By Deirdre Carlson, RD and Anita Klimanis, RD, LDN
The nutrition and hydration status of long term care residents are areas that both state and federal surveyors pay close attention to, and rightfully so. Malnutrition in elderly populations is associated with poor clinical outcomes and is an indicator for increased mortality.
In fact, those residents with severe malnutrition are also at increased risk for developing a number of chronic medical conditions. As a registered dietitian in long term care, it is important to not only complete nutritional assessments on your residents according to the facility policies and procedures, but also be familiar with what the MDS is and how to properly complete it.
What Does MDS Mean?
The minimum data set (MDS) is a tool for implementing standardized assessment and for facilitating care management in long-term care facilities. By law, all residents in Medicare and/or Medicaid-certified nursing homes must be assessed according to this prescribed instrument.
The MDS 3.0 has been designed to improve the reliability, accuracy, and usefulness of the MDS, to include the resident in the assessment process, and to use more standardized protocols.
Long term care dietitians generally code section K and parts of section V in the MDS. The MDS Coordinator will be able to explain which sections are to be coded by the RD at the individual facility level.
About MDS Assessments
MDS assessment forms are completed for all residents in certified long-term care facilities, regardless of their source of payment. The assessments are completed within 14 days of admission, and at quarterly and annual intervals as well as when there is a significant change in condition.
These assessments are completed by various members of the interdisciplinary team. They are used for resident care planning, Medicare and Medicaid payments, monitoring quality of care, and the Medicare/Medicaid Certification Process. The information gathered in the assessment is transmitted electronically to the appropriate state MDS database.
Per Federal Regulations – the facility must maintain 15 months worth of MDS documentation in each resident’s clinical record.
Some Common Terms within MDS
Assessment Reference Date: The Assessment Reference Date (ARD) is the date that signifies the end of the look back period. This date is used to base responses to all MDS coding items, and can vary depending on the section that is being completed. For section K of the MDS, the look back period is 7 days. The window is midnight to midnight. For example, if the ARD is 6/25/21, the look back time frame is: 6/19/21 to 6/25/21. Therefore, the RD should wait until 6/26/21 to begin coding the MDS for this resident.
A “Significant Change” is a decline or improvement in a resident’s status that:
- Will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions
- Impacts more than one area of the resident’s health status
- Requires interdisciplinary review (via a new MDS assessment) and revision of the Care Plan
5% Weight Loss in 30 Days: Start with the resident’s weight closest to 30 days ago, and multiply it by .95 (or 95%). The resulting figure represents a 5% loss from the weight 30 days ago. If the resident’s current weight is equal to or less than the resulting figure, the resident has lost more than 5% body weight.
10% Weight Loss in 180 Days: Start with the resident’s weight closest to 180 days ago and multiply it by .90 (or 90%). The resulting figure represents a 10% loss from the weight 180 days ago. If the resident’s current weight is equal to or less than the resulting figure, the resident has lost 10% or more body weight.
Physician Prescribed Weight Loss Regimen: A weight reduction plan ordered by the resident’s physician with the care plan goal of weight reduction. May employ a calorie-restricted diet or other weight loss diets and exercise. Also includes planned diuresis. It is important to note that the weight loss is intentional.
5% Weight Gain in 30 Days: Start with the resident’s weight closest to 30 days ago and multiply it by 1.05 (or 105%). The resulting figure represents a 5% gain from the weight 30 days ago. If the resident’s current weight is equal to or more than the resulting figure, the resident has gained more than 5% body weight.
10% Weight gain in 180 Days: Start with the resident’s weight closest to 180 days ago and multiply it by 1.10 (or 110%). The resulting figure represents a 10% gain from the weight 180 days ago. If the resident’s current weight is equal to or more than the resulting figure, the resident has gained more than 10% body weight.
Parenteral/IV Feeding: Introduction of a nutritive substance into the body by means other than the intestinal tract (i.e. subcutaneous, intravenous). This can include TPN, PPN, and IV fluids.
Feeding Tube: Presence of any type of tube that can deliver food/nutritional substances/fluids/medications directly into the gastrointestinal system. Examples include, but are not limited to, nasogastric tubes, gastrostomy tubes, jejunostomy tubes, percutaneous endoscopic gastrostomy (PEG) tubes.
Mechanically Altered Diet: A diet specifically prepared to alter the texture or consistency of food to facilitate oral intake. Examples include soft solids, puréed foods, ground meat, and thickened liquids. A mechanically altered diet should not automatically be considered a therapeutic diet.
Therapeutic Diet: A therapeutic diet is a diet intervention ordered by a health care practitioner as part of the treatment for a disease or clinical condition manifesting an altered nutritional status, to eliminate, decrease, or increase certain substances in the diet (i.e. sodium, potassium).
Here’s what a long term care dietitian should pay special attention to when it comes to state survey.
Check out these ways to keep residents engaged with food.
Deirdre Carlson, RD, lives in Northern California thanks to a travel position with Dietitians On Demand. She spent nearly two years working in long term care before transitioning to acute care. Anita Klimanis, RD, LDN is a regional corporate dietitian with Dietitians On Demand. She provides consultant services for both acute and long-term care facilities in the Baltimore area.
Dietitians On Demand is the nationwide leader in staffing registered dietitians, specializing in short-term, temporary and permanent-hire positions in acute care, long term care and food service positions. Our dietitians cover a vacancy, maternity leave, vacations, FMLA or increases in census. Check out our job openings, or request your coverage today!
Dempsey DT, Mullen JL, Buzby GP. The Link Between Nutritional Status and Clinical Outcome: Can Nutritional Intervention Modify It? Am J Clinical Nutrition. 47: 352-6.
Thomas DR, Ashmen W, Morley JE, Evans WJ. Nutritional Management in Long-Term Care: Development of a clinical Guideline. Council for Nutritional Strategies in Long-Term Care. 2000:55(12): M725-34.