ARD for day 8, completed and transmitted the MDS. Resident had 3 MLOAs - upon return for each one - we did a five day on day 1-8. We just found out a couple of weeks ago that the resident actually only had 3 days of Medicare available when he initially came to us!! Yes - someone dropped the ball (that's another story entirely) but is there anything we can do now to get payment for at least the first 3 days? I'm thinking not but my billing office wants to be sure. Thank you!

This new home that I have recently started at does things so differently than what I am used to! Can someone please clarify for me: Resident left facility on 7/26/22 at 11:35PM to go to acute hospital (Medicaid resident) Admitted to hospital on 7/27/22 at 2AM What should my ARD be for my DRA? Sorry for so many questions lately but again - very different thought process here! Thank you!

Can someone tell me what months of the MDS are reflected in the July 2022 quality measures? Thanks!

Our program (Matrixcare) automatically populates the form each time we complete an MDS. However we have noticed that certain things didn't seem accurate. For instance, the program kept checking off "contractures" for all residents who have limited ROM. But often the cause of the limited ROM was injury (ie: hip fracture). So we have been unchecking that box on the 672 since the resident does not have a contracture. But now, after reading the actual instructions, it seems appropriate to code contracture on the 672 as the instructions say the limited ROM can be due to "deformity, disuse, pain etc". So I guess my question, after all of this, is: should we be following the directions explicitly, even if it doesn't seem accurate to us? This came up because during a recent survey of our sister home, the 672 had several residents checked off as being on a urinary toileting program but there was no documentation of that - because the resident was not actually on a toileting program. But according to the instructions for the 672, the way the MDS was coded did indeed warrant toileting program being checked off on the 672 (H0300 =1,2 or 3) since the instructions direct us to code everyone NOT totally continent, as on a toileting program. I feel like if we follow the direction exactly the way they say, we do not get an accurate picture of the residents at all! I would appreciate any input. CMS672.pdf

If a resident can hold onto the 1/4 siderail while being positioned or while being given incontinent care - should we be coding that resident as totally dependent for positioning or as assist since they are holding onto the rail to keep themselves held over during care (they are not using the rail to move themselves in bed at all - just to keep from falling back while care is provided)? Thanks!

If a resident is coming from the hospital after a 1 day observation stay - never actually admitted to the hospital - do I code he was admitted from the community or from the hospital? Also - a resident coming from home who is on home hospice services - do I code coming from community or from Hospice? I just looked at the RAI manual and it seems I should code as coming from hospice, which I don't usually do. Just one of those things I've never questioned before! Thank you!

How would y'all code this resident for understands/understood? Sometimes or rarely? Me: good morning Mrs. S Mrs. S : hello Me: did you have breakfast yet? Mrs. S: I should have the thing ..it's good... Me: are you hungry? Mrs S: not really Me: It was very nice to meet you. I'll visit again soon Mrs S: yes it was nice

Their rationale is that it IS in the care plan. It's just not a separate care plan. I told them that I thought that just having it in one of the other CP - as an approach -didn't justify that we considered the category a problem. I've always thought that if we consider a CAA item a problem, we need a goal for that problem and approaches to reach that goal. Just listing it as part of another CP problem (IE: 'incont care as needed" in the ADL care plan) is not enough. They are agreeing that what I proceeded on does belong in the CP - the issue is that I think the problems need to have a separate CP with separate goals and approached specifically for each triggered problem- they do not. Maybe I'm the one who is wrong in this case...

I recently started a new job and the care plans are done 100% by nursing. When reviewing the CPs for my triggered CAAs I noticed they did not have a CP for antipsychotic Med. So I put one in…and was asked not to do that again. It seems they care plan AP meds under mood-but all that is addressed in the mood CP is that the resident receives the Med. Period. No mention of the risk for side effects, no mention of the need for GDR. No goal r/t the Med at all. I think they care planned “f/b psych service”. I have always put a separate care plan in for psych meds but maybe it doesn’t have to be?? They do the same for incontinence-“provide incontinence care as needed” as part of the ADL care plan. Done. No goal r/t to incontinence, no interventions such as “offer toileting at…” or “check resident every 2-3 hours for incontinence. Just “incontinence care as needed”. I’ve been doing this 30+ years so maybe I’m still doing it old school? I appreciate any feedback!

If a resident returns from an MLOA, how long do we have to determine if the resident is a significant change? Example: Resident returns from MLOA 11/21 (12 day hospital stay) Quarterly due - Day 92 is 11/23 Must we do a quarterly MDS by 11/23? Or do we have a grace period to determine if the resident should be a significant change? Thanks!

In completing this section for our non skilled residents, do we have to use the most recent admitting dx or the dx that is keeping the resident in the facility? For example, our resident's last admission to the facility was in January 2020 with a dx of COVID. Of course, she no longer has Covid or any effects of Covid. She remains in the facility because she has severe dementia with confusion. What dx should be coded in I0200? Thank you!

How are you all handling interviews when working remotely? I am working per diem for several buildings and they have asked that I work remotely to keep potential exposures from affecting several buildings. I have access to the chart and all documentation as we are totally electronic. But I am not going into the buildings to complete the interviews. Just wondering what others are doing.

Is a decline in ADL SUPPORT (G0110A-G2) considered a level decline for the QMs? Or is it just Self performance? Thanks!

Well, this just occurred to me: I know that when a resident disenrolls from hospice services, a COS is required. However the usual rule for COS is that when a COS is noted, you have 14 days to complete the COS MDS. How does this work with coming off Hospice? If the MDS has to be completed within 14 day of the change, won't we then have to code section O as a "yes" for "has the resident received hospice services in the past 14 days"? But if we wait until day 15 so we can code that question as "no" - aren't we out of compliance?

My new facility averages about 20 admission per week. We have care plan meetings only one day a week so all those admissions fall on the same care plan meeting day. I schedule the new adm care plan meeting on the first care plan day after day 14 Our SW would like to call the d/c meeting that is held around day 7 a “care plan meeting”. Can we call it a care plan meeting if the MDS is not even done? Looking forward to hearing your thoughts on this

I need some advice. Since our regional team has been working from home, they are checking every MDS done. They are frequently asking me to change coding for ADLs because it will affect the quality measures since they require more assist this quarter per the documentation. But How do I know that one particular CNA, new to floor, doesn’t ask for assist to move this resident in bed? I am a big woman-I might be able to turn someone by myself while a smaller CNA may need 2 people. Their response to my argument is that I need to personally watch that CNA turn and reposition the resident! I work 24 hours a week and our long term care census runs about 122. I also run care plan meetings for 3 floors and send out the invites and open every MDS and the eval’s that go with it. I don’t have time to watch every CNA who codes differently do her job! And the reason is always that it will trigger the QMs. I’ve been doing this job 22 years. I know that if a CNA coded a quadriplegic as ambulatory independently, it’s wrong and I need to change it and write a note but I don’t know what support every CNA needs to care for his/her residents! I have refused to change some responses because I am not be sure they are miscoded-and have been reprimanded for it. I’m not sure what to do but I’m certainly not changing a response simply so we don’t trigger on the QMs! They even hassled me because our QM for locomotion triggered-our residents are still restricted to their rooms due to COVID! Of course their locomotion got worse!! I would appreciate some input. I’m really ready to give up on MDS-a job I used to love.

Another thought: If the resident had a GDR say on 10/31/19, but had a risk vs. benefit note stating a reduction in med was contraindicated on 3/31/19, do you still code "Yes" for N0450D?

"In N0450B and N0450C, include GDR attempts conducted since the resident was admitted to the facility" Back to original admission date or most recent re-entry date? Also, our pharmacy puts a note in the chart documenting that a GDR is due. They include in the note a paragraph that states "a GDR attempt is likely to impair this individual's function or cause psychiatric instability by exacerbating an underlying medical condition or psychiatric disorder AS DOCUMENTED BELOW" On the line below, our MDs/psych service usually document : needs meds for stability. needs for schizophrenia. needs for yelling/agitation. Is this adequate for GDR contraindication documentation? Can this be considered a true "risk vs. benefit" statement? I have read and re-read the RAI manual multiple times. In your opinion, would you code that statement, as documented above, as a "yes" in section N 0450D - "Physician documented GDR as clinically contraindicated" ? I appreciate everyone's opinion!

How do you all interpret this question? Since there is no time frame associated with the question - how far back are you going? I have residents on Antipsychotics who have been here 10 years. Thanks for your input.

we admitted a resident who spent 4 days in the hospital on an observation stay - never actually admitted. He went to the hospital from home. Should I code him as admitting from community or hospital?

That is how we have always interpreted the RAI manual. However in a recent focused MDS survey, we received deficiencies for late Admission MDSes and were told that the manual states that the admission MDS must be completed within 14 days without condition and that only AFTER the admission assessment is complete does the "new 14 day" rule apply if the resident is MLOA during an assessment period. Per the manual: If a resident had an OBRA Admission assessment completed and then goes to the hospital(discharge return anticipated and returns within 30 days) and returns during an assessment period and most of the assessment was completed prior to the hospitalization, then the nursing home may wish to continue with the original assessment, provided the resident does not meet the criteria for a SCSA. In this case, the ARD remains the same and the assessment must be completed by the completion dates required of the assessment type based on the timeframe in which the assessment was started. Otherwise, the assessment should be reinitiated with a new ARD and completed within 14 days after reentry from the hospital. The portion of the resident's assessment that was previously completed should be stored on the resident's record with a notation that the assessment was reinitiated because the resident was hospitalized. Also: • Federal statute and regulations require that residents are assessed promptly upon admission (but no later than day 14) and the results are used in planning and providing appropriate care to attain or maintain the highest practicable well-being. This means it is imperative for nursing homes to assess a resident upon the individual's admission. The IDT may choose to start and complete the Admission comprehensive assessment at any time prior to the end of day 14.

Can someone please clarify the completion timeframe for an admission assessment if the resident goes out to the hospital with the first 14 days? I have a resident who was admitted then went out to the hospital on day 2 - was in the building approx 20 hours. We discharged him return anticipated since he was expected to return to us. Resident returned on day 14. Does my admission assessment still need to be completed by day 14? I would only have 20 hours of documentation to complete my MDS with. But per a recent MDS audit my company had, if the resident is in the building on day 14, the MDS must be completed. What if he had returned on day 16? When would my MDS be due then?