MDS Alert

Question: I don’t understand exactly what to count as a discharge. If a resident goes to the hospital for a procedure but then comes back, do I complete a discharge assessment?

Oregon Subscriber

Answer: According to the RAI Manual, a day is defined as 12:00 a.m. to 11:59 p.m.; go by the actual date of discharge, even if the discharge occurs at 12:00 a.m. on the dot.

Some background on discharges: “There are three types of discharges: two are OBRA required—return anticipated and return not anticipated; the third is Medicare required—Part A PPS Discharge. A Discharge assessment is required with all three types of discharges,” the RAI Manual says, on page 2-10. You don’t mention when the resident returned to the facility, but you may have to complete a discharge assessment if either of these two hospital-related scenarios apply, regardless of “facility policies regarding opening and closing clinical records and bed holds”:

• “Resident is admitted to a hospital or other care setting (regardless of whether the nursing home discharges or formally closes the record);
• “Resident has a hospital observation stay greater than 24 hours, regardless of whether the hospital admits the resident.”

So, if your resident left for a procedure but returned the same day — per the RAI Manual’s definition — then you probably don’t need to complete a discharge assessment.