MDS 3.0 "Things"
Legislative Chairman wrote to CMS to ask them to define the term "things" used in the MDS 3.0 section D.
Email to CMS Dear CMS, There has been much controversy and confusion over the "little pleasure or interest in doing things", found in section D0500 (A) and D0200 (A). The concern is with the word "things". This question is triggering activities quite often and there is major concern as to what the intent of the question is. If the term "things" does indeed refer to activities (recreational), then the question should be asked in such that manner. The resident should be made aware that the question refers to activities. I am assuming that things is referring to activities because of the relation to the answer has to triggering activities. On behalf of the Activity profession, I am asking you to please clarify the meaning of the term "things"? Thank you for your consideration. Kim Grandal, CTRS, ACC/EDU
CMS's Response
Specific "things" are defined by the resident. They might be activities such as visiting others, drawing, reading, dancing, conversing with others, maybe the resident used to braid her grandaughter's hair when she visited and now she doesn't want to, etc. It may also refer to wanting to do "things" alone...so not necessarily activities with others. The question on the PHQ-9 cannot be rewritten to include the word "activities" as the PHQ-9 is validated and tested tool as it is currently displayed on the MDS 3.0.
Teresa M. Mota, RN, CALA MDS
Help Desk MDSQuestions@cms.hhs.gov
MDS30Comments@cms.hhs.gov
MDS 3.0 Section F Questions and Answers 
By Kimberly Grandal, CTRS, ACC/EDU
NJAPA Legislative Chairperson
November 12, 2010
Here's just some of the questions I've received with my responses. Please share your knowledge and experiences as well!
1) I don’t see section F on the quarterly? When is section F completed?
Section F, Preferences for Customary Routine and Activities, is completed any time a comprehensive assessment is conducted:
- Admission Assessment
- Annual Assessment
- Significant Change Assessment
- Significant Correction of a Prior Full
2) Who completes section F?
Which individual or department is completing various sections of the MDS 3.0 varies from facility to facility. There are reports of Activity Professionals completing the following:
- All of the resident interviews, in addition to section F
- Some of the interviews (mood, cognition, and/or preferences)
- None of the interviews or sections of the MDS 3.0
- Some facilities are training each member of the IDT to conduct the complete interview and then taking turns in conducting the interviews.
- The most common, however, appears to be that the Activity Professional is completing all of section F
3) Do I still have to do quarterly notes even though section F is not in the quarterly MDS?
Just because section F is not included in the quarterly MDS, does not mean the Activity Department shouldn’t continue with their quarterly progress notes or other episodic notes. It is very important that the Activity Professional monitor each resident’s responses to activities and any activity interventions in accordance with the care plan. Quarterly and episodic notes help the Activity Professional to determine if changes should be made to care plans or if a change in the type of programming provided is needed.
4) Should I change my Activity Assessment?
Many Activity Directors are changing their Activity Assessments to be more compatible with the MDS 3.0. It’s really an individual choice. Look at your current Activity Assessment and be sure it doesn’t have any old MDS 2.0 language. If so, you may want to remove that and replace with current MDS 3.0 language. The Activity Assessment must provide the assessor with information that is necessary to plan a program of activities for the resident based on the resident’s individual need, interests, and preferences. Areas to consider include but are not limited to:
- Current, past and potential activity interests
- Potential barriers to activities such as psychosocial, cognitive, physical or health
- Family and community involvement
- Activity adaptations, modifications , adaptive equipment
- Cultural, language, education, religious, and spiritual considerations
- Special skills and strengths
- Recommendations or referrals
If you are looking to change your Activity Assessment to be more compatible with the MDS 3.0, then check out Recreation Therapy Consultants. They have a new Activity Assessment form available.
5) What exactly triggers activities in the MDS 3.0?
- Any 6 items for interview for activity preferences has the value of 4 (not important at all) or 5 (important, but cannot do or no choice) as indicated by any 6 of F00500A through F00500H is coded a 4 or 5.
- Any 6 items for staff assessment of activity preferences item L through T are not checked as indicated by any 6 of F0800L through F0800T are NOT checked.
- The Mood Interview reveals the resident has little interest or pleasure in doing things as indicated by: D0200A1=1.
- Staff assessment of resident mood suggests resident states little interest or pleasure in doing things as indicated by: D0500A1=1.
6) What is the difference between the Resident Assessment Protocols (RAPs) and the Care Area Assessment (CAAs)?
RAPS and CAAs are very similar in the respect that both:
- Review MDS and gathered data
- Involve decision-making and care planning
- Determine triggered care areas and assess further
- Include documentation in the medical record
The major difference between the RAPs and the CAAs is that there is no mandated assessment tool/ protocol like there was with the MDS 2.0 RAPs. Now facilities may choose to use CAA resources (Appendix C) and/or current standards of practice, evidence-based or expert-endorsed resources to conduct further assessment of triggered areas.
7) Do I have to care plan if the resident is alert and oriented and codes a 4 (not important) or 5 (important but can’t do, no choice) in the Activity Preferences Interview and triggers in activities?
One of the ways in which CAT number 10, Activities, will trigger is if the resident interview for activity preferences is coded with a total of six 4’s or 5’s. If the resident is alert/oriented and codes a 4 (not important at all), it just alerts us that we should look into it further. It could be that the resident is indeed alert/oriented, but is there some type of psychosocial factor or health issue that is the underlying cause of the resident answering a 4? Or is it that the resident answers 4's because he/she simply has no interest in those preferences being asked of him/her and may have other interests instead, such as crafts, exercise, computers, etc? Or if a resident codes a 5 (can’t do or no choice) this may indicate the resident has perceived or actual barriers or has developed a sense of learned helplessness. The primary concept of the CAA process is to look for those underlying causes and contributing factors.
The decision to care plan or not will vary depending on the CAA analysis and findings. It is also important to note that just because a resident triggers in activities, doesn't mean we have to care plan for it. It is equally important to note, however, that just because a resident doesn’t trigger in activities, doesn’t mean we shouldn’t care plan. The decision to care plan or not is truly based on the resident’s problems, needs, preferences, strengths and the IDT’s findings and recommendations.
8) What do I do if the resident cannot or refuses to answer the interview questions?
If the resident doesn’t answer a preferences question, or answers with an incoherent or nonsensical response, then the assessor is to code a 9. Three code 9’s and the assessor is to stop the interview and complete the staff assessment for customary routine and activity preferences.
9) What type of documentation do I need to do for the CAAs?
CAA responsibilities, how it is facilitated, and where it is written in the medical record, will depend on facility protocol. Further assessment in a particular area should be within the scope of training or practice of the discipline filling out the section. CAA process must be interdisciplinary and involve the resident/significant other. CMS clearly states that CAA documentation must include:
- Nature of issue/condition.
- Causes, contributing risk factors, complications.
- Need for referrals and/ or further evaluation.
- Factors that must be considered in developing individualized care plan interventions including appropriate documentation to justify the decision to plan care or not to plan care for the individual resident.
- Resources used - Facilities may have written policies/ protocols/ standards of practice.
- Completion of Section V (CAA Summary).
10) Where can I watch the VIVE
11) We have a resident that is confused but she was able to answer the interview questions. Now I am having a conflict with Social Services. She said we shouldn’t interview when the resident is confused. Do you have advice or the right answer for me? Should we interview residents with confusion? I believe why not try. They still may be able to answer questions about their likes and dislikes. Any advice would help.
In terms of residents with cognitive impairment, the answer lies with the coding of B0700 (makes Self Understood) . If the resident codes a 0 (understood) ,1 (usually understood) or 2 (sometimes understood) , then you conduct the interview. If the resident codes a 3 (rarely/never understood), then you do not interview the resident-your next step is to attempt to interview the family or significant other.
12) Is Section F on the Quarterly?
Typically, section F is not on the Quarterly-however be sure to check with your facility and state regulators. Your state may have different rules. For example, I was recently informed that in the state of South Dakota they are required to complete the full item set for quarterly assessments. The CAA's, care planning, etc are not done, but the full item set is completed. So be sure to check your state regulations!
13) Since we no longer have to do a quarterly MDS for activities.. do you think we should still be doing a quarterly assessment on each resident or does a quarterly progress note suffice?
I would think a quarterly note would be ok-you'd identify if there were any changes in the note.
14) Section F interviews only need to be completed initially, annual and sig. changes? This is what I am being told. Since the RAI manual is so big can you maybe direct me to the page number or chapter as to where it says this?
It doesn't say in the RAI manual that sec F is only provided with the comprehensive assessment: admission, annual, sig change and sig change of prior correction. Believe me, it was the first thing I tried to find. It does say what a comprehensive assessment is and when that is offered (as indicated by the 4 times I just noted). I believe that is written in the assessment chapter of the RAI. Since section F is only shown to be on the comprehensive assessment, and not on quarterlies, PPS's and such, then this is a logical assumption. Although, I, like you, would like to see it officially written in the RAI manual.
15) Is there a place where we can direct questions directly to CMS to answer?
Questions regarding the "MDS 3.0 RAI Manual" should be directed to MDS30Comments@cms.hhs.gov. Please note that CMS will not be providing an individualized response to each inquiry; however, CMS will make sure the issues or comments are addressed in the upcoming MDS 3.0 training sessions or updates to the information provided on this page.
16) In the section F interview, what do I do with the blank boxes if the resident codes three "9"s and I skip to do the Staff Assessment? Do I leave the unasked questions blank?
No-you code a dash (-) in the unasked questions, otherwise it looks like you just didn't complete the section.
MDS 3.0 Resources for Activity and Recreation Professionals
By Kimberly Grandal, CTRS, ACC/EDU
NJAPA Legislative Chairperson
August 31, 2010
Are you ready for the MDS 3.0? If you haven’t received any formal training on the MDS 3.0, I highly recommend that you do. There are a variety of on-line resources that you can check out that will help you in your preparations and implementation process. Below is a list of resources for Activity Professionals that will be completing section F of the MDS 3.0. Each facility is different and I’ve heard stories of Activity Professionals completing several sections such as mood, preferences, and cognition. In some cases, Activity Professionals are not completing any section. It will vary according to facility since CMS does not specify which department or individual should complete the various sections of the MDS 3.0.
I also wanted to address one of the most popular questions that I get asked about the upcoming MDS 3.0 which is, “What type of initial Activity Assessment do you recommend or how do I change my current assessment to accommodate the MDS 3.0”? I respond back with a question: “Why do you have to change your initial Activity Assessment?” The Activity Assessment does not have to reflect the MDS. In fact, why collect the data twice? Now, if your Activity Assessment has outdated terminology such as RAPs, Section N, Triggers for Little or No Activity, etc., then yes, you’ll want to either remove the old terminology and replace with the new lingo (e.g. CAT’s, CAA’s, section F, Resident Interview, Family/Significant other Interview, Staff Assessment, etc.)
I hope that you find these resources and links helpful in your preparations for the up and coming MDS 3.0.
RAI Manual and Training Materials
Download all of the RAI Manual and training materials from the CMS website at https://www.cms.gov/NursingHomeQualityIn its/45_NHQIMDS30TrainingMaterials.asp#To pOfPage There are also some materials, such as section F, section O, the CAA’s Resources related to activities and more available at http://www.recreativeresources.com/MDS3.0.htm . Please note however, that CMS is the official site and you should always check to ensure you have the most current information.
VIVE’:Interviewing Frail Elders (Video)
The Video on Interviewing Vulnerable Elders (VIVE) demonstrates best-practice approaches for implementing the new MDS interviews for cognition, mood, preferences and pain. The goal of VIVE, funded by Picker Institute and developed by the UCLA/Jewish Home Borun Center, is to help staff members build the confidence and skills they need to interview their residents both for MDS 3.0 and for other clinical evaluations. View this video at http://pickerinstitute.org/vive
Free Course: Interviewing for MDS 3.0 Resident Assessment by Care to Learn Enterprise
This great course-geared toward nursing, but as an Activity Professional, I found it helpful. Plus it's free and we just love FREE! Learn the interview skills that lead to better nursing home resident care while ensuring MDS 3.0 compliance. Visit http://redvector.web101.hubspot.com/mds3-mcknights
Operational Strategies to Implement the New MDS 3.0 Process Sponsored by MDI Achieve. Download at http://www.mdiachieve.com/mds30/webcast/OperationalStrategies_MDS30_ADVANCE.pdf
MDS 3.0 Basic Comprehensive Test Question and Answer Sheet by National Resident Assessment Institute.
Great test to review staff knowledge of the MDS 3.0 Visit http://www.nrai.net/mds3basictestanswers.php
Preparing for MDS 3.0 by Health MedX
A 24-page manual to help you prepare for the MDS 3.0. Great checklists and a fantastic overview of the MDS 3.0. Download at http://www.healthmedx.com/Libraries/Documents/MDS_3_0_White_Paper.sflb.ashx
Preparing for MDS 3.0 by Keane Care.
Download this 5 page MDS 3.0 overview at http://www.keanecare.com/products/pdf/mds30-flyer.pdf
HCPro Healthcare Marketplace
Free Newsletter about the MDS 3.0 at http://www.hcmarketplace.com/prod-6935-E MDSCB/MDS-30-Update.html . HCPro also did a nice review of the MDS 3,0 Train the Trainer Conference in Las Vegas. Visit http://www.hcpro.com/LTC-255375-6935/Updates-from-the-Las-Vegas-MDS-30-TraintheTrainer-conference.html. In addition, HCPro has a great MDS 3.0 blog at http://blogs.hcpro.com/mdscentral/
Article-A Closer Look at the MDS 3.0: News and Overview for Activity and Recreation Professionals.
This is an article written by Kim Grandal, back in February 2010. It gives a great introduction to the MDS 3.0 for Activity and recreation Professional. You can download this article at: http://www.recreativeresources.com/documents/MDS3.0UpdatefEB2010.pdf
MDH MDS 3.0 Web Ex MDS 3.0 Handouts
Twenty three sets of handouts regarding all aspects of the MDS 3.0. Download at
http://www.health.state.mn.us/divs/fpc/MDS30_webex.pdf
Getting Ready for MDS 3.0 Implementation-Montana Healthcare Association
A PowerPoint handout that gives an overview of the MDS 3.0. Download at http://www.mtha.org/spring/documents/A3%20MDS%203.0%20Clinical%20Essentials.pdf
MDS 3.0 Resident Interview and Cue Cards by Kansas Foundation for Medical Care
Download interview cue cards for the MDS 3.0. Visit http://www.kfmc.org/providers/nh/Resident_Interviews_and_Cue_Cards.pdf
Change is Coming MDS 3.0 by Lori Costa
A PowerPoint overview of the MDS 3.0. Download at http://www.aging.org/files/public/Change.is.Coming.ppt
Free Cue Cards for Section F-Daily and Activity Preferences
The RAI Manual and the Video on Interviewing Vulnerable Elders discuss the use of Cue Cards during the interview process. Here are two cue cards you can download. http://www.recreativeresources.com/MDS3.0.htm
With anything, change can be challenging. Mistakes will be made, new questions present themselves, turf wars may arise, and so on. Take a deep breath and just remember one thing, “It’s about the residents”. Whether you like or dislike the MDS 3.0, doesn’t really matter anymore because it’s going to happen on October 1, 2010. Focus on what you need to do and before you know it, it will become part of the norm and we’ll all be saying, “Remember when we had to do that section N?”.
Article "Activities Angst"-A Must Read and Must Comment On Article
By Kimberly Grandal, CTRS, ACC/EDU
NJAPA Legislative Chairperson
June 15, 2010
Check out the article Activities Angst. This is a must read article regarding the Universal worker and the quality of activities provided. I also urge you to comment on the article on the Long Term Care Living webpage. Please-this is our chance to voice our concern regarding the role of the Universal Worker!
There is also another blog related to this subject that I recently learned of entitled, The Vanishing Need for Activity Professionals. You can find this blog at http://tinyurl.com/vanishingneedforactivitypros. PLEASE read these articles and comment.
Read the Article:
A Closer Look at the MDS 3.0: News and Overview for Activity and Recreation Professionals
By Kimberly Grandal, CTRS, ACC/EDU
February 8, 2010
MDS 3.0 Update and CMS Training Information
January 20, 2010
By Kimberly Grandal, CTRS, ACC/EDU
NJAPA Legislative Chairperson
The MDS 3.0 RAI user manual is now available for download at http://www.cms.hhs.gov/NursingHomeQualityInits/25_NHQIMDS30.asp
Follow the link, scroll down the page and click on MDS 3.0 RAI Manual Jan 2010 to download the entire manual. The section for Customary Routine and Activities is called section F and is located in the Chapter 3 file folder. The section which refers to Recreation Therapy can be found in section 0, Special Treatments and Procedures. You can also download sections F and O at www.recreativeresources.com/MDS3.0.htm
CMS provided a webcast, entitled, MDS 3.0: Part 1- An Introduction, on December 17, 2009. You can view this archived webcast for free at http://surveyortraining.cms.hhs.gov/pubs/VideoInformation.aspx?cid=1074
This webcast was the first of a three part series focused on providing information about the MDS 3.0.
The other webcasts in the series include:
2nd Part: Coding the MDS 3.0 (late spring/early summer, 2010)
3rd Part: CMS Programs impacted by the MDS 3.0 (summer, 2010)
MDS 3.0 is Postponed!
On Thursday, March 5, 2009 CMS officials announced that they have postponed the implementation of the MDS 3.0. The new start date is October, 2010 which is one year later than originally planned. To review MDS drafts, timelines, crosswalks and more visit http://www.cms.hhs.gov/NursingHomeQualityInits/25_NHQIMDS30.asp. Activity Professionals really should review the MDS 3.0 draft and send your comments to CMS!
Elect to Promote and Vote
Voting and Election Day Activities in Healthcare Facilities
By Kimberly Grandal BA, CTRS, ACC
NJAPA Legislative Chairperson
Minimum Data Set (MDS) 3.0
Submitted by Kimberly Grandal, CTRS,ACC
NJAPA Legislative Chairman
The Centers for Medicare & Medicaid Services (CMS) held an Open Door Forum (ODF) regarding the Minimum Data Set, Version 3.0 (MDS 3.0) in Baltimore, Maryland on January 24, 2008 from 1:00 pm to 3:00 pm EST and reported on the findings of a 5-year CMS Nursing Home MDS 3.0 Validation Study.
There are many advantages to the MDS 3.0 such as:
- Increased resident’s voice
- Increased clinical relevance for assessment
- Increased accuracy, both validity and reliability
- Increased clarity and efficiency
- 45% reduction in the average time for completion
A section with significant revisions is the Customary Routine and Activity Section. The customary routine staff assessment is replaced by the MDS 3.0 Preference Assessment Tool. Residents are to be interviewed for their activity interests and routine preferences. For residents who cannot answer the questions, a staff assessment of activities and daily preferences is available. Staff is also instructed to observe the resident’s response during activity programs. In a sample of individuals that completed the revised Customary Routine and Activity Section, findings indicated that:
- 81% rated the interview items as more useful for care planning
- 80% found that the interview changed their impression of resident’s wants
- 1% felt that some residents who responded didn’t really understand the items
- More likely to report that post-acute residents appreciated being asked
CMS plans to implement MDS 3.0 changes nationally on October 1, 2009. To download the transcript, audio files, power point presentation, word presentation and the timeline, visit
http://www.cms.hhs.gov/OpenDoorForums/05_ODF_SpecialODF.asp
This session is accessible for downloading beginning January 30, 2008 (for 30 days) until the end of February.
The Centers for Medicare & Medicaid Services (CMS) announced that there will be an Open Door Forum (ODF) regarding the Minimum Data Set, Version 3.0 (MDS 3.0). This ODF is scheduled for the CMS auditorium in Baltimore, Maryland on January 24, 2008 from 1:00 pm to 3:00 pm EST and will report on the findings of a 5-year CMS Nursing Home MDS 3.0 Validation Study. CMS plans to implement MDS 3.0 changes nationally on October 1, 2009.
This session is currently full and closed to new registrants, however an audio recording of this Special Forum will be posted to the Special ODF website at www.cms.hhs.gov/OpenDoorForums/05_ODF_SpecialODF.asp and will be accessible for downloading beginning January 30, 2008 and available for 30 days.
To download the MDS 3.0 Timeline, visit
www.cms.hhs.gov/NursingHomeQualityInits/Downloads/MDS30Timeline.pdf
