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Significant change criteria

Q: I am a little confused on the significant change criteria and need some clarification. In MDS 2.0 the division of changes was 0,1,2 to a 3,4 and vice versa. Now with MDS 3.0 the division of changes is not clear. I know that it is always the team’s decision if the residents have changed enough to impact their need for care but has there been an ADL division. It seems doing a significant change for someone that goes from a 0 to 1 when even we can fluctuate in a day is redundant. Any clarification will be greatly appreciated.

A: Improvement or decline in two or more areas, such as decision-making or ADLs, are guidelines of types of common changes in residents for your team to use to evaluate a situation rather than a mandate to always code as a significant change. More important for you and your team is to determine the impact of such changes on the resident’s condition.  In Chapter 2 of the MDS 3.0 User’s Manual, there are several pages and many examples of what may constitute a significant change of condition.  A significant change in status assessment (SCSA) is not mandated just because ADLs improve or decline. SCSA decisions are not based on concrete criteria, but more broad-based criteria.

Guidelines for when a change in resident status in not significant (Note: this is not an exhaustive list):

  • Instances in which the resident continues to make steady progress under the current course of care. Reassessment is required only when the condition has stabilized.
  • Instances in which the resident has stabilized but is expected to be discharged in the immediate future. The facility has engaged in discharge planning with the resident and family, and a comprehensive reassessment is not necessary to facilitate discharge planning.
  • Improvement in two or more of the following such as decision-making, ADL are guidelines of types of common changes in residents for your team to use to evaluate a situation rather than a mandate to always code as a significant change.
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