PPS Alert for Long-Term Care
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the guidelines included in Chapter 3 of the RAI User’s Manual.
Item B4 requires the MDS coordinator or members of the interdisciplinary team to observe the resident, consult family members and facility staff members, and review
or how he or she compares to other residents, the MDS should be coded based on what the resident actually does. If the resident requires reminders and cues, he or she should be coded as a 2.”
the clinical record to determine the resident’s performance in making everyday decisions about tasks and activities, such as choosing items of clothing or knowing when to go to scheduled meals.
Indicators of delirium
Item B5 of the MDS 2.0 addresses behaviors that, if present, could be indicators of delirium. The behaviors assessed in this item are as follows:
The first step to accurately coding item B4 is under- standing what each code means. The RAI User’s Manual provides the following definitions for each code in item B4: ➤ 0: Independent. The resident’s decisions in organiz-
ing a daily routine and making decisions were con- sistent and reasonable, reflecting lifestyle, culture,
➤ ➤ ➤ ➤
Easily distracted Periods of altered perception or awareness of surroundings Episodes of disorganized speech Periods of restlessness Periods of lethargy Varied mental function over the course of the day
➤ 1: Modified independence. The resident organized his or her daily routine and made safe decisions in familiar situations, but experienced some difficulty
in decision-making when faced with new tasks or situations. ➤ 2: Moderately impaired. The resident’s decisions were poor; the resident required reminders, cues,
MDS coordinators and members of the interdisciplin- ary team record the presence of each of these behaviors over the previous seven days using one of the following codes: ➤ 0: Behavior not present ➤ 1: Behavior present ➤ 2: Behavior present, over the past seven days appears
and supervision in planning, organizing, and correct-
ing daily routines.
different from resident’s usual functioning (e.g., new onset or worsening)
➤ 3: Severely impaired. The resident’s decision-making was severely impaired; the resident never (or rarely)
In addition to knowing what each code means, MDS coordinators and members of the interdisciplinary team should put aside their own thoughts, opinions, and biases
when assessing a resident’s decision-making ability. “A lot of people think that all nursing home residents need some help or cues when making decisions and,
therefore, residents exhibiting these behaviors are often coded as a 0 or 1 at item B4,” Riggin says. “But it doesn’t matter what the nurses think the resident is capable of
“Although coding item B5 may seem somewhat straightforward, SNFs seem to have a lot of trouble with this item, especially when the resident is new to the facil- ity,” Riggin says.
SNFs can’t determine whether the behaviors in item B5 are new or different from a resident’s usual func- tioning if they can’t compare them to the resident’s be- haviors in the past.
Therefore, to accurately code item B5 for a new res- ident, a SNF staff member should interview the resi- dent’s family regarding his or her behaviors prior to admission.
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