While the minimum data set (MDS) 3.0 mandate requirements were clear—new policies, new procedures, and new paperwork for all nursing facilities—the ultimate benefits could only be implied: positive organizational culture change and improved resident care planning.
Specifically, the goal of MDS 3.0 is to introduce advances in assessment measures, increase relevance of items, improve accuracy of the tool, and include the resident’s voice through new interviews. To meet this goal, every department in a nursing facility now faces multiple challenges and responsibilities. The questions remain: How are facilities meeting these challenges since the mandate went into effect Oct. 1, 2010? How do providers assess their progress to date? And what are their concerns and expectations going forward?
Managing The Mandate
Elizabeth Beeson is MDS coordinator for Foss Home and Village, a 24-hour skilled nursing, long term, and dementia care facility with 211 beds in Seattle. In her view, the resident interviews have been the “best part of the whole MDS 3.0 process,” thanks to some training and preparation. “We had expert help in developing an effective transition plan and comprehensive on-site training,” she says.
To conduct resident interviews and gather the increased amount of information required with MDS 3.0, the facility takes an interdisciplinary approach, according to Beeson. Social workers do mood assessments, activities workers do customary routines, and nursing staff do cognition and pain assessments.
In fact, MDS 3.0 not only requires more interaction with residents, but also more interaction with other staff members to compile multiple assessments as determined by various schedules and resident status and condition, she says.
Care plans are also handled by different staff, depending on resident status. “For custodial care or long term care residents, the whole team is involved in interviews, and we’ll do the care plan on an annual basis,” Beeson says. “For our short-term clients or for quarterly assessments, the nurse will write the care plan.”
Nurses involved with short-term care—or the Medicare unit—are the most time-challenged. “We had what were called nurse managers, or resident care managers, that had numerous responsibilities, including staffing, oversight of their unit, admitting and discharging people, and dealing with families,” says Beeson. “Those nurses now are more focused on completing the MDS, so part of the work they were doing is now being passed down to medication nurses.”
There are no plans now to add staff, she adds. “We’re in the process, like many facilities, of downsizing rather than hiring, so the workflow just gets stretched further and further.”
Beeson is concerned about the overwhelming work load for staff—and the possible impact on assessment accuracy. “I see people talking about the fact that if you have a five-day Medicare assessment that’s done and a discharge three days later, we have to do two assessments only three days apart and collect the same information with a different end point. We basically have to redo the same assessment but look at everything differently,” she says. “And the expectation from the Centers for Medicare & Medicaid Services [CMS] is that you would again do the interview even though it’s three days later.”
New Benefits To Staff And Residents
As staff face new challenges, are they seeing new benefits? “Absolutely,” says Beeson. “They have verbalized to me that they see the benefit in the interaction they have with the residents. Everybody is hoping that there will be some changes down the road in some of the requirements to make it more realistic in getting the work completed. But the interview process, giving the residents voice, including them in decisions about their care, their preferences—everybody has been very optimistic about that.”
In fact, staff have been very surprised with how many residents can actively participate in the interviews and with their level of appreciation. “The bottom line is that it’s been a very positive thing,” Beeson says. “Giving residents voice is right in line with the whole concept of achieving culture change.”
Pamela Powell, director of nursing at Elness Convalescent, a 99-bed skilled nursing facility run by Mark One Corp., Central Valley, Calif., experienced a rocky start during the MDS 3.0 transition, with computer problems at the state level and the lack of return validation for data transmittals from the facility.
The staff transition is going much smoother, Powell admits. “It’s just been a change. I had to go in and change all our assessment forms for our different departments that do input on the MDS, and that made it easier for them.
“And I’ve added another [MDS] person to help out because [the original coordinator] is just overwhelmed,” says Powell. “The MDS takes longer right now, and we can’t run behind.”
From Our Care To ‘I Care’
Elness also takes an interdisciplinary approach to conducting resident interviews, which meets one goal of the MDS 3.0 transition: increasing resident voice. “Yes, it gets your resident much more involved in your care planning process. In our training, we learned about doing new ‘I Care’ plans as opposed to the care plans we’d normally done in the past,” says Powell.
“Now we can write it as if we were the resident talking, and it makes much more sense when you read it. It’s the resident’s goals, not our goals. We invite residents to the care plan meetings, so every time we do an MDS we also have a care plan meeting where the whole team gets together with the resident or the resident’s responsible party, or both, and we all sit down and talk about what’s gone on with the resident and what the care plan goals should be.”
Powell believes MDS 3.0 will help with state surveys as well. “You should be doing better on surveys in the future, because you will know your resident better than you have in the past,” she says. “And better surveys can help change your [CMS] Five-Star rating. That’s a good thing for your facility and your business.”
Powell speaks for many in the long term care industry when she says, “You have to be able to adapt to change.”
Though facilities are now coping with workflow and work load issues, internal and external computer issues, delays in the availability of quality indicators, and other challenges, some providers are seeing improved resident care planning and positive organizational culture change.
The biggest factor in determining if MDS 3.0 presents a success or crisis for the facility is the proper preparation of staff—and systems—through on- site training combined with effective, market-tested system solutions.
Click HERE for some preparation tips and information about how MDS 3.0 impacts each and every department within the nursing facility.
Ladd Nichols is vice president of marketing for Gulf South Medical Supply, a leading supplier of products and services for long term care, assisted living, and home care. Gulf South provides MDS 3.0 training programs in conjucnction with Pathway Health Services and PointClickCare.