AT A GLANCE
Besides promoting resident-centered care, the new Resident Interviews in the MDS 3.0 will ensure greater accuracy of the information obtained, the author says.
Resident-centered care should by now be a familiar phrase in long-term care settings and it is apparent that the Centers for Medicare & Medicaid Services (CMS) has embraced the concept.
This is accomplished through Resident Interviews contained within the new MDS 3.0 in Section C (Cognitive Patterns), Section D (Mood), Section F (Preferences for Customary Routine and Activities), and Section J (Pain).
There are several reasons for including the resident's voice, other than the obvious one of promoting resident-centered care. When questions are asked directly of the residents, the information obtained is much more accurate. Also, when a resident feels he or she has a vested interest in their care, clinical outcomes are better. Being involved in decision making about their care gives the residents a sense of dignity and respect.
Long-term care staff may have concerns that, due to a large number of their residents having some level of dementia, these interviews cannot be conducted. The interview questions used in the MDS 3.0 are structured and have been validated in other healthcare settings. For example, the PHQ-9, which is used for Section D-Mood, is the very same questionnaire physician offices use to assist them in diagnosing depression in their patients. In addition, the interview questions are scripted. The RAI Manual instructs the interviewer to ask the questions exactly as they are written in the MDS. It is the way the questions are structured that allows most residents to participate.
Effective interview techniques need to be used to obtain accurate answers during the interview process. It is important that the setting be private and comfortable. Some of the questions (especially in Section D-Mood) are quite personal so eliminating the chance of being interrupted is essential. In addition, make sure the resident has any communication devices they normally use in place and in working order. If an interpreter is needed, one should be available.
The person chosen to conduct the interview needs to have a good rapport with the resident. It would be counter-productive to have a staff member who the resident does not particularly like to act as interviewer. The chances of getting no response or inaccurate responses would greatly increase. On the other hand, someone who the resident has a particular fondness for would be able to elicit much more information. The RAI User's Manual does not dictate who must do the interviews. It can be anyone who has been taught the proper interview techniques and the process.
Finally, look at each resident individually. What works for one does not work for all. Some residents may not have the physical ability to be able to complete all the interviews at one time. Although it is preferable for an interview to be conducted in a single sitting, it is not imperative. If a resident is unable to sit up, you may have to position him or her on his or her side in the bed and place your chair at bedside so you can easily be seen.
After the interviews have been completed, review the answers. Some answers may seem wrong, and there may even be evidence in the medical record or from family that contradicts how the resident answered. However, always code the resident response. Discrepancies can be documented in the clinical record.
At the end of the interview for Section C, called Brief Interview for Mental Status (BIMS) and Section D (PHQ-9), there is a Total Summary Score. This area provides a mean for comparison for future MDSs. Tracking the scores over time will assist in determining improvement, digression, or maintenance of cognitive status and mood.
Implementation of the MDS 3.0 may be causing long-term care providers and, especially, MDS coordinators stress simply because change is never easy. It is clear, however, that this is one change that is definitely for the better. So be patient, relax, and hear the resident's voice.
Debbie Belt, RN, LNHA, is Vice President of Education/Clinical Services for the Illinois Health Care Association, a trade association for long-term care facilities and programs. She has been in long-term care for more than 30 years and has held positions as director of nursing, administrator, regional director, and assistant vice president for operations for several long-term care companies. She can be reached at
firstname.lastname@example.org. Long-Term Living 2010 August;59(8):24