Long-Term Care

Examining Section E: Correctly code behaviors and rejections of care

PPS Alert for Long-Term Care, January 1, 2011

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The intent of Section E of the MDS 3.0 is to identify behavioral symptoms that may cause distress to the resident and others. However, coding this section has caused distress for many facilities since the October 1, 2010, implementation. The majority of the challenges facilities have faced with this section are due to difficulties with cognitively impaired residents and some misunderstandings about how to code rejection of care.

Before coding Section E of the MDS 3.0, SNF staff members must know what behaviors they should be looking at, how to determine impact, and when a behavior is considered a rejection of care. Staff should also know how a resident’s cognitive impairment can affect the behaviors addressed in this section and be able to correctly code despite the challenges often raised by cognitive impairment.

Psychosis and behavior symptoms

Although items E0100, Potential Indicators of Psychosis, and E0200, Behavioral Symptom–Presence and Frequency, may seem relatively straightforward, some facilities are struggling to correctly code these items.

First of all, facility staff must know what type of behaviors they should be looking for. According to the RAI User’s Manual, a hallucination is “the perception of the presence of something that is not actually there. It may be auditory or visual or involve smells, tastes, or touch.” A delusion is defined as “a fixed, false belief not shared by others that the resident holds even in the face of evidence to the contrary.”

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to PPS Alert for Long-Term Care.

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