mdecastronp

if you have a social service consultant, i recommend discussing your resident with hx of being a sex offender. i was consulted once on a case in which the ltc did not know the resident was a sex offender until his parole officer called. i consulted with our social worker and indeed there were regulations that we have to follow. if your facility is near a school, you may want to review it also with the parole officer even if he is w/c bound.

i requested information from this website http://milvalihealthcare.com/Guestbook.php... they have good tools and forms...

please email me or let me know your email... you just need to save it on 2003 excel to ensure that you have the format correct... as you add months and information into it, it will automatically calculate the number of infections and will do the sorting (as long as you pick what you want) and will also produce the graphs you need as it is entered.

I've seen these situations happen over and over again. I've worked mostly in the management, corporate level in my career. I've been asked by fellow Filipinos whether I still or even understand the language, in which, I always reply "yes". Following that question, I am frequently asked why not speak to fellow Filipinos in the native tongue? My answer is very simple: I want to set examples to other Filipinos. The workplace is not to show off whether I understand or speak or even to favor Filipinos. I have been branded as a snob for not gossiping or have leisure time or conversing with fellow Filipinos. The worst of all, I was told I do not respect my elders, which I respond when told, that I respect them as they are older but they should also respect me for which position I represent the company in which we work. The problem is, most Filipinos feel that since there is someone up ranking high in the management/corporate level, most countrymen assumes that they will be provided with a special treatment. It is sad to hear bad things about Filipino nurses. I find them as the most hardworking ethnic group. But, having been in so many management positions, the best group of nurses are those blended from different nations. I tend to limit the number of Filipino nurses I hire (not being prejudicial) because of what was said that started this thread.

grievance or complaint form - usually we think this form is only for residents, but this system is for everyone. this will start the ball rolling. you can also place a complaint with your HR department, so that information is on record. if you have a compliance department, i would suggest to start calling and you can either provide an anonymous report or not. every nursing home is required to have a compliance department. i would also suggest that you recommend having a psychologist see the resident to see what kind of fixation he/she has. if there are no prior records of what has been done with previous employees, it will be tough to prove your case later as your best defense is the record of what have happened in the past and chronology of the incidences. suggesting a meeting with the family, with resident present and getting the threat on the record will be helpful to you. consider this as a form of abuse (threatening verbal abuse) and remember, abuse goes both ways and must be investigated. it can also be from resident to staff. goodluck!

i would start a log of your whereabouts when you are out on the floor. avoid interactions with this resident without anyone present. request that your DON have a meeting with family to indicate what was said. BTW, you can also file a grievance/complaint. remember that process goes both ways, not just for residents and if there is one, management has to get back to you with a resolution. goodluck!

please google national patient safety and also enter Morse scale... you should be able to get the website that includes the protocols that goes with it and the assessment also includes intrinsic and extrinsic factors which is answers the information on the CAA part of the MDS. goodluck!

CA - Difference between North and South is 20% (that is due to cost of living)... just want to correct prior post - highest paid in CA - SF, although it can be insanely high in Sacramento area or Reno, only because of the shortage in that area. SF (not looking at Sacramento) is followed by San Jose, Monterey, and the rest of Northern Cal counties are almost the same. As far as Southern Cal - Orange County, LA, San Diego and the Valley areas are the same, followed by the Inland Empire Area (Riverside, San Bernardino, etc). BTW, NA makes 120k-150K, NPs makes 85K to 120K (depending on experience), expert witness $120- 150/hr for reviews and court appearances at $250/hr. DONs for LTC makes 80-150K depending on the size and number of beds, while CNOs starts at 120K. Nurse consultants starts at 100K with bonus packages depending on the company plus expenses and mileage. Highest paid are nurses in CA and Hawaii because of the high cost of living. (I work for a company that have hospitals and NH nationwide and have seen budgets for different states). Credentials: NP, LNC-CSp, MSN - I work as nurse consultant and have contracts in the entire state. If you want more information as to specifics on salary ranges, please send me a message.

that depends on which State you are in. In CA, F does not triggered a re-survey. only when you have a substandard care (G) triggers re-survey. if you would like to see the guidelines on re-survey, cms just release in october the new survey guidelines... i found it easy to look at the regulatory updates at milvalihealthcare.com if you want to download the guidelines.

What are things or processes or procedures, you would like to see offered, started to make your daily work easier as the MDS Coordinator?

Your software company is correct. If you look at Appendix H on the RAI Manual for NQ (nursing quarterly), Section F is not included. Only Section S and the RUG scoring (which is in Section Z) are "State" specific.

There is no board approval here in CA also, but inorder for the training to be called a certification training, the Board of Nursing has to approve the class as a certification class versus a regular CEU class. I attended the AANAC training and was not very pleased since the CMS training in Blatimore closed and the August training was not projected then. I thought it was a money making deal. The training cost, at least $3000 for 3 attendees, not including expenses. In the end, I had to review the 3.0 MDS on my own to provide classes on it. Not really impress with the trainers since I worked with some of them in the industry. One trainer, was the consultant for a Rehab company I work with. That Rehab company had so many violations and very minimal understanding of the reimbursement. Really, I dont know how they screen their educators! You would think, that Rehab company should be up and up with what's going on and up-to-date since their consultant is AANAC certified and I found that to be the opposite. They dont even know how to code short stay and was arguing about payment!

I am wondering why you asked? In CA, to get a course certified, it will have to be approved by the Board of Nursing. It is the same application as CEU provider except with a twist.

Your BIMS score was lower than 5 to trigger ADLs. Although you may need to care plan the ADL need, it does not trigger on the new MDS 3.0 unless your BIMS is at least 5. I quoted below Chap. 4 from RAI. Hope that helps. Goodluck! The new CAT logic does not trigger ADLs if the following were not met: 1. Cognitive skills for daily decision making has a value of 0 through 2 or BIMS summary score is 5 or greater, while ADL assistance for bed mobility was needed as indicated by: (G0110A1 >= 1 AND G0110A1 ( (C1000 >= 0 AND C1000 (C0500 >= 5 AND C0500 2. Cognitive skills for daily decision making has a value of 0 through 2 or BIMS summary score is 5 or greater, while ADL assistance for transfer between surfaces (excluding to/from bath/toilets) was needed as indicated by: (G0110B1 >= 1 AND G0110B1 ( (C1000 >= 0 AND C1000 (C0500 >= 5 AND C0500 3.Cognitive skills for daily decision making has a value of 0 through 2 or BIMS summary score is 5 or greater, while ADL assistance for walking in his/her room was needed as indicated by: (G0110C1 >= 1 AND G0110C1 ( (C1000 >= 0 AND C1000 C0500 >= 5 AND C0500 4. Cognitive skills for daily decision making has a value of 0 through 2 or BIMS summary score is 5 or greater, while ADL assistance for walking in corridor was needed as indicated by: (G0110D1 >= 1 AND G0110D1 ( (C1000 >= 0 AND C1000 (C0500 >= 5 AND C0500 5. Cognitive skills for daily decision making has a value of 0 through 2 or BIMS summary score is 5 or greater, while ADL assistance for locomotion on unit (including with wheel chair, if applicable) was needed as indicated by: (G0110E1 >= 1 AND G0110E1 ( (C1000 >= 0 AND C1000 (C0500 >= 5 AND C0500 6. Cognitive skills for daily decision making has a value of 0 through 2 or BIMS summary score is 5 or greater, while ADL assistance for locomotion off unit (including with wheel chair, if applicable) was needed as indicated by: (G0110F1 >= 1 AND G0110F1 ( (C1000 >= 0 AND C1000 (C0500 >= 5 AND C0500 7. Cognitive skills for daily decision making has a value of 0 through 2 or BIMS summary score is 5 or greater, while ADL assistance for dressing was needed as indicated by: (G0110G1 >= 1 AND G0110G1 ( (C1000 >= 0 AND C1000 (C0500 >= 5 AND C0500 8. Cognitive skills for daily decision making has a value of 0 through 2 or BIMS summary score is 5 or greater, while ADL assistance for eating was needed as indicated by: (G0110H1 >= 1 AND G0110H1 ( (C1000 >= 0 AND C1000 (C0500 >= 5 AND C0500 9. Cognitive skills for daily decision making has a value of 0 through 2 or BIMS summary score is 5 or greater, while ADL assistance for toilet use was needed as indicated by: (G0110I1 >= 1 AND G0110I1 ( (C1000 >= 0 AND C1000 (C0500 >= 5 AND C0500 10. Cognitive skills for daily decision making has a value of 0 through 2 or BIMS summary as indicated by: (G0110J1 >= 1 AND G0110J1 ( (C1000 >= 0 AND C1000 (C0500 >= 5 AND C0500 11. Cognitive skills for daily decision making has a value of 0 through 2 or BIMS summary score is 5 or greater, while ADL assistance for self-performance bathing (excluding washing of back and hair) has a value of 1 through 4 as indicated by: (G0120A>= 1 AND G0120A ( (C1000 >= 0 AND C1000 (C0500 >= 5 AND C0500 12. Cognitive skills for daily decision making has a value of 0 through 2 or BIMS summary score is 5 or greater, while balance during transition has a value of 1 or 2 for any item as indicated by: ( (G0300A = 1 OR G0300A = 2) OR (G0300B = 1 OR G0300B = 2) OR (G0300C = 1 OR G0300C = 2) OR (G0300D = 1 OR G0300D = 2) OR (G0300E = 1 OR G0300E = 2) ) AND ( (C1000 >= 0 AND C1000 (C0500 >= 5 AND C0500 13. Cognitive skills for daily decision making has a value of 0 through 2 or BIMS summary score is 5 or greater, while resident believes he/she is capable of increased independence as indicated by: G0900A = 1 AND ( (C1000 >= 0 AND C1000 (C0500 >= 5 AND C0500 14. Cognitive skills for daily decision making has a value of 0 through 2 or BIMS summary score is 5 or greater, while direct care staff believe resident is capable of increased independence as indicated by: G0900B = 1 AND ((C1000 >= 0 AND C1000 (C0500 >= 5 AND C0500

i worked with several software and each one received several patches already. one software has not been able to resolve the issue of CAT logic up to this point and I was told it will take a while.

readmission/return is a PPS assessment and has the same ARD and grace period rule. and yes, PPS assessment can be combine - the rule is any unsceduled PPS assessment can be combined wuth scheduled PPS assessment as long as the ARD falls within the same timeframe.

i think that is vendor specific... the lastest updated from CMS was released 10/28/10.

That's too bad that your corporate office makes you do the 4-6 pages of CAAs. CMS does not endorse the CAAs but merely uses it as a recommended format, if your company is not using evidence based assessment. There are a lot of talks on when to use or not use the CAAs. I have been in CMS training and they specifically do not mandate the use of the CAAs as long as "this is specified in your policy" and that "your assessments are evidence, expert tested assessments". This is also indicated on Chapter 4 of RAI manaual. Request your company to send you the policy on CAA documentation, if it is not specified, I would not worry about it. Indicate the location of your information on Section V and do a narrative. However, I will caution you on not using the CAAs forms, if your company has not adapted the use of evidence based assessment and practice. CAAs requires clinical cirtical thinking analysis to draw the conclusion from it aside from having to check the forms. I have updated all our company policies, including the RAI and CAAs to eliminate the use of the CAAs forms but updated all our company assessments to evidence based practice and clinically tested forms. Having to do this eliminated having all my MDS coordinators in answering the CAAs forms. My policies have been tested on surveys prior to MDS 3.0 implementation and my bldgs had the most of 5 total deficiencies no more than "D" with either 1 or 2 nursing service deficiencies! I feel your pain... Goodluck!

I have taught MDS training from basics and seen that it can be done by someone that had to learn it from scratch. You will need tremendous patience and great organizational skills to do MDS when your beginning and lots of cheat sheets!

first question: yes... do entry tracking for resident that was out less than 23 hours, granted resident was out at 12 midnight (midnight rules applies). then 'readmission/return assessment' next question: john doe, who is out before the 30 days is up - if skilled and with change of condition - do entry tracking, next combined readmission/return assessment with change of condition assessment, then follow 14 PPS, 30 days, etc depending on how many medicare days are left. there is a financial trick to the next question: the reason why you will do sig. change of condition with 5day PPS and/or readmission/ return assessment is to be able to use the grace days, especially if the resident is receiving rehab. If you combine sig change of condition with 14 days PPS - you cannot use grace days for the 14th day PPS as the sig change will need to be completed on day 14 versus when it is not combine (a 14 day PPS if not combined with OBRA admission and/or sig change - can use grace days to increase reimbursement).

Here's my response: 1. You will have to do an "entry" assessment. This is required for every admission and re-admission. The entry tracking cannot be combine with any assessments. If your resident has no change of condition, you can continue the same schedule you have prior to discharge. Otherwise, you will have to do a significant change of condition. Admission assessment can only be completed once in the resident's stay, and since you have discharge the resident with return anticipated, you will need to do a significant change of acondition if there was a change. However, if there were no significant change, you can continue the next "due assessment" prior to the resident's discharge. 2. You'll have to do an entry tracking. Then complete "Readmission/Return assessment. This type of assessment tells CMS that the resident came back to your facility after 3 days and re-start counting the Medicare days, the resident is eligible for this admission. The grace period for this assessment is the same as your 5-day PPS. If your resident is covered under Medicare for clinical services only and then started on therapy, you can combine this two types of assessment (as long as the ARD falls within the same time period). The next assessment will be 14-day PPS assessment. If the resident had a change of condition on re-admission, you may want to combine this assessment with the Readmission/Return assessment. 3.Yes, an entry tracking will need to be submitted for any admissions and re-admissions. This tracking as well as death in the facility tracking cannot be combine with any other assessment. 4.Yes, see my response on number 2. 5.If you are talking about A2400 - this asks for the Medicare dates of service. Goodluck!

I have worked with several different software and was also instrumental in setting a new system from scratch. I have seen this problem when a software does not carry over the information from a prior MDS. I have not seen a software that completely transfers any information from 2.0 to 3.0. However, I have worked with one software that translate only a few information from 2.0 to 3.0 (depending whether the section question did not change). I had to call the software company and requested the information for all the different companies and/or software to add and/or "turn on" this feature. I recommend that you call your software provider and request if there is such a feature that will allow you to "copy information from latest assessment". The companies that I had to request this feature did not pay extra for this. You can also ask and download information on milvalihealthcare.com and get responses right away. Goodluck!

I agree on the AANAC training. I attended the training in Las Vegas from AANAC, and 2 others from our company and felt that it did not meet its goal. I spoke with other nurses who went to the same training, and was told they had to attend and pay for other training. Another nurse said it was a waste of money and it only confused her!

Answer to rukiddingme: Here's the answer to A2400: This section is used to: 1) Identify when a resident is receiving services under the SNF PPS. 2) Identify when a resident’s Medicare Part A stay begins and ends. 3) The end date is used to determine if the resident’s stay qualifies for the short stay assessment. Answer "NO" and then skip to Section B if you are doing an OBRA assessment. Answer "YES" if you are doing a PPS assessment or if the assessment is combined with any type of PPS assessment. Enter the dates of: Start Date is Day 1 of Medicare coverage for which you are completing the PPS assessment for that admission and End date is the last covered date, enter dashes if resident is still receiving Medicare services. If you have other MDS questions, post your questions on: Guestbook

Originally Posted by afolmsbee What, if anything, are facilities using to help capture and document pain and behaviors??? Anyone willing to share? Thanks! As a consultant, I do not expect my MDS coordinators to do interviews for pain separate of the MDS as this should be part of the daily care. To avoid having to repeat this, your facility will need to develop an evidence based practice for pain management. Please visit Guestbook to request for a copy of pain assessment form that will address Section J interview and Section D.