Long-Term Care Survey Alert

Here’s how your interview skills for the cognitively impaired can apply to chatty residents.

Ensure that resident interviews conducted for MDS 3.0 don’t get derailed by gabby patients. Use the techniques our experts suggest to keep them focused and completing the interview in time.

“The resident will sometimes talk and keep talking,” noted Tracy Montag, RN, BSN, RAC-CT, manager of the Senior Living Services Consulting Group for Reinsel, Kuntz, and Lesher, LLP, in a recent Centers for Medicare & Medicaid Services (CMS) panel discussion. “That does happen.”

Remember: “You have to just keep in mind that sometimes you’re the only person that [residents are] really talking to, or you’re the first person to come in to talk to them to ask them these questions,” Montag reminded. “And sometimes they will feel that you’re the only person and will start talking and talking, talking about all sorts of other things … that don’t relate to the questions.”

And although when the MDS 3.0 was still in its testing phase, testers found that all the MDS interviews took only 17 minutes per resident, that isn’t the case when you have a resident who just loves to shoot the breeze for hours on end. But interestingly, you can employ many of the same interview techniques to keep chatty residents focused that you use for cognitively impaired residents.

Schedule the Interview Ahead of Time

“Avoid awakening residents or interrupting social visits, meals, or activities to conduct an interview,” states the Vanderbilt Center for Quality Aging’s Interview Protocol.

Better: Instead of dropping in on a resident to conduct MDS interviews, set a time and date with the resident in advance. This can sometimes help chattier residents to focus on the interview, because they’re expecting that appointment for the specific purpose of participating in the MDS interviews.

Eliminate Distractions to Help Residents Focus

Not only should you conduct resident interviews in a private area where others won’t overhear your conversation, but you should also ensure that this quiet area has few distractions. Try to minimize or eliminate any background noise, turn off the television or radio, and encourage the resident to focus on your questions.

Employ ‘Unfolding’ & ‘Disentangling’

The RAI manual’s interview techniques of “unfolding” and “disentangling” can also help to curb extraneous conversation with your chattier residents. With unfolding you would use a general question about the symptom followed by a sequence of more specific questions if the resident reports the symptom as present.

For disentangling, you would separate items with several components into manageable pieces, according to the RAI manual. You would give the resident a chance to respond to each piece separately. For instance, if you’re asking the resident about “poor appetite or overeating,” you would ask the two separately: “Do you have a poor appetite?” (Wait for response.) “Do you overeat?”

You can also use “echoing,” which is simply restating or summarizing the resident’s response to your question. Repeat what the resident told you, and then repeat the response scale on the MDS item and ask the resident to clarify which specific response option would apply.

“Sometimes respondents give a long answer to an interview item,” noted Debra Saliba, MD, MPH, director of the UCLA/Jewish Home Borun Center for Gerontological Research in Los Angeles, in a CMS educational video. “To narrow the answers to the response choices available, it can be useful to summarize the longer answer and then ask which response option best applies.”

Don’t Be Afraid to Repeat Questions

If the resident keeps going on a tangent and digressing from the interview questions, don’t hesitate to repeat the question and the response options. You might need to do this for each question, but it could help to steer the resident back to the interview.

In some cases, you may want to try breaking up the interview into smaller sections and completing them at different times. Although you should try to complete the performance-based cognitive items in a single interview, you can break up other item sets into different interview sessions.

Keep in mind: “But I also found that the residents who talk to you a lot, there’s lots of information you can get from them,” Montag said. “Not only do you get the answer to your question, but you’ll get all kinds of other things to be able to plan the care for the resident.”