Nursing homes that receive Medicare or Medicaid are required to perform a comprehensive assessment of new residents and then to perform routine or follow up assessments at set times. These assessments are referred to as Minimum Data Set (MDS) reviews. The Centers for Medicare and Medicaid describe an MDS in this fashion:

The MDS is a powerful tool for implementing standardized assessment and for facilitating care management in nursing homes (NHs) and non-critical access hospital swing beds (SBs). Its content has implications for residents, families, providers, researchers, and policymakers ….

A number of different people from varying disciplines may be involved in MDS reviews. These individuals can include staff members from the administration, nursing, therapy (physical, occupational and speech), nutrition, psycho-social, physiatry, respiratory, and other departments, depending upon the reason, length, and purpose of an admission to the nursing home. Most nursing homes will designate an MDS coordinator, and that person is most often a registered nurse. The MDS coordinator is responsible for ensuring that the necessary evaluation is done on each resident and that follow-up evaluations are properly and timely performed.

An MDS covers a variety of areas of potential concern, including: cognitive patterns; communication and hearing patterns; vision patterns; physical functioning and structural problems; continence levels; psychosocial well-being; activity pursuit patterns; disease diagnoses; other health conditions; oral/nutritional status; oral/dental status; skin condition; medication use; and treatments and procedures.

Among these designated items, the staff should evaluate things such as the medications received and their potential effects on the patient, fall risks, mood and depression levels, and family dynamics and support. From this information, nursing homes will utilize the MDS evaluations to form care plans and to set forth a plan to treat and monitor a patient/resident’s well-being and course of care and treatment while at the nursing home.

The MDS reviews occur at least quarterly and are a tool used by the nursing homes to ensure that a patient’s status has not materially changed or that additional needs are not required for proper care and treatment. This information is compiled in a national database and is relied upon to determine the levels of care needed by residents and patients in nursing homes. It is also used for other purposes, such as to monitor the rate of bedsore developments or other complications among nursing homes. The MDS review is a compiled form.

The MDS coordinator, and those on the MDS review team, must follow the form and complete the applicable sections. Most of the sections do not call for narratives but literally marking the blanks or spaces that apply, compiling scores, and recording the information. Each person involved in the MDS review is required to sign and print their name to the form indicating which section of the report they addressed. Over time, the MDS review process has evolved somewhat. The prior form was MDS 2.0; the current form used is MDS 3.0. The primary difference between the two is that the resident is now more involved in the process.

From a practical standpoint, the amount of Medicare or Medicaid benefits a nursing home may receive is dependent upon the MDS outcome, scores and codes that are assigned to the patient. This is referred to as the “daily rate,” which is based upon the coding and the “amount of resources used by residents.” In other words, the more needs the resident has, the more the daily rate should be.

For example, if a resident was admitted for physical strengthening, the resident will certainly need physical therapy. If the resident is having difficult eating, getting in and out of bed, gathering her thoughts, etc., then she may also need speech therapy (which performs choke/swallow assessments), occupational therapies (for assistance with activities of daily living, or ADLs), additional nutritional support (for diet modification and nutrition), psychosocial assessments (such as a social worker following up to ensure the patient’s needs are being adequately met and that those needs are being relayed to the nursing staff), or others. As you might guess, the more needs of the resident, the greater the daily rate, which means that the nursing home is paid more for that resident’s care.

The lawyers in our firm have found the MDS forms to be important in the litigation process. That’s because they identify certain key persons involved in the care of a patient; establish important matters such as cognitive abilities of the resident; determine the course of treatment and any meaningful change in treatment over time; and indicate whether the MDS review is consistent with reports by nursing and other medical staff.

By the nature of the MDS – that it is government-mandated and created – one would believe that the nursing home staff would strive to adequately report patient/resident conditions, changes in conditions, and issues that arise. If the facility is accurately reporting this information, CMS and State Health Departments should be better able to identify problem areas in different facilities by comparing problem rates between the facilities. Unfortunately, the facilities don’t always report adequately.

For example, a facility that is over-reporting medication problems should be investigated to determine if the facility is giving its residents too much medications or the medications are too strong. If you need more information, contact Ben Locklar, a lawyer who handles Nursing Home Litigation for our firm, at 800-898-2034 or by email at Ben.Locklar@beasleyallen.com.

Sources: www.CMS.gov and http://assistedliving.about.com/od/nursinghomes/a/Mds-3-0-What-You-Need-To-Know.htm

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