MDS Alert

Overall deterioration may include a pattern of changes.

When deciding whether to initiate a Significant Change in Status Assessment (SCSA), you don’t have to wing it. The RAI Manual provides a variety of SCSA-related guidance, including some helpful scenarios.

The scenarios listed below are among those that would prompt an SCSA. According to the RAI Manual, pages 2-23 and 2-24, which provides SCSA criteria, you should watch for a decline in two or more of the following:

• Resident’s decision-making changes for the worse;
• Presence of a resident mood item not previously reported by the resident or staff and/or an increase in the symptom frequency (PHQ-9^©), for example, increase in the number of areas where behavioral symptoms are coded as being present and/or the frequency of a symptom increases for items in Section E — Behavior;
• Any decline in an Activities of Daily Living (ADL) physical functioning area where a resident is newly coded as 3 — Extensive assistance, 4 — Total dependence, or 8 — Activity did not occur since the last assessment;
• Resident’s incontinence pattern changes or there was placement of an indwelling catheter;
• Emergence of unplanned weight loss problem (5 percent change in 30 days or 10 percent change in 180 days);
• Emergence of a new pressure ulcer at Stage 2 or higher, or worsening in pressure ulcer status;
• Resident begins to use trunk restraint or a chair that prevents rising when it was not used before; and/or
• Overall deterioration of resident’s condition.

Also, watch for improvement in two or more of the following:

• Any improvement in an ADL physical functioning area where a resident is newly coded as 0 — Independent, 1 — Supervision, or 2 — Limited assistance since the last assessment;
• Decrease in the number of areas where behavioral symptoms are coded as being present and/or the frequency of a symptom decreases;
• Resident’s decision-making changes for the better;
• Resident’s incontinence pattern changes for the better; and/or
• Overall improvement of resident’s condition.