Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency
The decision to complete a resident interview or a staff interview is guided by coding in Section B0700. When coding the gateway question for each interview (which asks if the interview should be conducted) the assessor should only code a dash (not assessed) if the ability to interview the resident was not assessed.
- When Section B0700 is coded as a 3-Never or Rarely Understood the gateway question should be coded as a no, and the interviewer should proceed with the staff assessment.
- When the patient is coded as a 0, 1, or 2 in Section B0700 the interviewer should attempt the resident interview. All answered questions should be coded, and the assessor should follow the instructions for incomplete interview for each interview section to determine if the resident interview should be followed by a staff interview.
The first step in a successful interview process is to determine if the resident is capable of participating in an interview, or if the staff interview should be completed. The resident’s ability to participate is determined by Section B0700 (Makes Self Understood) of the MDS 3.0 Assessment. According to the RAI User’s Manual, how the patient makes himself or herself understood is defined on page B-6 as the following:
“Able to express or communicate requests, needs, opinions, and to conduct social conversation in his or her primary language, whether in speech, writing, sign language, gestures, or a combination of these. Deficits in the ability to make one’s self understood (expressive communication deficits) can include reduced voice volume and difficulty in producing sounds, or difficulty in finding the right word, making sentences, writing, and/or gesturing.”
The assessor is instructed to conduct the assessment using the resident’s preferred language, and to consult with staff who care for the patient across all shifts. The assessor is to observe and assess the patient directly, as well as observe and assess the resident’s interactions with others over all shifts. Based on these assessments, the patient can be coded as following:
- Code 0, understood: If the resident expresses requests and ideas clearly.
- Code 1, usually understood: If the resident has difficulty communicating some words or finishing thoughts but is able if prompted or given time. He or she may have delayed responses or may require some prompting to make him/herself understood.
- Code 2, sometimes understood: If the resident has limited ability but is able to express concrete requests regarding at least basic needs (e.g., food, drink, sleep, toilet).
- Code 3, rarely or never understood: If, at best, the resident’s understanding is limited to staff interpretation of highly individual, resident-specific sounds or body language (e.g., indicated presence of pain or need to toilet) (RAI User’s Manual, page B-7).
- Section C:
- To be considered a completed interview the resident had to attempt and provide relevant answers to at least four of the questions included in C0200-C0400.
- To be relevant, a response only has to be related to the question (logical); it does not have to be correct.
- The interviewer will stop the interview after coding Section C0300 (Day of the week) if all responses have been nonsensical, or there has been no written or verbal response up to this point, or if there has been no verbal or written response for some questions and for all others the resident has given a nonsensical response.
- Section D:
- To be considered a completed interview the resident has to answer the frequency response of at least 7 of the 9 items on the PHQ-9.
- If the symptom frequency is blank for 3 or more items the interview is considered to be incomplete, and the staff assessment should be attempted.
- Section J:
- If the patient is unable to answer Section J0300 (Pain Presence), the interviewer should skip to the staff assessment for pain.
- If the patient is able to provide a relevant answer to J0300, the interviewer should complete the resident interview for pain.
- If the patient is unable to answer Section J0400 (coded as a 9) then interviewer should also complete the staff interview.
- Rationale for completing the resident interview is that any information gleaned directly from the resident about their level of pain will be helpful in care planning for treatment of pain.
- Section F:
- If the patient is unable or unwilling to participate in the resident interview, the interviewer should conduct the interview with a family member or significant other.
- Section F Interview is the only interview that does not rely directly on patient self-report.
- The interview is considered to be incomplete if the resident gives nonsensical responses or fails to respond to 3 or more of the 16 items in Sections F0400 and F0500.
- If the interview is stopped because it is considered to be incomplete the remaining questions will be coded as a 9, and the interviewer will proceed with staff assessment.
The interview process is completed to encourage the resident to make his or her voice heard during the Care Planning process. The interview process also provides an opportunity for staff to delve deeper into any concerns that the patient may have in order to provide more resident-specific care and increase patient satisfaction with their stay.
Resident and staff interviews are scripted, and the script for the interview should be followed exactly for each interview. This ensures that there is reliability between different staff members and assures that each overall score is an accurate representation of the patient’s deficits. If the scripted interview process is not followed, variations of the overall score may be representative of different interviewer techniques, and not changes in the patient’s overall condition.
Please keep the above tips in mind when completing the MDS and determining whether interviews are accurate, applicable and the process supports inter-rater reliability!
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