In a world full of ups and downs, consistency is something that can be difficult to accomplish. But consistency is exactly what the doctor ordered (or in this case what the federal government ordered), especially when it comes to regular assessments in long term care. The MDS (Minimum Data Set) is an interdisciplinary assessment tool that is mandated at regular intervals in long term care, as outlined in the RAI Manual. The assessment structure and time frame was set forth back in 1987 by the Omnibus Budget Reconciliation Act.
A quick history lesson:
The Omnibus Budget Reconciliation Act of 1987, or OBRA ’87, was signed into law as the first major revision of the federal standards for nursing home care since the 1965 creation of both Medicare and Medicaid. This legislation changed society’s legal expectations of nursing homes. Long term care facilities that wanted Medicare or Medicaid funding had to provide services so that each resident could “attain and maintain her highest practicable physical, mental, and psycho-social well-being.” Phrase sound familiar? It should sound VERY familiar to therapists in long term care. Out of this Act, the MDS was created to provide a thorough evaluation and facilitate the development of a care plan designed to care for each resident, in order for that resident to “attain and maintain” her highest level of function.
The Therapist and the MDS:
When it comes to explaining to therapists why the MDS process is one they should be involved in, it can often lead to push-back. These days, therapists have very limited time in their day to perform “screens,” and to them, the MDS is a “screen.” The focus of therapy (since it is a revenue center) has been to maximize the use of the therapist time and limit it to “billable” services only. Screens are not a billable service. Also, the RAI Manual has made it clear that a therapist is not required to complete any particular sections of the MDS, though in some facilities, therapy does play a role in completing a specific portion.
To screen or not to screen? So where is the happy medium? Therapists should make it practice to “screen” residents on a regular basis in accordance with the MDS schedule. They don’t have to use the MDS as the screening tool, rather, perform an assessment of their choice that best fits the need of each resident. What is key is that therapists screen residents on a regular basis. Screens can be quarterly, bi-annually, annually, whatever you decide. The point is, if every resident is expected to “attain and maintain her highest level of function,” therapists—experts in function— should be involved at some frequency.
Just look at this excerpt from the State Operations Manual. This regulation is used by surveyors to ensure facilities are following OBRA ’87:
§483.25(a) Activities of Daily Living. (F310)
Based on the comprehensive assessment of a resident, the facility must ensure that:
(1) A resident’s abilities in activities of daily living do not diminish unless
circumstances of the individual’s clinical condition demonstrate that diminution was
unavoidable. This includes the resident’s ability to —
(i) Bathe, dress, and groom;
(ii) Transfer and ambulate;
(iv) Eat; and
(v) Use speech, language, or other functional communication systems.
This screams OT, PT, Speech!!!
So, does the federal government mandate that a therapist perform components of the MDS? No
Are therapists part of an interdisciplinary team that is in place to ensure quality of care is upheld by establishing a plan for each resident in long term care to attain and maintain the highest level of function? Yes
So…. how will YOU ensure this? Hmmm… As a therapist, what is your mission?
Any questions, Just Ask!
In YOUR Corner,