Have you listened to the song, “Cats in the Cradle” by Harry Chapin? It’s a folk song written in the early 1970s. If you haven’t heard it, give it a listen. I think you’ll like it.

The phrase “Cat’s in the cradle” is often used to refer to situations in which one person has neglected another, or there is a total breakdown of communication. It’s the theme of this song.

I have been keenly aware of the risk of leaving the cat in the cradle as I have been preparing and providing training related to MDS 3.0 v1.18.11 — there is so much new to get used to. I’ve often expressed that this feels more like MDS 4.0. 

The final version of the RAI Manual was released by the Centers for Medicare & Medicaid Services just a few weeks ago. One area with significant revisions that seems to have been somewhat overlooked in all the hubbub is Chapter 4 and Appendix C of the RAI Manual. 

Have you taken a close look at the changes? Your interdisciplinary team should, before Oct. 1. Here are a few of the key revisions:

CATs

The following CAT Specifications include changes. 

  • CATs for CAA 5: ADL Functional/Rehabilitation Potential
  • CATs for CAA 6: Urinary Incontinence and Indwelling Catheter
  • CATs for 16: Pressure Ulcer/Injury
  • CATs for CAA 11: Falls

CATs for CAAs 5, 6 and 16 were revised to remove references to section G and add section GG 0130 and GG0170 items. The section G balance items were removed from the CATs for CAA 11. However, references to balance remain in CAA 5.

  • CATs for CAA 20: The triggering condition changed, not only from the current trigger, but from the DRAFT Manual. Now the trigger is, “Resident wants to or may want to talk to someone about returning to community as indicated by: Q0500B = 1 or 9”.

CAAs

There have been many revisions to the CAA Resources. Here are some prominent ones that will require IDT attention.

  • Section GG0130 and GG0170 have replaced section G items throughout the CAA resources. Special attention needs to be paid to the breadth of section GG evaluation vs section G.
  • Reference to the PHQ 2-9 now populates specific CAA resources. It will be important to consider the resident responses to MDS items D0150A and D0150B regardless of whether the remaining seven questions are considered.
  • Three distinctly new line items have been added, one to CAA1 Delirium (Terminal condition (J1400) and two to CAA 19 Pain (Venous or arterial ulcers (M1030) and Limits participation in rehabilitation therapy (J0520)). These will require the IDT to analyze concepts they have not encountered before in these CAAs.
  • In multiple CAAs, Item J1900, falls with major injury, has been added as an expanded approach to further analyzing the impact of falls.
  • Item J1400, Terminal Condition has been added to several CAAs as well to further consider the impact that end of life/hospice services has on the resident’ care plan needs.
  • While the term “social isolation” is peppered throughout the current CAA resources, with the implementation of v1.18.11, new MDS item D0700, Social Isolation, now shows up specifically in CAA7, Psychosocial wellbeing as it relates to loneliness. Considering this as a social determinant of health within the CAA resources will be a new concept for IDTs that will need to assimilate it into care planning.
  • Now that section K0520 and section O0110 items have additional columns and time frames to consider, teams will need to recognize how these additions potentially change their CAA analysis.
  • The pain interview has expanded into three specific instances when pain might interrupt things like sleep, therapy and day-to-day activities. This expansion has been added to several CAA resources and teams will need to consider the implications in analysis and care planning.

While this is not an exhaustive list, it is fodder for considering that while the number of CAAs has not grown, the new and revised MDS items have expanded the IDT’s responsibility to integrate these changes into the RAI process.

There should be a sense of urgency to get this right. The data that will be produced by a completed MDS 3.0 v1.18.11 will be different in many significant ways than an MDS completed prior to Oct. 1 with residual impact to care plan details. 

Adapting to these changes is no small task and will require attention to detail, not to mention staying alert to the fact that on the SNF/LTC Open Door Forum CMS admitted that there are two CATs (6 and 16) in error, and that a forthcoming errata document or some other type of correction is in the works. More to learn.

The chorus to “Cat’s in the Cradle” goes like this:

And the cat’s in the cradle and the silver spoon,

Little boy blue and the man in the moon.

“When you coming home, Dad?” “I don’t know when,”

But we’ll get together then

You know we’ll have a good time then.

This song makes me nostalgic, partly because it was written during the time of my childhood and hearing that style takes me back to fond memories. However, more powerfully, it reminds me of my own dad and how important time is now. He will be 90 this year.

I called him up just the other day. I wanted to hear his voice, see what he had to say. I plan to spend time with him later this fall. I wish it were today. 

Now is the time to get together around the new CATs and CAAs — not then. Don’t neglect these important changes. Begin now to talk about them and how your IDT will work them into your RAI process before Oct. 1.

Waiting could cause a total breakdown of communication. You won’t have a good time then.

Joel VanEaton, BSN, RN, RAC-CT, RAC-CTA, is a master teacher and the executive vice president of PAC Regulatory Affairs and Education at Broad River Rehabilitation.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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