question when doing my assessment

[guereb07]

I am a restorative nurse and although I know LTC resident eventually go downhill due to age related changes, diagnosis' and so forth, I feel like I have been informing MDS about a lot of significant changes for MDS. I monitor for 14 days to see if the changes are permanent or transient due to UTIs or any type of infection..Well I have this resident who has been slowing needing more assistance as every assessment comes along. She was using a rollator and now is in a wheelchair for safety measures therapy has recommended for her to walk to dine and also participate with walking on unit to maintain functional ambulation..She also has been getting co dependent with staff and due to shortage of staff, staff does not encourage for resident to do as much independently. So my question is would she be considered a significant changes because of needing a little more assistance???

[TheCommuter, BSN, RN]

Yes, these changes would be significant for the purposes of MDS assessment and overall Medicare / Medicaid reimbursement.

It is well known that a resident who is wheelchair-bound and requires total assistance with some ADLS will generate a much higher reimbursement rate from Medicare and/or Medicaid than someone who walks with a rollator and completes most ADLS with general staff supervision.

[guereb07]

Thanks! I just looked and I did already do a significant change. But when there is a decline noted we have to monitor for 14 days before scheduling a sig change is that correct?

[CapeCodMermaid, RN]

Yes. You must monitor for the 14 days. She might improve if it is a UTI. You need to have a decline in 2 or more areas in order for it to be considered a sig change. Pity the woman is becoming more dependent because of staffing issues. Have you tried OT or PT?