MDS Alert

Nursing homes, hospices should focus on coordinating care.

When deciding whether to do a sig change on a resident who elects hospice care, consider this: The July 2008 RAI user's manual clarification encourages SNFs to do one in that type of scenario.

What it says: The revision combines the previous directive in the RAI manual with new advice (in bold), as follows: "While the need to complete an SCSA will depend upon the resident's status at the time of election of hospice care, and whether or not the resident's condition requires a new assessment, CMS encourages facilities to complete an SCSA due to the importance of ensuring that a coordinated plan of care between the hospice and nursing facility is put into place."

Consultant Ron Orth, RN, NHA, CPC, RAC-CT thinks CMS' clarification makes sense.

"A resident who goes on hospice will likely have a change in the care plan, which will become more focused on palliative care," says Orth, president of Clinical Reimbursement Solutions LLC in Milwaukee.

Handwriting on the Wall?

Pointing to more stringent hospice Medicare conditions of participation that go into effect Dec. 2, hospice expert and consultant Beth Carpenter thinks the RAI manual clarification may signal that it's imperative that nursing homes understand there must be joint care planning with hospice for hospice patients residing in a nursing home.

"It's expected that there will be changes to the Medicare nursing facility conditions of participation [so they] more closely match the new hospice conditions of participation," although that could take up to three years, says Carpenter, president of Beth Carpenter and Associates in Lake Barrington, IL.

Editor's note: See the next MDS Alert for an inside look at how the new hospice conditions of participation affect nursing homes, including care planning.