Tuesday, May 21, 2013
Are Nursing Homes Referring People to the Community? Information Bulletin # 380 (May, 2013) Several years ago, the disability and elder communities and the Centers for Medicare and Medicaid Services worked to revise the Minimum Data Set questionnaires. The MDS must be completed quarterly by each nursing home for each resident and then electronically submitted to CMS. The famous “Q1a” was the focus of the revisions that very much concerned the disability and elder communities. One of the primary goals was to change the system to help people transition to the community. Here are some national findings for the 1,322,697 people in nursing homes on 3/31/13. The following data is from what CMS collected from the nursing homes. 1. MDS Questions 100A-C report on the percentages of people in nursing homes who “Participated in the Assessment and Goal Setting”. Nationally, 84.48% of the residents participated. Nationally 31.73% of “family or significant others” participated, and 10.08% had a “guardian or legally authorized representative” participate. 2. MDS Questions 300A-B focus on “Residents’ Overall Expectation” and the “Goal Established During the Assessments.” The results show that nationally 27.63% of the residents “expect to be discharged to community.” That means 365,461 nursing home residents wanted to leave and expected to live in the community. While we do not have a breakdown, we know that residents themselves made up 62.27% of these respondents and another 30.23% were family or significant others. 3. Proceeding to question MDS 400A, nationally there were 84.85% of these 365,461 residents (that equals 310,093 people in nursing homes) had an “Active Discharge Plan” in place to return to the community. We have no idea why the 15.15% (55,367 people) did not have a plan since they wanted to leave the nursing homes and had an expectation they would leave. But when asked in MDS 400 B, “What determination was made by the resident and the care planning team regarding discharge to the community,” no data is provided. CMS writes “please be patient. This may take a few seconds to load.” It never loaded. It is not clear what “determination” had to be made for the 310,093 people who had an “active discharge plan.” Nor is it clear whether a nursing home “planning team” could trump a resident’s decision to move to the community. Are community advocates present when such a determination is made? Does the nursing home “planning team” have any knowledge of what community-based services could be provided? 4. When the MDS goes beyond the “Active Discharge Plan” stage, it asks if the “resident asked to return to the community?”(MDS 500 A). Again, no data was provided. Also, we do not understand why the resident, who had an “expectation” to return to the community (MDS 300 A/B) and who has an Active Discharge Plan, is then asked (how many times are necessary) if the resident asked to return to the community. What if a family member asks? 5. Here’s the real kicker. When the nursing homes completed the MDS 500 B question, the nursing homes concluded that 86.55% of the people had no “possibility of returning to community.” A death sentence imposed! The nursing home concluded that only 5.75% of the residents - remember, this is according to the nursing homes – had even a “possibility’ to return to the community. What services did the nursing homes think could not be provided in the community? 6. As appalling as these numbers are, the nursing homes are supposed to refer people to a “local contact agency” which is supposed to come into the nursing home and is supposed to provide assistance for the nursing home resident to transition back to their homes and apartments with appropriate home and community-based services. 7. And now for the final blow: only 2.5% of the nursing home residents were actually referred to a “local contact agency” as reported on MDS 500B. We assume (and hope) that these 2.5% are from those residents whom the nursing home thought there was a “possibility” to return to the community. Disability and Elderly Advocates: Based on the above data, it might be hard to imagine but people in nursing homes are Not Dead Yet! What are advocates doing to help disabled and elderly in nursing homes move back into the communities? 1. Here is a link for the MDS data which is available by State. http://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/Minimum-Data-Set-3-0-Public-Reports/Minimum-Data-Set-3-0-Frequency-Report.html 2. There are a limited number of prizes for advocates who know the name of your “local contact agency.” There are more prizes for the local contact agency that has received the most such referrals. These prizes are time-limited so please send in your responses as soon as possible. 3. Can anyone explain why CMS’ nursing home office of “Surveys and Certifications” does not check on any of the above MDS questions? Is there any doubt that if CMS included these MDS questions in its annual surveys the percentages of people who wanted to leave would increase? Maybe even more people would transition back to the communities. 4. There is a very special prize for the advocates who can identify any person in a nursing home who could not reside and be cared for in the community with appropriate services. Steve Gold, The Disability Odyssey continues Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/ To contact Steve Gold directly, write to firstname.lastname@example.org or call 215-627-7100. Ext 227.