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Care area triggers, the CAA process, and how they help the IDT

Editorial Note: This post has been adapted from HCPro’s popular title Long-Term Care MDS Coordinator’s Field Guide by Carol Maher, RN-BC, RAC-CT. For content details and ordering information, visit our Marketplace!

What is a care area trigger?

Certain single MDS items can trigger a care area. Some care areas are triggered by comparing responses entered on the previous MDS to the present MDS. Care area triggers (CAT) alert the assessors to potential problems/needs/strengths. The triggers also direct the assessor to conduct assessment activities. Triggered CAAs must be completed even if the same CAA triggered on the previous comprehensive MDS. All triggering care areas are available on the MDS 3.0 item set except for:

  • Delirium (BIMS summary score compared to previous BIMS summary score)
  • Mood state (PHQ9 score compared to previous)

MDS items target (trigger) care areas for additional assessment and review. Specific resident responses for one or a combination of MDS elements may trigger a CAA. The triggers identify residents who have or are at risk for developing specific functional problems and require further assessment.

How does the CAA process help the interdisciplinary team (IDT)?

Understanding the causes and relationships between a resident’s clinical issues and needs, discovering the “whats” and “whys” of the resident’s clinical issues and needs, and finding out who the resident is and consideration for incorporating his or her needs, interests, and lifestyle choices into the delivery of care are key.

In addition to identifying causes and risk factors that contribute to the resident’s care area issues or conditions, the CAA process may help the interdisciplinary team (IDT) with the following items:

  • Identify and address associated causes and effects
  • Determine whether and how multiple triggered conditions are related
  • Identify a need to obtain additional medical, functional, psychosocial, financial, or other information about a resident’s condition that may be obtained from sources such as the resident, the resident’s family or other responsible party, the attending physician, direct care staff, rehabilitative staff, or that requires laboratory and diagnostic tests
  • Identify whether and how a triggered condition actually affects the resident’s function and quality of life, or whether the resident is at particular risk of developing the conditions
  • Review the resident’s situation with a healthcare practitioner (e.g., attending physician, medical director, or nurse practitioner) to try to identify links among causes and between causes and consequences and to identify pertinent tests, consultations, and interventions
  • Determine whether a resident could potentially benefit from rehabilitative interventions
  • Begin to develop an individualized care plan with measurable objectives and timetables to meet a resident’s medical, functional, mental and psychosocial needs as identified through the comprehensive assessment