MDS Alert

Also ask yourself this question, advises nurse expert.

The MDS 3.0 can help identify residents who may be depressed. But "whether the resident is in a lookback period should not affect our policy for ferreting out depression" or whether someone is suicidal -- "or evaluating for pain or cognition," reminds Judy Wilhide Brandt, RN, BA, C-NE, RAC-MT, of Judy Wilhide MDS Consulting Inc. in Virginia Beach, Va.

"People die over untreated depression," Brandt cautions. "They stop eating and stop getting up," she says. "And psychosocial, psychiatric, spiritual, and physical factors can cause someone to be suicidal. People in nursing homes every day make a quiet decision that they are done. They stop eating, stop moving around. I had an 87-year-old lady who did that and got pneumonia and UTI and didn't come back from it."

Key: "You have to look for those subtle changes," Brandt advises. That includes "the person who doesn't go to Bingo when she's gone every day for 16 years -- or the person who stops moving around or eating."

"Ultimately, the person has the right to make that choice," says Brandt. "But the question is -- did they make it because we didn't provide a place that they felt made their lives have value, a place they don't feel ... is worth living in?"