Test Questions posted at:

http://cms.internetstreaming.com

For current RAI updates:

www.cms.hhs.gov/quality/mds2.0

Top 5 Discrepant MDS Sections

1. Section P - Special Treatments and Procedures2. Section I - Disease Diagnosis3. Section O - Medications 4. Section J – Health Conditions5. Section G – Physical Functioning and Structural Problems

Top 5 Discrepant Section G items

1. G1b(A) - Transfers/Self-Performance

2. G1a(A) - Bed Mobility/Self -Performance

3. G1i(A) – Toilet Use/Self-Performance

4. G1d(A) –Walk in Room/Self-Performance

5. G1a(B) – Bed Mobility/Support Provided

Section G 1

Physical Functioning and Structural Problems

G1(A) - ADL Self-Performance Codes

0. Independent

1. Supervision

2. Limited Assistance

3. Extensive Assistance

4. Total Dependence

8. Activity Did Not Occur During the Entire 7 Day Period

Staff Support G1 (B) ADL Support Provided Codes

0. No Setup or Physical Help from Staff

1. Setup Help Only

2. One Person Physical Assist

3. Two+ Persons Physical Assist

8. ADL Activity Itself Did Not Occur During the Entire 7 Days

Revised Long-Term Care Resident Assessment

Instrument User’s Manual, Version 2.0

(referred to as RAI User’s Manual)

0. Independent - No help or staff oversight -OR- Staff help/oversight provided only one or

two times during the last 7 days.

1. Supervision - Oversight, encouragement, or cueing provided 3 or more times during last 7 days -OR- Supervision (3 or more times) plus physical assistance provided, but only 1 or 2 times during last 7 days.

2. Limited Assistance - Resident highly involved in activity, received physical help in guided maneuvering of limbs or other non weight-bearing assistance on 3 or more occasions -OR- limited assistance (3 or more times), plus more weight-bearing support provided, but for only 1 or 2 times during the last 7 days.

3. Extensive Assistance - While the resident performed part of activity over last

7 days, help of following type(s) was provided 3 or more times:

-- Weight-bearing support provided 3 or more times;

-- Full staff performance of activity (3 or more times) during part (but not all) of last 7 days.

4. Total Dependence - Full staff performance of the activity during entire 7 day period. There is complete non-participation by the resident in all aspects of the ADL definition task. If staff performed an activity for the resident during the entire observation period, but the resident performed part of the activity himself/herself, it would not be coded as a “4” (Total Dependence).

0.   No Setup or Physical Help from Staff

1. Setup Help Only - The resident is provided with materials or devices necessary to perform the activity of daily living independently.

2. One Person Physical Assist

3. Two+ Persons Physical Assist

8. ADL Activity Did Not Occur During the Entire 7 Day Period -Over the last 7 days, the ADL activity was not performed by the resident or staff. The particular activity did

not occur at all.

Restorative Program Requirements

        measurable objectives

        interventions

        evidence of periodic evaluation by a

licensed nurse

Resident Assessment Protocol: Activities of Daily Living – Functional

Rehabilitation Potential

pages C 25- 29

Refer to:

MDS RAI User’s Manual

Bed Mobility - How the resident moves to and from a lying position, turns side to side, and positions body while in bed, in a recliner, or other type of furniture the resident sleeps in, rather than a bed.

Transfer - How the resident moves between surfaces - i.e., to/from bed, chair, wheelchair, standing position. Exclude from this definition movement to/from bath or toilet, which is covered under Toilet Use and Bathing.

Walking in Room:

How the resident walks between location in his/her room.

Walk in corridor:

How the resident walks in corridor on unit

G8

ADL Functional Rehabilitation Potential

Locomotion on Unit - How the resident moves between locations in his or her room and adjacent corridor on the same floor. If the resident is in a wheelchair, locomotion is defined as self-sufficiency once in the chair.

Scoring ADL Self Performance

Refer to the MDS RAI User’s Manual

Flow chart on page 3-90

Locomotion Off Unit - How the resident moves to and returns from off unit locations (e.g., areas set aside for dining, activities, or treatments). If the facility has only one floor, locomotion off the unit is defined as how the resident moves to and from distant areas on the floor. If in a wheelchair, locomotion is defined as self-sufficiency once in chair.

Nursing Rehabilitation/Restorative Care

Section P3

Dressing:

How the resident puts on, fastens and takes off all items of street clothing, including donning/removing prosthesis

G7

Task Segmentation

Eating:

How the resident eats or drinks (regardless

of skill). Includes intake of nourishment by

other means (e.g., tube feeding, total

parenteral nutrition)

Toilet Use - How the resident uses the toilet

room, commode, bedpan, or urinal, transfers

on/off toilet, cleanses, changes pad, manages

ostomy or catheter, and adjusts clothes. Do

not limit assessment to bathroom use only.

Elimination occurs in many settings and

includes transferring on/off the toilet,

cleansing, changing pads, managing an

ostomy or catheter, and clothing adjustment.

The toileting activity subtask consist of:

• Hands-on assist to adjust clothing

• Weight-bearing assist to lower her to the seat

• Cleaned self independently

• Stood up from toilet with assistive device

• Pulled pants up independently

• Urinary catheter

• Incontinent briefs for bowel incontinence

• Check and change q2h and prn

Appliances and Programs

H3

Any Scheduled Toileting Plan:

• Scheduled

• Toileting

• Program including: organized, documented monitored and evaluated

Bladder Retraining Program

• Assessment

• Documented Plan of Care

• Communication to resident and care givers

• Scheduled times and approaches

• Evaluation of the plan

• Periodically reviewed and documented

Personal Hygiene - How the resident maintains personal hygiene, including combing hair, brushing teeth, shaving, applying makeup, and washing/drying face, hands, and perineum.

Refer to the RAI User’s Manual

Section 1.12 Completion of the RAI

Pages 1-17 thru 1-19

Participants in the assessment/process have

the requisite knowledge to complete an

accurate and comprehensive assessment

conducted or coordinated by an RN who

signs and certifies the completion of the

assessment.

The attending physician is an important

participant in the process.

The assessment process:

identifies resident’s problems, needs, strengths, and risk factors

Section 1.12 Completion of the RAI

pages 1-17 thru 1-18

Section 1.13 Sources of Information for Completion of the MDS

pages 1-18 thru 1-19

Refer to the RAI User’s Manual

Refer to the RAI User’s Manual

Section 1.14 CMS Clarification Regarding Documentation Requirements

pages 1-23 thru 1-24

The process of information gathering

should include:

• Direct observation

• Communication with direct caregivers

• Consult all shifts

• Review relevant information in the resident’s clinical record

• Consult with family members with direct knowledge