For years, I have joked that I teach things for the Utopian World — the world as it should be — with the knowledge they won’t always happen that way. But, as of late, I am struggling with statements I hear from my fellow post-acute care providers. We need to take a step (or five) back and reconsider how to incorporate the Resident Assessment Instrument into our daily routines.
If you are at all familiar with the RAI process, you know we now use a tool developed for the plan of care to drive survey, reimbursement, quality measures and outcomes. This is an actual quote from the manual: “The RAI helps nursing home staff look at residents holistically — as individuals for whom quality of life and quality of care are mutually significant and necessary.”
We are responsible for completing this comprehensive assessment to identify significant issues that impact the plan of care and reflect the acuity of the elders we care for. None of us can afford to have an inaccurate assessment, especially with Patient-Driven Payment Model, where so many conditions impact our reimbursement.
That said, I have heard nurses responsible for completion of the MDS Assessment say, “I don’t have time to go see every patient.” How can you assess them if you don’t go see them? The RAI manual has some very specific examples of how to assess areas such as GG function (observation and interviews of resident, direct care staff and therapy), interview sections (such as the BIMS, PHQ9, Preferences and Pain), functional range of motion and more. Every one of these assessment instructions involves seeing and touching the resident to complete the assessment.
Direct care nurses have never seen the RAI manual, so I know they don’t complete a pain interview as it says. They certainly don’t understand a functional assessment for Section GG. We are experiencing a catastrophic staffing crisis. Why would we even ask the direct care nurses to do anything more than take care of their residents? Yet, knowing we are challenged in current staff and charting, we have companies making a new form that assigns direct care staff the responsibility of gathering that GG information.
Let’s take a minute and ponder why we just decreased the frequency of assessments with the implementation of PDPM. It’s about QUALITY. While CMS gives us some guidelines we question, the one big theme today is QUALITY. Let’s look at the time we may be saving in some small areas and redistribute our resources to good quality assessments.
A nurse who goes to the bedside frequently in a seven-day assessment window to interact with the elder, ask about pain, complete GG assessments, integrate the resident voice into the plan of care and help drive the clinical outcomes? That’s a pretty awesome plan! Kudos to the clinicians guiding the revisions for trying to put a better clinical focus on what we are doing.
Take a minute to look at your MDS coordinators. Do you give them the tools and resources to complete these assessments accurately and thoroughly and document them on the MDS in the required time frame? Do you make it an expectation to see them on the patient care units a good portion of the day?
I think if we all truly embrace PDPM for what it is — a quality-driven payment system focusing on clinical acuity — and we incorporate the instructions for assessment, planning implementation and evaluation into our daily process with a focused clinical assessment coordinator, we are truly going to win. Good financials, good outcomes, awesome clinical care plans and clinical care: That all translates into a Utopian outcome, doesn’t it?
Rosanna L Benbow, RN, CCM, CIC, DNS-CT, RAC-CT is the owner and lead MDS consultant for Leading Transitions Post Acute Care Consultation and Staffing, LLC. Leading Transitions provides MDS consulting and Interim MDS services. Rosie has over 22 years’ experience in post-acute care in roles such as MDS coordinator, director of clinical reimbursement, director of nursing services and MDS consultant.