MDS Alert

Follow these field-tested strategies to keep your PPS rates in the ballgame.
 
When you assess ADLs, a single omission of caregiver assistance can land your resident in a lower-paying RUG - and shortchange your facility.

These three strategies will go a long way toward helping staff capture and code resident's ADL requirements.

1. Make sure all staff knows which residents are in the assessment window. Also turn ADL assessment into a 24-hour effort involving all caregiving staff during the seven-day lookback period. That way the MDS staff won't miss that one instance of a two- or three-person assist when coding column B of G1 (ADL support provided). Remember: In column B, you code the highest level of support provided to the resident - even if it occurred only one time during the lookback.

2. Devise "user friendly" ADL flow sheets that capture the ADL support provided to residents. For example, in the ADL support field (column B), staff often struggle with the concept that a score of "2" represents one person providing physical help while a score of "3" represents two or more staff providing physical help, notes Andrea Platt, RN, an MDS consultant with Thomas Healthcare Consulting in Indianapolis.

"Formats that require the caregiver to simply circle or record the actual level of assistance (two people or one person or set up help only) can work by allowing the MDS coordinator who knows the coding to translate the information accurately to the MDS form itself," Platt advises.

3. Consider using the decision tree in the RAI user's manual for coding column A of Section G1 (ADL self-performance). The MDS coordinator or person doing the coding should actually have the tree available when coding the MDS, in the view of Rita Roedel, RN, MS, with BDO Healthcare Group/Heritage Healthcare Group in Milwaukee (see Clip N' Save: Don't Make A Wrong Turn When Coding Residents' ADL Self-Performance: Use this Decision Tree).