MDS Alert

Find out how to handle these 'if and or but' examples.

Would you code the following examples for MDS Item B4 "Cognitive Skills for Daily Decision-Making"?

Example 1: A nonverbal resident who seems to have severe cognitive impairment usually clamps his mouth shut when offered a bite of food.

Example 2: A resident who does not generally make conversation or make his needs known replies "yes" when asked if he would like to take a nap.

Coding Options:

0. Independent - The resident's decisions in organizing daily routine and making decisions were consistent, reasonable, and organized reflecting lifestyle, culture, values.

1. Modified Independence - The resident organized daily routine and made safe decisions in familiar situations, but experienced some difficulty in decision-making when faced with new tasks or situations.

2. Moderately Impaired - The resident's decisions were poor; the resident required reminders, cues, and supervision in planning, organizing, and correcting daily routines.

3. Severely Impaired - The resident's decision-making was severely impaired; the resident never (or rarely) made decisions.

RAI manual clarifications: If the resident "rarely or never" made decisions, despite being provided with opportunities and appropriate cues, Item B4 would be coded as "3" for severely impaired. If the resident attempts to make decisions, although poorly, code "2" for moderately impaired.

Answer:

The RAI manual notes that the two examples are "similar in that the residents are primarily non-verbal and do not make their needs known." But both residents "make basic verbal or non-verbal responses to simple gestures or questions regarding care routines (e.g., comfort)." Thus, to code B4, you'd need "more information about how the resident functions in his environment," instructs the manual.

Based on the limited information provided about these residents, "one would gather that their communication is only focused on very particular circumstances ..." In that case, code MDS item B4 as a "3" for severe impairment.

Don't stop there: "The assessor should determine if the resident would respond in a similar fashion to other requests made during the seven-day observation period. If such 'decisions' are more frequent, the resident may be only moderately impaired or better."