MDS Alert

Don’t factor into answers whether you feel expectations are realistic.

Q0300 — Resident’s Overall Expectation is perhaps the most important item in the MDS when it comes to care planning and understanding the wishes of each resident. So be sure that you’re conducting this little resident interview the right way, and that your resident’s voice is heard loud and clear.

Report Response As-Is

If the resident selects the response Q0300A1 — Expects to be discharged to the community, this is often a routine situation where the resident expects to go back home. He may say that he expects to be at the nursing home for a short time due to a medical crisis, and he’ll return home after two weeks or 30 days, explained Mary Beth Ribar, an RN consultant in Baltimore, MD and technical director in the Disabled and Elderly Health Programs Group (DEHPG), in a recent CMS instructional session.

But you may encounter situations where the resident believes he will be discharged to go home, when in actuality that’s probably not going to happen. Don’t let this throw you off.

What to do: “Record the resident’s expectations as expressed, whether they are realistic or not realistic,” stressed Mary Rodger, RN, BSN in a recent presentation for Quality Insights Delaware.

Explore Further When Resident Expects to Stay

The next response option is Q0300A2 — Expects to remain in this facility. “This may be someone who is medically fragile who came from a situation that is not available to go back to live in,” Ribar noted.

But this is nevertheless “something you would explore with further assessment,” Ribar advised. “Why do they expect they are going to stay here?”

The resident may answer, “Well, I am here because my family can’t take care of me anymore and I can’t pay my rent, and I think I am staying here,” Ribar pointed out. But this “doesn’t mean that person has to stay in the facility, but that is what that person thinks is going to happen at this point in time.”

Keep in mind: “The resident may not be aware of the option of returning to the community and that services and supports may be available in the community to meet long-term care needs,” Rodger said.

Expect These Types of Situations for Third Choice

The third response choice is Q0300A3 — Expects to be discharged to another facility/institution. You can encounter this response in a variety of situations, but Ribar provides the following example:

Prior to entering the nursing facility, the resident has been living in a group home. The resident is admitted to the hospital for a medical concern or procedure, and then transfers to the nursing facility because his medical status is unstable. But the resident wants and expects to go back to the group home — where they were before and what they’re used to.