More MDS 3.0 Section F Questions and Answers for Activity Professionals
Question: We have a resident that is confused but she was able to answer the interview questions.
Now I am having a conflict with Social Services.
She said we shouldn't interview when the resident is confused.
Do you have advice or the right answer for me? Should we interview residents with confusion? I believe why not try.
They still may be able to answer questions about their likes and dislikes.
Any advice would help.
Answer: In terms of residents with cognitive impairment, the answer lies with the coding of B0700 (Makes Self Understood).
If the resident codes a 0 (understood),1 (usually understood) or 2 (sometimes understood), then you conduct the interview.
If the resident codes a 3 (rarely/never understood), then you do not interview the resident.
Your next step is to attempt to interview the family or significant other.
Question: Is Section F on the Quarterly? Answer: Typically, section F is not on the Quarterly, however be sure to check with your facility and state regulators.
Your state may have different rules.
For example, I was recently informed that in the state of South Dakota they are required to complete the full item set for quarterly assessments.
The CAA's, care planning, etc.
are not done, but the full item set is completed.
So be sure to check your state regulations! Question: Since we no longer have to do a quarterly MDS for activities, do you think we should still be doing a quarterly assessment on each resident or does a quarterly progress note suffice? Answer: I would think a quarterly note would be OK-you'd identify if there were any changes in the note.
Question: Section F interviews only need to be completed initially, annual and significant changes? This is what I am being told.
Since the RAI manual is so big can you maybe direct me to the page number or chapter as to where it says this? Answer: It doesn't say in the RAI manual that section F is only provided with the comprehensive assessment: admission, annual, significant change and significant change of prior correction.
Believe me, it was the first thing I tried to find.
It does say what a comprehensive assessment is and when that is offered (as indicated by the 4 times I just noted).
I believe that is written in the assessment chapter of the RAI.
Since section F is only shown to be on the comprehensive assessment and not on quarterlies, PPS's and such, then this is a logical assumption.
Although, I, like you, would like to see it officially written in the RAI manual.
Question: Is there a place where we can direct questions directly to CMS to answer? Answer: Questions regarding the "MDS 3.
0 RAI Manual" should be directed to MDS30Comments@cms.
hhs.
gov.
Please note that CMS will not be providing an individualized response to each inquiry; however, CMS will make sure the issues or comments are addressed in the MDS 3.
0 training sessions or on their website.
Question: In the section F interview, what do I do with the blank boxes if the resident codes three "9"s and I skip to do the Staff Assessment? Do I leave the unasked questions blank? Answer: No-you code a dash (-) in the unasked questions, otherwise it looks like you just didn't complete the section.
Question: I know what triggers the CAA, but I don't know how to fill in the notes or how to fill in the explanation, it's all very confusing for me.
Answer: Did you do the RAP's for the 2.
0? If so, then the process is the same.
Is your facility using the CAA Resources? If so, simply use the 4 page CAA Resources for activities and check off the areas that apply to the resident.
Use that information gathered to write a narrative at the end of the CAA Resources describing why the resident triggered (or potential reasons).
If you are not using the actual CAA resources checklists that CMS provided, then use the CAA resources information to write your CAA summary.
I love the CAA Resources checklist because it really makes you look at many possible reasons why the resident triggers for activities.
Is it a health reason such as pneumonia? Is it because the resident is a short term stay and has no interest in activities? Is it a cognitive deficit, and so on.
The point is to work through the CAA resources (or whatever additional assessment tool you have decided to use), to find out potential causes and reasons why the resident triggered.
Residents typically trigger in activities because of some other reason-the underlying cause (mood, behavior, cognition, lack of resources, shyness, lack of interest, health reasons and diagnosis, need for leisure education, medications, pain, availability, etc.
Use the CAA resources to help determine that underlying cause.
Try it on one resident, checking off each box in the left side of the CAA resource check list.
In the right column write how you know that information.
Was it in the medical record, or perhaps you observed it or a family or resident told you.
It's a very helpful tool.
It will also help you determine if you going to care plan or not.
Question: Dear CMS, There has been much controversy and confusion over the "little pleasure or interest in doing things", found in section D0500 (A) and D0200 (A).
The concern is with the word "things".
This question is triggering activities quite often and there is major concern as to what the intent of the question is.
If the term "things" does indeed refer to activities (recreational), then the question should be asked in such that manner.
The resident should be made aware that the question refers to activities.
I am assuming that things is referring to activities because of the relation to the answer has to triggering activities.
On behalf of the Activity profession, I am asking you to please clarify the meaning of the term "things"? Thank you for your consideration.
Kim Grandal, CTRS, ACC/EDU Answer from CMS: Specific "things" are defined by the resident.
They might be activities such as visiting others, drawing, reading, dancing, conversing with others, maybe the resident used to braid her grand-daughter's hair when she visited and now she doesn't want to, etc.
It may also refer to wanting to do "things" alone...
so not necessarily activities with others.
The question on the PHQ-9 cannot be rewritten to include the word "activities" as the PHQ-9 is validated and tested tool as it is currently displayed on the MDS 3.
0.
Now I am having a conflict with Social Services.
She said we shouldn't interview when the resident is confused.
Do you have advice or the right answer for me? Should we interview residents with confusion? I believe why not try.
They still may be able to answer questions about their likes and dislikes.
Any advice would help.
Answer: In terms of residents with cognitive impairment, the answer lies with the coding of B0700 (Makes Self Understood).
If the resident codes a 0 (understood),1 (usually understood) or 2 (sometimes understood), then you conduct the interview.
If the resident codes a 3 (rarely/never understood), then you do not interview the resident.
Your next step is to attempt to interview the family or significant other.
Question: Is Section F on the Quarterly? Answer: Typically, section F is not on the Quarterly, however be sure to check with your facility and state regulators.
Your state may have different rules.
For example, I was recently informed that in the state of South Dakota they are required to complete the full item set for quarterly assessments.
The CAA's, care planning, etc.
are not done, but the full item set is completed.
So be sure to check your state regulations! Question: Since we no longer have to do a quarterly MDS for activities, do you think we should still be doing a quarterly assessment on each resident or does a quarterly progress note suffice? Answer: I would think a quarterly note would be OK-you'd identify if there were any changes in the note.
Question: Section F interviews only need to be completed initially, annual and significant changes? This is what I am being told.
Since the RAI manual is so big can you maybe direct me to the page number or chapter as to where it says this? Answer: It doesn't say in the RAI manual that section F is only provided with the comprehensive assessment: admission, annual, significant change and significant change of prior correction.
Believe me, it was the first thing I tried to find.
It does say what a comprehensive assessment is and when that is offered (as indicated by the 4 times I just noted).
I believe that is written in the assessment chapter of the RAI.
Since section F is only shown to be on the comprehensive assessment and not on quarterlies, PPS's and such, then this is a logical assumption.
Although, I, like you, would like to see it officially written in the RAI manual.
Question: Is there a place where we can direct questions directly to CMS to answer? Answer: Questions regarding the "MDS 3.
0 RAI Manual" should be directed to MDS30Comments@cms.
hhs.
gov.
Please note that CMS will not be providing an individualized response to each inquiry; however, CMS will make sure the issues or comments are addressed in the MDS 3.
0 training sessions or on their website.
Question: In the section F interview, what do I do with the blank boxes if the resident codes three "9"s and I skip to do the Staff Assessment? Do I leave the unasked questions blank? Answer: No-you code a dash (-) in the unasked questions, otherwise it looks like you just didn't complete the section.
Question: I know what triggers the CAA, but I don't know how to fill in the notes or how to fill in the explanation, it's all very confusing for me.
Answer: Did you do the RAP's for the 2.
0? If so, then the process is the same.
Is your facility using the CAA Resources? If so, simply use the 4 page CAA Resources for activities and check off the areas that apply to the resident.
Use that information gathered to write a narrative at the end of the CAA Resources describing why the resident triggered (or potential reasons).
If you are not using the actual CAA resources checklists that CMS provided, then use the CAA resources information to write your CAA summary.
I love the CAA Resources checklist because it really makes you look at many possible reasons why the resident triggers for activities.
Is it a health reason such as pneumonia? Is it because the resident is a short term stay and has no interest in activities? Is it a cognitive deficit, and so on.
The point is to work through the CAA resources (or whatever additional assessment tool you have decided to use), to find out potential causes and reasons why the resident triggered.
Residents typically trigger in activities because of some other reason-the underlying cause (mood, behavior, cognition, lack of resources, shyness, lack of interest, health reasons and diagnosis, need for leisure education, medications, pain, availability, etc.
Use the CAA resources to help determine that underlying cause.
Try it on one resident, checking off each box in the left side of the CAA resource check list.
In the right column write how you know that information.
Was it in the medical record, or perhaps you observed it or a family or resident told you.
It's a very helpful tool.
It will also help you determine if you going to care plan or not.
Question: Dear CMS, There has been much controversy and confusion over the "little pleasure or interest in doing things", found in section D0500 (A) and D0200 (A).
The concern is with the word "things".
This question is triggering activities quite often and there is major concern as to what the intent of the question is.
If the term "things" does indeed refer to activities (recreational), then the question should be asked in such that manner.
The resident should be made aware that the question refers to activities.
I am assuming that things is referring to activities because of the relation to the answer has to triggering activities.
On behalf of the Activity profession, I am asking you to please clarify the meaning of the term "things"? Thank you for your consideration.
Kim Grandal, CTRS, ACC/EDU Answer from CMS: Specific "things" are defined by the resident.
They might be activities such as visiting others, drawing, reading, dancing, conversing with others, maybe the resident used to braid her grand-daughter's hair when she visited and now she doesn't want to, etc.
It may also refer to wanting to do "things" alone...
so not necessarily activities with others.
The question on the PHQ-9 cannot be rewritten to include the word "activities" as the PHQ-9 is validated and tested tool as it is currently displayed on the MDS 3.
0.
