miccay

I am also starting July 7th. I am nervous about going back to school but excited as well. Starting with one class, NR500, of course, but hope to take two classes in September.

Thanks for posting your opinions. I am about to start an online program. I chose online for two reasons - one so I continue to work full time during the day (until I get to the clinicals) and the other is because there is only one college locally that offers the program and there is a long waiting list for it. I am looking forward to being a NP and I am glad to know there are NPs who feel it was a good decision to make the sacrifices to get the credential.

Thanks for all the positive comments on this post. I have been wandering the same for myself. I am 44 yrs old and about to start a NP program. I will be close to 47 when I am finished. I have had doubts at times, thinking I am crazy for going to school now, but now I have more confidence. I appreciate words of encouragement and wisdom.

I am the DON at a 88 bed facility. Right now our census is 76. I am being told that the nurses are staying over on their shift too much and they have to clock out and leave after their 8 hrs. The census is down and we cannot have overtime. The nurses are saying they have too much documentation to do to get out on time. Of course they document on residents who are on antibiotics and any incidents for 72 hours and they have daily medicare A charting. We only have 5 medicare A residents at this time. However, we have about 10 residents receiving part B services. The DON before me implemented that the nurses have to document on the part B residents on Tues and Thurs. Where I worked before, we did not document on the residents receiving Part B. We only documented three days prior to therapy starting to establish a reason for therapy and then we documented when therapy ended. I would like to know how other facilities are documenting and how other DONs handle getting the nurses off their shifts on time.

I have been a member for three years and I am certified through AANAC. I have never regretted it.

Your MDS nurse is looking for documentation to help her code that particular resident. The MDS and care plan should paint a picture of what is going on and it can only show that if the documentation is in the chart. She is looking for behaviors such as refusing care, combativeness, wandering, delusions, hallucinations. She is looking for shortness of breath - and if it occurs - when? At rest? on exertion? Lying flat? She needs to know about continence or incontinence. Hopefully all disciplines are writing in the chart any changes or updates such as dietary, treatment nurses, social services, activities and the interviews are being completed. It is so difficult and frustrating to complete an MDS when you know what is going on with a resident and there is no documentation.

I have to code a resident's diet that is full liquid. She had an esophogeal repair and she is to have a full liquid diet now. I have never had to code this and I can't decide where it fits. It is not mechically altered in my opinion. It is just regular fluids and broth. It is not therapeutic because it does not have anything to do with nutritional content and it is not regular. Please offer some help.

MDS has changed quite a bit. To me, the new 3.0 is very time consuming. Interviews have to be conducted for each assessment - BIMS for cognition, PHQ9 for mood, pain, discharge preferences, activities preferences. In my facility, the SS worker conducts the BIMS, PHQ9, discharge, activities director conducts the activities preferences, and a nurse conducts the pain interview, but it is redundant. The old discharge tracking has been replaced with a discharge assessment, so if you work in a facility where there are a lot of unplanned or planned discharges, it takes a lot of your time. Then there are End Of Therapy OMRAs and Start of Therapy OMRAs , and starting soon there will be a Change of Therapy OMRA. Alot more work than 2.0 in my opinion. Good luck.

In the facility where I work, I have a nurse consultant that comes monthly and completes an audit on the MDS I have completed. She always comes up with one more physician order that she says I should have coded. I know what the problem is. I was taught that you do not code physician orders that are written the day of admission unless it is because of a drastic change in condition of that resident. She is wanting me to code orders from the day of admission such as when the MD changes one medication to another or wound treatment orders. These are not clarification orders ( I know they can not be counted), but they do not indicate a change in the resident's condition. I have looked in the manual for clarification and I still believe I should not be counting these orders. She states she has always counted such orders. Should I be counting them? Please advise.

I agree with the first answer. MDS is not a 9-5 job. You have to consider what other tasks come with that position. In some facilities, the MDS Coordinator has to take call. That is very hard to do. How many beds is the facility and what is their medicare census? The MDS position is no joke. Some may think it is an easy office job, but it is demanding and in some cases it will drive you crazy if you do not have the support of management. Do more investigation into the job and find out more details of other duties they will expect from you. You may have to work weekends if you can not get the work done during the week. The 3.0 has a lot of assessments that are time consuming and have to be completed and transmitted within a short period of time. Good luck.

I totally agree that this MDS needs to be revamped. We have so many unplanned discharges it is ridiculous. I try not to use dashes, but as you say, if the interview was not completed, we can not falsify the MDS! I can understand interviewing the residents annually, but with every assessment, it is ludicrous. I can only pray that CMS will wake up and revise MDS 3.0.

I agree, good for you! I understand what you went through. I work in 122 bed facility but we have what they call a transitional care unit. We have anywhere between 30-40 Medicare. Most are there 20 days. Some stay longer, but hardly never a full 100 days. They come and go - new admissions, discharges to the hospital, readmissions. It is crazy. We were lucky to have 2 full time MDS Coordinators - which I am one of - and one part time MDS Coordinator. When 3.0 hit in October, we were going crazy and I turned in my notice. I could see myself going through what you just described. Management offered to hire a fourth MDS Coordinator to complete the interviews and conduct the care plan meetings. She also does some MDS's when she can. So I retracted my resignation and stayed. The fourth person has helped us tremendously, but we still work hard every day, coding and completing MDS after MDS. I used to love being a MDS Coordinator, but I am burnt out with all the work that goes with 3.0. Good luck to you. I am sure you will find another job. Other facilities need good coordinators and some are just not as fast paced and unorganized as what you were dealing with.

First of all, I would ask myself "is this job really worth it?" You stated that you agreed to the job of MDS Coordinator because you love the facility and wanted to come back at any compacity. If you still feel that way, I suggest you make a detailed list of all your job duties and expectations and go to your D.O.N. Present it in a way that you are asking for support. Your job performance not only effects the revenue of your building but indicates the quality of care your residents are receiving. Stay positive (as positive as you can as you sit in your office with your space heater, windows sealed with garbage bags, and leaking roof) and express your desire to do a great job. Accentuate that your performance depends upon a team effort and you can not give 100% if you are constantly being delegated more tasks. It is like spreading your abilities too thin. Don't present it like a whine or complaint, but indicate how you can improve the case mix, etc. if you can concentrate more on assessments, care plans, and coding correctly. The so called "fixing" documentation does not need to fall on you. There should be inservices for the staff on what they need to document for support of the MDS. You can provide the information, but it should be up to nurse management to make sure it is done and done correctly. A good MDS needs support of the whole interdisciplinary team. Good luck.

Under section M, what type of documentation is required in the chart for a turning and repositioning program? I am confused because I thought it had to be specifically for the resident with interventions such as positioning device or pillows - documented, monitored, and reassessed to make sure this program is working for the resident. I am told the turn q 2 hrs meets the requirements if the CNAs sign off on the CNA ADL care plan that states turn q 2 hr.

I agree with all the above comments. When I first heard about 3.0 coming out, I was excited and thought they would really improve and simply the MDS. I was so disappointed when I saw it. I think most of it is a waste of time. I don't understand what they were thinking when they created it. They sure weren't thinking environmently friendly with making it so many pages. We also can not keep up with the discharge assessments at my facility. And the questions are so redundant. Some of our residents refuse to keep answering the same questions when multiple assessments are due. I hope they make some revisions in the near future, but I am not holding my breath. I have already been disappointed once with the new MDS.

I know you all have heard this request before, but I am looking for a PPS/medicare daily tracking form. I used to work where we had one that updated days used when the date was changed at the top of the page. The cells had formulas in them that calculated. The one that I am using now at my new job has to be updated manually everyday. We run 24-28 medicare per day usually, with admissions and discharges everyday. Updating this one manually is time consuming, confusing, and leaves a lot of room for error. Does anyone have a template for something that will calculate days for you? Thanks.

That is good advice. Also if you are working for a company already as a MDS Coordinator, they may be willing to pay for your certification. That is how I got mine. I worked as the MDS Coordinator for two years before I was certified.

I was being pushed also to do "off cycle" quarterlies to capture a better RUG for case mix. I was very hesitant to do this, but I called my state MDS coordinator and explained it to her and asked her opinion. She said there is nothing in the RAI manual that says you can not do that, and in fact, most facilities are doing this, but too many does raise a flag. I believe one day this loop hole will be closed, but for right now, it is open to jump through. As for the medicare questions, refer to Chapter 8 in the Medicare Benefit Policy Manual. You should not be skilling people that are not in a skillable RUG category. When therapy ends, we monitor that resident for 7 days, then if there is anything nursing wise to skill for, of course, an OMRA is completed. If not, they come off of medicare.

This is a constant battle at my facility also. We have been using Caretracker since March and we have inservices frequently on correct coding. I don't have any advice on how to successfully obtain a consistant and accurate documentation record, but I do believe the CNAs are your best of information since they work one on one with the residents. You have to talk with all shifts to get the whole picture.

You certainly can pass the CPNE. I did it with no hospital experience. You are given the study material and if you study and practice and take a workshop, you can pass. Go for it! Good luck.

I am the MDS Coordinator for our 66 bed facility. I complete and transmit all the MDS - Obra and Medicare, update careplans and head the careplan meetings. We are certified fro 15 medicare, but right now we only have 10. When we are full of medicare and they are going in and out of the hospital, it gets very hectic.

I understand that assessments can be moved around - done early or whatever to capture a better RUG, but I am being told that an "off cycle quarterly" does not restart the clock for the 92 days for the next assessment due. It is completed and transmitted to the state, but it is an extra assessment that is thrown in there between real assessments. This is the part that doesn't make any sense to me. Why would the state allow this and why would an MDS coordinator waste time completing an extra assessment just to keep the QI report from flagging? I am being told that it is something that is expected to be done from my management company. I do not want to do anything that would cause the facility to be cited. And I don't want to do anything fraudulant.

In my facility, our MDS consultant insists there is something called an off cycle quarterly that can be done to increase your RUG or get something off the Quality Indicator Report that is flagging. She says this does not take the place of a quarterly assessment and does not reset the clock for the next assessment due. I am totally confused about this. It doesn't seem right and there is nothing in the RAI manual about it that I can find. Does anyone know if this is kosher? I am thinking an off cycle quarterly is possibly a significant change assessment or a correction because those are done off cycle usually. Please help.

As an Excelsior College student, you already have experience in the medical field - LPN, EMT, Resp Therapist, etc. - you are expected to already know this - you go for your clinical to show you know your stuff. Of course, the school gives you information to study so you know what they expect. The first day is lab simulations - IV push, IV calculations - gtts per minutes - sterile wound packing, injections - either SQ or IM then the next two days are with patients - you have to do hands on and careplans. It is strict but if you know your stuff, you can pass. It is all about skills, skills, skills.

Congratulations on your new job. I am a DON in a LTC center. My ADON is an LPN and she is awesome. Our facility is small - 66 beds. She is in charge of the restorative nursing program, labs, infection control. She does help on the floor when we are short staffed. She makes rounds with the doctors and makes sure they are visiting as required and have their progress notes in the charts. She stays busy. You will have to just take it day by day and be willing to be flexible with whatever comes up. Life in LTC is not easy, but it is rewarding. Good Luck.