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November 2009

PPS Alert for Long-Term Care

Page 5

Avoid confusion when coding cognitive patterns

To test a resident’s long-term memory, a SNF staff

After reading this article, you will be able to: Assess and code a resident’s short- and long-term

member should ask the resident questions about his or her life, such as “Where did you live before you came here?” “Are you married?” or “When is your birthday?”

memory Identify the types of decisions addressed in item B4 of the

“When assessing a resident’s short- or long-term mem- ory, you always want to make sure that you either know

MDS 2.0 Discuss how the MDS coordinator and members of the

interdisciplinary team should assess and code a resident’s decision-making ability List the indicators of delirium in item B5 of the MDS 2.0 Explain how to assess and code indicators of delirium for

or can verify the answers to the questions you ask,” says Sarah Riggin, RN, RAC-MT, CRNAC, C-NE, MDS nurse consultant at LTC Systems in Conway, AR. “The answers for most questions related to long-term memory can usually be found in the resident’s record or by speak- ing with family members.”

a new resident

Coding Section B of the MDS 2.0, which deals with a resident’s cognitive patterns, can be a challenge for many

MDS coordinators. Fortunately, it doesn’t have to be. Armed with some helpful tips and techniques, MDS co-

ordinators can cut through the confusion and code Sec- tion B with ease.

Memory Although coding item B1, comatose, is relatively

straightforward, the same cannot be said about item B2, which deals with a resident’s short- and long-term mem- ory. Fortunately, the RAI User’s Manual provides exam-

ples of tests SNF staff members can conduct to assess a resident’s memory. The two short-term memory tests in- cluded in the RAI User’s Manual are as follows: Ask the resident to describe the breakfast meal or an

activity just completed. Ask the resident to remember three items (e.g., book,

When assessing a resident’s memory, SNF staff mem- bers must also be able to identify when he or she is con- fabulating, or making things up.

“For example, when you ask a resident what he or she had for breakfast, he or she may say something like, ‘It was very good. It was the best meal I’ve had all day.’ Although this may seem like an acceptable answer, the resident is actually evading the question and not get- ting into the specifics of what he or she ate,” Riggin says. “Rather than just saying, ‘I don’t know what I ate,’ the resident may use other tactics to try to provide a more socially acceptable answer.”

When it comes to coding short-term memory, MDS coordinators and members of the interdisciplinary team should also remember to code the most representative level of function, rather than the highest.

Short-term memory functions can vary during the day, so SNF staff members should complete numerous assessments to get an accurate picture of the resident’s overall functioning.

watch, and table) for a few minutes. After you have

stated all three items, proceed to talk about some- thing else. Do not keep silent or leave the room. After five minutes have passed, ask the resident to repeat

the name of each item. If the resident is unable to re- call all three items, code 1, meaning there is a memory


Decision-making Coding item B4, cognitive skills for decision-making,

can be quite challenging for MDS coordinators and members of the interdisciplinary team. However, they can avoid some common coding issues by following

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    continued on p. 6

© 2009 HCPro, Inc.

For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at www.copyright.com or 978/750-8400.

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