Mauves08

Let me briefly explain my facility's set up before my question: The ADON does the preliminary assessment and does the footwork to get the resident into the facility. She is also suppose to do the Medicare MDS assessments as she is the one working closely with therapy and likes to follow the patients from the hospital through their rehabilitation stay. When I was hired for the MDS position, it was explained to me that my duties only consist of LTC assessments and the careplans. We're a 115 bed facility with an average of 12-15 Medicare residents. The ADON feels "overworked" by the assessments and managing her CNAs. Instead of time managing effectively, she has recruited another LPN (coincidentally, her best friend) to do her medicare MDS assessments for her, allowing this LPN to get overtime- much of it unnecessary. Also, this particular nurse has a horrible working relationship with the therapist- creating more division between departments and inability to effectively communicate. I have now been in my MDS "LTC/Careplans Only" position for almost two years. I have the time to complete these other assessments, I am always below my allotted hours per week, and I feel like I will have nothing to show for my experience as an MDS coordinator if I am not trained and well-educated on Medicare MDS coordination. I have approached my boss (DON) once regarding this and she informed me to stay out of it because the ADON and the other nurse have an agreement. At what point should I buck? If I was to go to another facility, I would have absolutely nothing to offer them as far as Medicare MDS coordination goes. Do other facilities have such a division between their Medicare MDS and LTC MDS coordination and planning? For me, especially if the person is planning on staying LTC, I want to be involved from the beginning. However, because I'm "LTC only" I'm not even notified of family meetings, therapy changes, etc. I've asked, with the response of "They're not LTC yet." Then, once they're transferred over to me, I'm back tracking through sometimes three months of work to figure out what the heck happened. Help?!

For Medicare patients, our therapy/social services department coordinates their meetings according so they have a family meeting during therapy (generally by the person's two week mark in our facility) as well as discharge planning meeting. For my long term care folks, I send out letters. I use to send out letters that had traditional time slots on our "careplan day" (it was Wednesday afternoons) and families had to arrange their schedules accordingly to attend. However, in our "culture change" attempt, I changed my letters and careplans to be more flexible with the families. Instead of time slots, I give them an entire week to choose when would be best for them & we work to make sure all staff members are present. This can be inconvenient at times, but we have had meetings before at 6pm with families that NEVER have attended before and we otherwise wouldn't get to hear from them! Since doing it this way, our family involvement has increased quite a bit.

I agree with SRK. Especially since the tube feedings are new, you should reflect that your staff is, at the very least, supervising these which includes the education as well. When our patients are at that point in their rehabilitation, I generally code it as 1/1. Hope this helps!