Wendy Strain

I’ve trained hundreds of MDS coordinators since CMS announced the Patient Driven Payment Model in 2018.

All of them have heard me say time and time again, “You aren’t a data entry clerk, you’re an assessment nurse. Get out of your chair, leave your office, and go assess.” 

For a long time, I believed an MDS coordinator needed to physically see residents and have in-person connections with care providers and back-office staff to submit an accurate MDS assessment. 

Then, COVID-19 hit. 

The COVID-19 pandemic and mass exodus of talent from long-term care have enormously impacted the MDS role. Some communities can’t find a skilled local MDS coordinator, so they ask floor nurses, untrained in the MDS, to fill in. Other communities have an MDS Coordinator on staff, but they’re constantly pulled away from their job to help with clinical tasks. In both cases, the MDS assessment isn’t done well, which threatens the clinical and financial standing of a community. In both cases, staff feel frustrated, burned out, and unsupported in their roles. 

This isn’t unique to the MDS role, and we need systemic solutions to solve the staffing shortage. However, we do have a solution for this specific gap and its impact on our overstretched teams: remote MDS coordinators. 

In mid-2020, I had the opportunity to serve as a remote MDS coordinator for a community experiencing a short-term vacancy. The community’s senior leadership couldn’t find an onsite replacement, and their MDS assessments were more important than ever. At this point in the pandemic, 55% of nursing homes were operating at a loss, and 89% were operating with a profit margin of 3% or less. Accurate and timely reimbursement was critical, so the leadership team decided to try a remote option to fill their open MDS position. 

I was tasked with both serving as the remote MDS coordinator and building the remote program. In practical terms, that meant I was at my home office in Mississippi, working for an Illinois community 800 miles away. While my “Get out of your chair, leave your office, and go assess” mantra no longer applied, I quickly found a new and equally effective one: “Join every team meeting, connect with your community contact, and go assess together”. 

I was in every morning meeting, triple check and Medicare huddle so I had both a bird’s-eye view and detailed look at our operations. I partnered with an onsite team member who became my eyes and ears, connecting me with clinicians if I had questions and confirming resident care if need be. Most importantly? I still thoroughly assessed. 

In fact, since I wasn’t on site, I could focus 100% of my time, attention and expertise on the MDS assessment and process improvements. Instead of being pulled to the floor, I reviewed charting with a fine-toothed comb and ensured there weren’t discrepancies or errors. Instead of filling in at dinner service, I analyzed documentation to identify lapses in assessment processes, developed a plan to prevent them moving forward, and tracked down every dollar for care rendered. 

The outcomes were clear: our residents continued to receive excellent care, our assessments were submitted on time and without errors, and our community optimized its reimbursement. 

Almost two years later, our industry continues to struggle under the weight of low census, COVID-19 variants, and staffing gaps. However, I’ve seen many more communities employ creative solutions like remote MDS coordinators with similar, positive results. Some communities opt for an interim remote coordinator. Other communities have discovered long-term remote MDS coordinators are an effective and affordable option. One operator who expanded her use of remote MDS coordinators echoed my own thoughts and feelings about the switch from in-person to virtual. 

“I was hesitant about a remote MDS coordinator at first. You’re used to having that person down the hall, physically accessible in their office. However, we’ve found that remote MDS coordinators are just as integrated with our team as onsite staff. We don’t miss a beat not having an MDSC in the building.” 

I’ve worked in nursing for 25+ years, and I’ve never seen our industry in such turmoil with limited relief in sight. At a certain point, we need to start thinking creatively and trying new solutions. Remote programs expand access to talent, reduce costs associated with interim staffing solutions, and most of all, they let our valued employees focus their time and talent on their actual jobs. And as someone who’s lived, built and seen this remote MDS coordinator approach, I think it’s a winner. 

Wendy Strain, RN, RAC-CT, is the Director of Consulting Services for Polaris Group, a long-term care consulting and staffing organization. She has over 25 years of healthcare experience ranging from acute care to the long-term care setting. In her current role, Wendy is responsible for the development, implementation, and management of clinical and regulatory programs. 

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.