MDS 3.0 Challenges

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Teri Weiman, SSD-AD
Teri Weiman, SSD-AD

Our Minimum Data Set (MDS) coordinator gave me warning that the social services section was going to be increased “exponentially” with MDS 3.0. Throughout 2010, I read everything I could get my hands on and was able to attend a seminar prior to initiating 3.0.

We were pleased when our SNF was picked as a beta test site.  Our interdisciplinary team completed both MDS 2.0 and 3.0 simultaneously. We felt that this was a “plus” because it allowed us the opportunity to become familiar with the new, extensive federal form.

The scripted questions quickly assess a resident's mental status and gives her a chance to have a voice in her activity and care preferences. Gradually, the questions have become easier to ask and I am getting a rhythm to my assessments and summaries.  

By the way, please share with me … am I the only one who still cringes when we get to section D0200? AKA the Resident Mood Interview? 

When I ask, “Do you have little interest or pleasure in doing things?” the initial confusion sets in. That's because what I'm aiming to ask, and really ought to say is, “Are you content? Do you find pleasure here?”

Some of my residents appear to enjoy the opportunity of being interviewed and number their answers from 0 (never) to 3 (nearly every day) as they hold the cue cards in their hands. Others answer “no” to every question because it appears to be the safe answer for them.

“Feeling down, depressed or hopeless?” “Feeling tired or having little energy?” (Who doesn't?) Then, the serious questions need to be asked: “Have you been feeling bad about yourself? “Or that you are a failure?” “Do you feel that you have let yourself or your family down? (Hmmmm, I think, who does not have a single regret about their life?)

“Have you been moving or speaking so slowly that other people could have noticed?”  One alert resident retorted (appropriately), “How do I know what other people notice?” and continued, “I don't care what other people notice.” I took that as a “no.” 

I find myself struggling with the final questions: “Do you have thoughts that you would be better off dead?” and “Do you think about hurting yourself?” Taking into account the health, dependency and age of our population, are those compassionate questions?

One does not have to be suicidal or depressed to realize that the promise of heaven is better than what we weather here on Earth. Most of them believe that the best of their lives are finished and their families are moving on well without them. 

This question has been met numerous times by shock, hung jaws, and tears. One resident was visibly disturbed by this mandated question and abruptly ceased the interview. She went to her room, saw her bed was in the middle of being changed and called her daughter to report, “They want me dead here.” After which, the agitated daughter immediately called me for clarification. Following lengthy explanation, the daughter requested that her mother never be asked that question again. I have complied. 

I have learned that any or all of the questions can be avoided upon family requested.  Remember to document any such request.  

There can be some levity to the MDS 3.0. I once asked a hard of hearing resident to repeat three words after me: “Sock, blue, bed.” She made a scrunched face at me and said, “Sock me dead? What does that mean?”

I couldn't help but giggle and give her a hug. 

Teri Weiman, SSD-AD, is a social services designee and activity directory in a central California skilled nursing facility. She oversees 80+ volunteers, supervises 11 activity aides and has two amazing assistants. She has learned that all long-term care residents have valuable attributes and can teach a lot about life ... which she will share here. An early riser and eternal optimist, she lives by the saying Carpe Diem.

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