susanthomas1954

Yes, you can set it any time in the first 14 days. Most people like to use day 8 just in case there is a skilled payor source. OBRA MDS coordinators like to use day 14 because it gives you a better picture for a comprehensive plan of care. Sometimes seems like the PPS coordinators and the OBRA coordinators are living in different worlds. Actually in OBRA Medicaid world it is better to use day 8 anyway, because you can usually capture a higher ADL score, as people need more help in the first few days getting settled in, and when you consider you are setting a pay rate for three months possibly, you want to capture the highest documented ADL level you can get. Happy Nurse Assessment Coordinator's Day. ST

I guess my first question is why do you want the job? Administration needs to keep a close relationship with the MDS people because it is closely tied with re-imbursement. If the administrator does not know you well, or consider you to have the skills needed, you won't be considered. Adminstrators really don't know or care about the care planning part of the MDS process, and most DON's really only care about the Quality Indicator part when it reflects badly on them, so........the way to ge the job is to show inside knowledge of re-imbursement, and have good relationships with admissions and the business office as well as the administrator. Hope that helps. ST

Just FYI, always do your admission MDS by day 8, because when this happens, you usually have a rehab rug. Even the long term care admits, because you never know who might have missed a payor source on admission. ST

Only MDS should open the assessment in the computer, early in the look back period if possible.

The COC required for a hospice admit has up to ten days look back. If he died the second day no COC needed.

Nursing school didn't teach me the 4,000 regulations that regulate SNF's and nursing homes. Since my job as an MDS Nurse addresses over 3,000 of these regs, quality indicators and RUG levels for re-imbursement, the new grad needs to be someone who is willing to stay in the RAI Manual and the Guidance for surveyors night and day. The one plus that I can think of is that a new grad can probably write a decent care plan, IF they know what actually can and cannot be accomplished by the staff. Short answer:Whoever is considering this needs to preceptor the new grad with a seasoned MDS nurse for about 6 months. ST

You could offer to go salaried. Don't shoot me, I'm only the messenger. That's too much skilled for one person, much less expecting you to do LTC. The MDS 3.0 increased time by no less than 25% per nurse. You need two full time nurses to do what you are doing. Two full time nurses that know what they are doing.

Andy3k: Let me know if there is a charge for this. There should be! ST ([email protected]) Thanks

Could you send me one too please? My old one is worthless now. Thanks so much. [email protected]

Our facility has a great Restorative CNA who was trained to do all our interviews for section C, and the G section for 0300 to the end. Soc svc. does section D and Q, so the only interview I have to do is the pain interview. She does all the scheduling, as well, and lots of paperwork, since we are 100% paper here. We all do our own data entry. (There are 3 nurses for 300 patients, I do 25 to 40 skilled. If I get over 35 skilled, I run late now. With the new CoT's and lookback changes, there is no doubt there will be almost EXACTLY 25% more work.) ST

BTW, gotta keep an eye on the ADL charting, too, because that can change the rehab RUG as well. ST

You only do a EOT/CoT, etc if the rehab RUG level changes. If your patient has 720 minutes on the 5 day, done on day 8, and only has 719 minutes on day 15, then you gotta do the CoT to reflect that it went from Ultra to Very in that period. You gotta check your minutes daily, so that your patient has the same level of therapy this Friday, as they did last Friday. If not, you have to do the CoT, including all the interviews. Then, when they are back at 721 NEXT Friday, you do it all over again, even though the 30 day isn't due for two weeks. Patients see my office mate coming down the hall and they yell, "Sock, blue, bed!" They see me and scream "5!, My worst pain has been a 5!" The interviews are way over used. Sock, blue and bed are now testing long term memory in over half our patients/residents. ST

Yes, tell me the logic of cutting the MDS staff when we are your only lifeline to payment for Med A patients, and that represents over 30% of your income if you are average. I am hearing the same things around town. ST

Thank you for posting this, missed the open door forum today, but got the notes from a colleague. Completely eliminates the concept of grace days, as far as I'm concerned. What's anybody else think?

Believe me, I hearby declare as law that no one misses three days of therapy while skilled for therapy. End of story.