chaotick

Just got fired from my job on Friday (hee hee - the owner/admin thinks that my assistant is going to be able to take over - she's sadly mistaken - as the assistant's refusal to be trained to do ANYTHING to help me out was one of the major reasons I was always 'causing problems'), but I rescued all of the forms that I developed over the past 2 years for MDS-ing... Here is what I (used to) send out. There's a way to set it up to make it a form letter - it's kinda complicated if you're not computer savvy - but easy enough to do if you've got Microsoft Word/Works on your computer. Look up 'Mail Merge' feature in the help section(s) on http://www.microsoft.com. ------------------------------------------------------ {Center the name of your nursing home spaced out like this, with 'of your city' on the next line - also centered} X Y Z N U R S I N G C E N T E R O F Y O U R C I T Y {insert an inch or so and then line up date with right margin ->} December 19, 2006 To the family of X, On Wednesday, January 3, 2007, we will be having an Interdisciplinary Care Plan Meeting. At this meeting, we will be reviewing X's treatment plan and making any necessary updates or changes. If you would like to attend or if you have any concerns or suggestions you would like to discuss, please contact me at (000) 111-2222. The meeting will take place in the conference room at XYZ. We have allotted a specific time for each resident's family to discuss any concerns or suggestions you may have. Your time frame will be from 1:00-1:15 PM. We will be care planning other residents on this day, so we need to adhere to the time frame and ask that you be brief. If there are other concerns that you would like to discuss that do not relate to X's plan of care, we can set up a different time to meet individually with you so that there may be more time to devote to your concerns. {line up next 3 lines with right margin -------->} Sincerely, {skip a couple of lines for your signature} Your Name, RN Care Plan Coordinator {Space to bottom of page and center} P O BOX 1111, 300 GERIATRIC DRIVE, YOURCITY, ST 11111 PHONE: (000) 111-2222 FAX (000) 111-3333

I'm lucky enough to have an 'assistant' coordinator - though management doesn't feel that there is enough MDS work to justify her doing that alone - so she has other job functions outside of completing MDS. She picks and chooses what she actually does when I'm gone (so far in our 1-1/2 years of working together - I've had 1 one-week vacation and an odd-day-off here and there - I've always come in when I'm sick, since I don't have to have patient contact.) What she actually accomplishes while I'm gone is minimal - just keeping things going - such as the meetings and such (from my stand-point it seems 'minimal' - I'm sure she really is working her tail off - I should be more grateful). I set up all the scheduling ahead of time - and she has a rudimentary idea of how to access the 'essential' files on the computer we share that need to be distributed (I've tried teaching her how to submit assessments to the state - but reality is that CMS allows up to 30 days to transmit - so that can wait for all but the most extended of leaves to be done). Ironically enough - I got this job when the old coordinator took 6 to 8 weeks off for a surgery and just sort of never told anyone (except her assistant) that she was seriously considering retiring after that was all said and done. The admins thought the DON/ADON could cope for the 6 to 8 weeks - the assistant ended up resigning from the stress of trying to hand-hold them through the process - neither had the time to take on the extra duties NOR the aptitude for the nit-picky-ness needed to do MDS - so it took me months to clean up the mess they all left behind - all the while, trying to learn the job. The former coordinator eventually came in a couple of days a week to 'orient' me to the job - but by then I had been doing it long enough that all I needed was an occasional impossible question answered (those ones that fall between the cracks of the RAI manual - I agree with SLS703- it is THE most single important resource you have - it IS the letter of the law as to what is the right or wrong answer to filling in the MDS) - and she spent most of that time 'auditing' the stuff done while she was gone to make it more compliant with what it needed to be. I was left without her assistant (who had gone back to the halls) and then they hired (without my input) a new assistant - who (much to my extreme horror) had never even worked in a nursing home before, let alone had any clue what an MDS was. Oh well. I also recommend developing a network of more experienced MDS people to call on for those impossible questions mentioned above... I would assume most states have people within their hierarchy that will also field calls of the 'help, I don't know what to do!!!' nature (ours are kinda grouchy and make you feel like you-know-what for calling and bothering them - but they will be helpful if you are patient and don't lose your cool). Heck - email me brookshire[underline]mdsnurse[at]earthlink[dot]net and maybe I can be helpful. (trying to avoid spam robots - just use the characters to replace the stuff in the brackets [] above). If I don't know the answer, I might have someone in my network that does. It's a very helpful community - I've never had anyone I've called - even total stranger MDS coordinators that I got a name from some intermediary - that was even remotely put-off by some weirdo (me) calling them out of the blue. Go get 'em kid!

I've had to deal with this one at my facility... There were a fair number of grace days being requested by therapy (a contracted outfit) - which didn't make a lot of difference to my workload either way - and it mostly to make up for late in the week admissions... The owner got freaked and yelled at me for being too cordial/catering to therapy and was deathly afraid of triggering audits. And she also implied that the higher RUG levels meant a bigger slice of the pie for the therapy company and smaller slice for nursing/etc. (Beats me...) and (I like this one...) that all of the excessive therapy was causing the short term rehab people to leave early because they were all tired out from too much therapy... (most of the time they really didn't LIKE being in a stinky old nursing home and just wanted to be home in their own beds as quickly as possible...) Now we're about to undergo a big 'culture shift' - the owner decided to hire 'in house' therapy people (March 1st) - and it seems that Grace Days are going to be just hunky dory 'cause a) everyone does it at least sometimes, b) not doing it at all ALSO can trigger an audit (what are they trying to hide?) and c) probably not necessary if the admit has had IV/transfusions in the hospital (it came to light recently that owner had also thought that people who'd had IV/transfusions had to not be in therapy to get the "L" or "X" level category... but then someone clarified and that became obsolete about 2 years ago... Beats me - I had no idea what MDS stood for a little more than a year ago... and I was trained (more or less - mostly less) by the old retiring MDS person who didn't feel comfortable with computers and didn't seem to keep up with changes in the law). The only reason I got the job was because the DON put her foot down and refused to take on MDS's on top of the other 1 million things she does every day (I love her to death - but she is NOT a detail oriented person in the way one needs to be to be good at MDS).

I'm an MDS coordinator in 80 bed facility/10-25 Medicare A (rehab) and lots of finicky families to keep happy. I have been required to be 'on call' in a rotation every x-th weekend with various other facility RN's since about 1 year after I started working there. Currently weekends are alternated between myself, assistant MDS coordinator (also an RN - she gets a lot of other duties dumped on her (Restorative Nursing, Dining room duty, and (eyeroll!) doing pedicures with the Activity Director on Tuesday afternoons) (our owner/administrator thought it would be a good way to do regular foot assessments... sigh) because she's not 'the main MDS coordinator'), the evening shift treatment nurse (an RN imported from overseas for a 2 year contract in exchange for Green Card - i.e. indentured servant), night shift RN (ditto to treatment nurse - she took over my old position which had been unfilled after I got 'promoted'), and the SDS nurse (education and training) nurse (older than dirt RN and cranky as cranky can be...) -- so every 5th weekend. It's been as little as every other weekend (when cranky SDS put her foot down... and we had yet to import the current crop of indentured servants) which got REALLY old - I almost missed my younger daughter's high school graduation but one of the floor LPN's took pity on me and covered a Friday night 2nd shift callout so I could go... ... DON and ADON (also RN's) cover weekday evening/night call - somehow only the ADON ever has to actually come in and cover for a callout... I think the DON would probably see things a whole lot differently if she had to work a night shift and then do her regular job, too (we technically get 'comp time' - DON, ADON, SDS, and I are salaried... the other 3 are paid hourly... since all but the two foreign nurses have 'flexible' job specs - even if we do take 'a day off' - the work is not done for us while we are home 'relaxing' - so we have to somehow make up for lost time anyway.) On call pay is $75 a night (if the weekend covers end of month/beginning of next - we're paid twice monthly - they split it up on two separate paychecks!!!) If we don't take comp time we get a flat $150 for each shift we have to work... but we're constantly told how tight their budget is and so we are encouraged to do the comp time thing... which ends up being not at all - unless I'm physically exhausted because... as I said ... I have to do the work anyway even if I'm off... I also have to cover for CNA call-offs if we drop below 'minimum staffing' level. I haven't worked the floor since I took over as MDS coordinator and it's been even longer since I had to regularly do CNA duties... so I end up giving almost criminally substandard care if I do have to fill in... I had to work 8 pm to 8 am plus the other weekend... on short notice (i.e. no sleep) due to a couple of unexpected injuries combined with (chronic) lack of 'spare staff'. We are not allowed to call agency (at times I've considered offering to pay for them out of my 'on call pay'... I know, I know... I wouldn't - but it's tempting given the stubborn as a mule-like attitude of the owner/administrator... the joy of being a family owned facility). I worry I'm going to make a bad med/care error as a result - and so I marched into the DON's office last Monday and said I was getting too old to take call and wanted off the rotation until staffing levels improved. She laughed and said a) Tough - it's part of an 'administrator's' job description to share 'on call' and b) if I knew of a way to improve staffing levels I was welcome to let her know... I like her a lot and she's one of the main reasons I put up with the crazy owner instead of looking for another job. Oh well. I wouldn't want her job for all the money in the world... (the owner/administrator is even harder on her) and it IS only one weekend out of 5 (and - yeah - I do sometimes luck out and don't even get a phone call - for example at 10 pm on a Sat. night saying they have a broken call light cord, no replacement where there's supposed to be a spare - and what do they do...)(the head of housekeeping/maintenance - theoretically also on call at all times... somehow always manages to have a non-working cell-phone number... and I live 5 minutes away and they know I'll come...)( A) cut the switch off the end of the cord - plug into the socket in an 'empty' bed (to silence automatic "hey someone pulled the call light out of the wall" emergency signal) - and use the functional cord to replace the broken one... B) leave somewhat obnoxious 'work order' for head of housekeeping/maintenance to repair cut cord on Monday since they somehow can't be bothered to have a working phone number on record... and C) Cross fingers that I don't get written up (again) for being a smart-ass and not following the 'chain of command')