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.

Oh, yes, and if the Big K and others still try to get a > 40 day length of stay they will have mutiny on their hands. My administrator took one look at it and said, "Well, if they are cutting our pay by 11%, I don't see how I can get you any help." We are the largest facility in AZ, and we are privately owned, not a part of a big company.

Per the open door forum notes I received today, I believe that it will first of all, eliminate the consideration of grace days. Just do the 5 day on day 8, the 14 day on day 15, the 30 day on day 22 (each of these resets the 7 day period) then one on day 29, 36 (and dear god can we please send them home now? and do the dc assessment?), etc., using the day 7 "evaluation" as a scheduled assessment on a day that would normally fall. By the way, whoever develops a spreadsheet tool for this gets my vote for queen or king of the universe.

Note: When applying for other jobs, you will have to explain how the Minimum Data Set is crucial to re-imbursement and Quality improvement. No one out in the other world understands. You will have third party payer knowledge that nurses rarely get, and you will need to capitalize on this when you leave.

Do not believe for one minute that you will never go in on a weekend. Why did the last person leave? ST

Too funny, I worked for them too. It makes you really marketable on your resume though. Everyone wants the nickels you learned to earn. They just don't have the weasels teaching for them.

Well...........10 days into the job, the other RN in my office was in a serious motorcycle crash. My staff is in their mid-sixties to late seventies. The job is still humanly possible, but it is so hard to fit into a new place where a huge number of the employees have been there >10 years and quite a few are related to other employees. Somebody please tell me everything will be alright..... She will be off at least 8 weeks, and we found some work on her desk that was due the next day, and the other nurse panicked, asking "What was she doing all last week?, etc" As the supervisor, I didn't think it was all that bad, but now the other nurse thinks she's a slacker. All the ARD's are set well over a week early,and I suggested that for the first week of September we move some ARD's down a few days. She had a FIT, "We have done it this way for 12 years, blah, blah." I explained that we have all seen people die with thousands of $$ in the bank, denying themselves services they need, that they could have afforded, and tried to explain that someone 12 years ago put these days in the bank for us to use in an emergency, which I perceive this to be, and she is ready to have me fired. THERE WILL BE NO CHANGES. Please, please tell me this will be ok. ST

I carry a salt packet in my pocket to demonstrate weight bearing, and explain that "extensive" doesn't mean you are dead tired after you do it. I also ask, "If you have this many patients that are zero's, how on earth can you say you are overworked?" and "So, if the people that work your days off are not as good as you, why on earth do you just copy whatever they charted?" Shocking but standard fare.

Do you have any experience herding feral cats? That's always a plus as well.

Thank you. We were all right. I was trashed verbally after I left, but the tables got turned on the trashers by people who really cared, and had no stake in my reputation, but only cared about truthfulness. I was actually quite touched to hear the story of how the trasher was handled. She has actually invited me to dinner this week, since she has decided not to take my old job, and is returning to her home state. The facility deserves better, and I hope they get it. Thanks to all, and I am enjoying having a job that appears to actually be humanly possible to do. ST;)

Hey colleagues, Recently a colleague took a position outside the MDS field, which opened our community for the "sidestep dance" of several of us moving to other facilities. I applied for and received his job, and corporate sent someone into my department. I gave a two-week notice, which I fully intended to work out, but after one day of listening to my replacement tell nurses to record resp therapy minutes when they were not supervising the tx., and about two or three other things that were really questionable, I asked if they really needed me in that cramped, hot office for the next ten days. They allowed me to go yesterday, and I took my personal computer monitor home with me, as well. My dilemma is, I know she is telling people this stuff, and I know good and well that she will be trashing me now that I am gone. I have a very good reputation around town, and I was wondering how people will react to the trashing? Do you believe what you hear about colleagues? I personally don't, but I value my rep., and the new facility is replacing someone who has been there 7 years, whose rep is stellar, and he walks on water. I will do well, lots less pressure than where I have been. Thoughts? Thanks for any input. ST:confused: