Talk To Me
Sep
8
Written by:
9/8/2010 3:10 PM
Finding the patient's voice in the complicated healthcare process: an overview of the MDS 3.0 assessment process.
If you are unfamiliar with nursing homes and are about to engage with one, you’re in for a big surprise. I’m not referring to the scary hobgoblins and monsters looming out from long, dank hallways to the tune of the “Funeral March,” as many media stories would have it. No, instead, you are about to get a taste—upclose and personal—of something nearly as frightening in its own way: the incredible burden of red tape that nursing homes grapple with every day.
I have had occasion in past blogs to allude to a formidable piece of nursing home paperwork called the Minimum Data Set, or MDS. Resembling a substantial engineering document, it is a deeply comprehensive, detailed checklist/practice guideline that nursing home staff is required to fill out for every resident. It is crucially important that they get this right, on the MDS will depend not only the quality and precision of their care, but their compliance with annual state inspection regulations and their Medicare reimbursement. A third iteration of this hefty document, called MDS 3.0, will go into effect October 1—that’s right, a few weeks from now.
Here’s where you come in, whether as a resident or family of a resident. For the first time, the MDS assessment process will require personal interviews with the resident or, if the resident is absolutely unable to participate, a family member. This isn’t a “Hi, how are you?” or “What kind of food do you like?” type of encounter. It—or rather not one, but four interviews that are required for each resident (focusing on cognition, mood, lifestyle preferences and pain)—will be highly structured, with scripted questions from which no deviation is permitted, and numerical scoring of responses. The interviews can be conducted by virtually anyone on the staff, though ideally it will be a hands-on caregiver with whom the resident is familiar and comfortable.
There will be no getting out of this or declining to participate. Nursing homes are required to do this by law. On the other hand, you may welcome the chance for you or your loved one to speak out about personal needs, reactions and attitudes. After all, one of the knocks against long-term care—and against the healthcare system in general, for that matter—is that the patient’s voice often gets lost in the complicated healthcare process. How often does your personal voice cut through all the busyness around you? This is the reason why the new interview process was developed and became a central feature of the MDS 3.0 assessment.
Obviously, this is a new process for nursing homes and their staffs, and you shouldn’t be surprised if miscommunications or other gaffs occur during these set-piece interviews. Nursing homes are busily training their staffs on these even as we speak (I hope). But there could be some awkward situations.
But residents or their proxies at last have a chance to speak up and be listened to. So don’t be shocked if the next nursing home you encounter really does want to know what you think!
4 comment(s) so far...
As a Hospice Chaplain, I visit nursing homes frequently. The care and attention to the residents varies greatly, not necessarily even based on price. The potential changes to the MDS requirements could help empower families. The care varies so much and families often do not feel they can speak up and demand what their loved ones are entitled to. These proposed changes may help families did deeper and ask more questions and feel freer to voice their concerns when they know that someone else may be watching and listening.
Also, if families start conversations early with their aging parents, they may be able to make smarter choices and make decisions that will provide and enhance the quality of their loved ones care for their of their lives.
By Dale Susan Edmonds on
9/13/2010 8:34 AM
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Good information! I'm in distress. My brother is 61, has severe dementia and has down syndrome. I'm legal guardian. He fell breaking hip in Aug. He's now in a nursing home. His hip's better, but dementia worse. His medicare has been approved until March. They want him out saying he can't visit with the residents, and just sits; BUT they love him. I'm bulking. They're trying him on dementia unit daily program as unit is full; but still want him to go elsewhere. I feel that the home won't be making any money because he will then go to medicaid and my father's monthly SS check. I've tried to be responsible. Years ago I started burial reserve, now up to almost $10,000.00. I CARE and want him to stay where he is now. Both the county CMSU social worker and nursing home social worker are mr and mrs milktoast. Neither one want to do anything for him; rather get rid of him. Do you have any suggestions. May I rebel, is this within my rights as his legal guardian. He is next in line at another dementia unit BUT someone has to die for that vacancy to happen. Any suggestions will be appreciated
By Linda Wilcox on
11/4/2010 12:39 PM
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Hi Linda. I can see the difficulty. I'm sure there are Alzheimer's units that worry about taking on the extra challenge of a young person with Down's syndrome, especially in a resident population that already has cognitive problems. I would suggest contacting your state's long-term care ombudsman program in the state's department of health (you can probably Google it). They're geared toward helping residents and their families with personal problems in the system. There is also the National Down's Syndrome Society, which maintains an information hotline at 1-800-221-4602. I hope you get the information you need! Richard Peck
By Richard Peck on
11/10/2010 2:21 PM
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Hi sir your blog is very good I am with you. Your voice is very nice and I am satisfied with you. Thanking you.
By senior home on
6/6/2011 5:07 PM
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