Team approach


Administrators contacted by Long-Term Living say they are taking a team approach to make sure the new MDS 3.0 is implemented smoothly and correctly in their respective communities.

A team approach seems to be the consensus of administrators polled concerning implementation of MDS 3.0 in their communities. Some industry experts have called MDS 3.0 one of the largest operational changes to hit long-term care since 1999 when electronic transmissions and the prospective payment system began.

Eli Pick

Eli Pick, executive director of Ballard Rehabilitation, Des Plaines, Illinois, says his three MDS nurses act as coaches and gather information from the nursing unit coordinator, the therapists, recreational staff, or any other specialty area and review the completed assessment, reconcile conflicting information, and accurately code the assessment. The nurses do not complete the process on their own. Each discipline completes its own section of the MDS with the exception of nursing where the MDS nurses review the chart, interview staff, and with the advent of 3.0, interview the resident.

“Our structure is atypical,” Pick says. “We are decentralized.” All staff members who participate in the assessment process are going through 3.0 training. The MDS nurses received their MDS 3.0 training through the American Association of Nurse Assessment Coordinators (AANAC). The staff at Ballard has also taken advantage of training through the Illinois Council on Long-Term Care and the Illinois Healthcare Association. “Other groups like the therapists have had additional training through their own specialty groups,” he says.

Global picture

A weekly management meeting brings everyone together and department directors share MDS 3.0 information they’ve learned. “As a management group we can talk about the impact of 3.0 and how to reorient our approaches to things that 3.0 is changing or introducing,” Pick says. He likens the change to the story of the blind man and the elephant. Everyone is touching parts of the elephant and is trying to figure out how each part fits into the whole. “It’s not until everyone gets together and talks it through do you begin to get a global picture of what’s going on,” Pick says. He characterizes the new assessment tool as a “refinement,” rather than a fundamental change. He does concede that aspects like the resident interviews are new, different, and important.

Pick says he thinks MDS 3.0 took an “earnest effort” in trying to address the awkwardness of the instrument’s ability to achieve all the different objectives it was designed to achieve.

“I think the QI/QM aspect is very important because the evolution that has occurred as MDS was changing from its original intent as far as application,” Pick says. He explains MDS was originally only intended to be an assessment instrument as a means for policy planners to get some data on what makes up the types of people being treated in nursing facilities. It then evolved into a payment instrument and then as a quality instrument. “It was built to do one thing and then they kept adding aspects. It’s like building a one-room house and then keep adding rooms onto it in various places. You need to have an understanding of its functional application at its core. From my perspective, that’s one of the weaknesses of MDS. That was not done.”

IT upgrades important

Tim Dressman

Tim Dressman, executive director of St. Leonard, a Franciscan community in Centerville, Ohio, agrees implementation of MDS 3.0 takes a team approach. He began training staff last year at state association meetings. This year, St. Leonard’s parent company will provide system-wide training for administrators, DONs, MDS nurses, and eventually STNAs at all five of its properties. Dressman says IT system upgrades will be essential and is keeping a close eye on St. Leonard’s provider to make sure they get the upgrades. All of the staff use the electronic medical records system to input into the MDS document.

Both Pick and Dressman agree the new MDS 3.0 will take more man-hours to complete. Through E-Health Data Solutions’ software, Pick will gain a side-by-side analysis of MDS 2.0 and MDS 3.0 and the differences between them. “The software actually analyzes the data before it’s released to MDS,” Pick says.

Interview aids

Elizabeth Kaeser

All disciplines at the Inova Loudoun Nursing and Rehabilitation Center, Leesburg, Virginia, have copies of the entire MDS 3.0 manual or copies of their respective sections, says administrator Elizabeth Kaeser.

Her MDS coordinators, social workers, unit managers, DON, as well as herself, have all attended the first Virginia Health Care Association conference on MDS 3.0. The dietician, activities manager, and physical medicine and rehab staff (including the speech, physical, and occupational therapists) will receive training this month. The MDS coordinators are nationally certified on the new MDS 3.0 through the AANAC. Kaeser’s software vendor, Salinas Office Systems, visited her community and set up software in a “training” mode so that staff can begin to practice with the new software program for MDS 3.0.

“We’ve also developed some interview aids for the new interviewing process,” Kaeser says. “We have laminated flash cards for the interview question responses. This will be helpful in that the resident can see, as well as hear, the interview question answer choices and be able to point to their answer choice.”

Kaeser, the business office manager, and MDS coordinators are all online subscribers to CMS Open Door Forums.

Education, communication

Kris Graphman

Kris Graphman, administrator at the Forum at the Crossing, Indianapolis, feels the key to successful implementation is education and communication. He has been sending those closely involved in the MDS process to seminars in the Indianapolis area and the staff follow updates from the Indiana State Department of Health. He and his team also received two days of training sponsored by his company. “There’s not much [education] out there, to be honest,” Graphman says. “Our team has been working together for several years and I feel confident we will all work through this together.” Long-Term Living 2010 August;59(8):32-33

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