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Coding the RAI-MDS 2.0for Experienced Assessors Cognitive and Mental Healthand Quality of LifeParticipant WorkbookRevised: November 2014

All rights reserved.The contents of this publication may be reproduced unaltered, in whole orin part and by any means, solely for non-commercial purposes, provided thatthe Canadian Institute for Health Information is properly and fully acknowledgedas the copyright owner. Any reproduction or use of this publication or its contentsfor any commercial purpose requires the prior written authorization of the CanadianInstitute for Health Information. Reproduction or use that suggests endorsement by,or affiliation with, the Canadian Institute for Health Information is prohibited.For permission or information, please contact CIHI:Canadian Institute for Health Information495 Richmond Road, Suite 600Ottawa, Ontario K2A 4H6Phone: 613-241-7860Fax: 613-241-8120www.cihi.cacopyright@cihi.ca 2014 Canadian Institute for Health Information Based upon the Resident Assessment Instrument (RAI) RAI-MDS 2.0 User’s Manual, CanadianVersion, 2012. The RAI-MDS 2.0 is interRAI Corporation, Washington, D.C., 1997, 1999. Modified withpermission for Canadian use under licence to the Canadian Institute for Health Information. Canadianizeditems and their descriptions are protected by copyright: 2002, Canadian Institute for Health Information.CIHI 2014-20152

Coding the RAI-MDS 2.0 for Experienced Assessors:Cognitive and Mental Health and Quality of LifeTable of ContentsAbout CIHI . 4Acknowledgements . 4Objectives . 5Materials Needed . 5Coding and Interpreting. 6RAI-MDS 2.0 Guidelines . 6RAI CODE Critical-Thinking Strategy. 7Pre-Work Activity . 8Activity 1 – Interpret Coding. 9Activity 2 – Coding and Interpreting .17Data Quality .31Ensuring Quality Data for Quality Care .31Activity 3 - Data Quality .33CIHI 2014-2015i

About CIHIThe Canadian Institute for Health Information (CIHI) collects and analyzes information on healthand health care in Canada and makes it publicly available. Canada’s federal, provincial andterritorial governments created CIHI as a not-for-profit, independent organization dedicatedto forging a common approach to Canadian health information. CIHI’s goal: to provide timely,accurate and comparable information. CIHI’s data and reports inform health policies, supportthe effective delivery of health services and raise awareness among Canadians of the factorsthat contribute to good health.AcknowledgementsCIHI wishes to acknowledge and thank interRAI and staff at participating organizations acrossCanada who provided expertise and support and who volunteered to pilot the Coding theRAI-MDS 2.0 for Experienced Assessors: Cognitive and Mental Health and Quality of Lifetraining. Their generous contribution has allowed us to provide you with this education material.We would like to thank the residents/clients, staff and volunteers at the Élisabeth BruyèreResidence, Extendicare Starwood, Bethany Care Society and Champlain Community CareAccess Centre for giving CIHI permission to use their pictures, including those of their familiesand homes.All names and stories used in this training are fictitious.SymbolsImportant NoteCIHI 2014-20154

Coding RAI-MDS 2.0 Experienced Assessors – Cognitive and Mental Healthand Quality of LifeObjectivesThe web conference Coding the RAI-MDS 2.0 for Experienced Assessors: Cognitive andMental Health and Quality of Life is a two and a half hour activity-based training session. Thissession covers the following sections of the RAI-MDS 2.0 assessment: Section B: Cognitive Patterns Section E: Mood and Behaviour Patterns Section F: Psychosocial Well-Being Section N: Activity Pursuit PatternsIn this training, you will Use the RAI-MDS 2.0 User’s Manual to interpret and apply coding standards in the areasof Cognitive and Mental Health and Quality of Life; Document Cognitive and Mental Health and Quality of Life assessment findings using theRAI CODE critical-thinking strategy; and Identify ways to improve data quality in your facility.The primary intent is for you to engage in peer discussion and sharing. In this session, you willdraw on each other’s clinical judgment and expertise to code vignettes where the interpretationof the coding standards for documenting items becomes challenging. You will also explore theconsequences of incorrect coding for clinical and organizational decision-supporting yourfacility.Materials NeededThe following materials are required for this web conference: Resident Assessment Instrument (RAI) RAI-MDS 2.0 User’s Manual Coding the RAI-MDS 2.0 for Experienced Assessors: Cognitive and Mental Health andQuality of Life Participant WorkbookCIHICIHI2014-20155

Coding RAI-MDS 2.0 Experienced Assessors – Cognitive and Mental Healthand Quality of LifeCoding and InterpretingRAI-MDS 2.0 GuidelinesAs described in the RAI-MDS 2.0 Manual, there are several integral concepts used to assistclinicians in documenting assessment findings. These include: The resident is a person with strengths, preferences and needs Clinical Assessment Protocols identify persons with potential to improve and those at risk ofdecline An interdisciplinary approach to resident care is vital – both in assessment and indeveloping the resident’s care plan Good clinical practice requires sound assessment skillsUsing the RAI-MDS 2.0 Guidelines in the assessment process Minimum data set (MDS) Observation period is the seven days prior to the assessment reference date, unless alonger time frame is specified Information is obtained from multiple sources Clinical judgment is key—it is not a questionnaire Coding standards guide the assessment process Coding reflects resident’s functioning Regardless of the assumed cause With assistive/adaptive aids in placeAll sections work together to give a holistic view of the residentCIHICIHI2014-20156

Coding RAI-MDS 2.0 Experienced Assessors – Cognitive and Mental Healthand Quality of LifeRAI CODE Critical-Thinking StrategyThis mnemonic helps guide the critical-thinking process that often occurs intuitively as part ofyour assessment process. It is a tool for reflective problem-solving and decision-making.CIHICIHI2014-20157

Coding RAI-MDS 2.0 Experienced Assessors – Cognitive and Mental Healthand Quality of LifePre-Work ActivityIn This Activity You WillPrior to the web conference: Read the vignettes for Activity One and Activity Two Activity #1 – Vignettes 1 and 2 Activity #2 – Vignettes 1 and 2Note: The documentation of your findings and rationale will be completed during the webconference. Approximate time to complete: 10 minutesCIHICIHI2014-20158

Coding RAI-MDS 2.0 Experienced Assessors – Cognitive and Mental Healthand Quality of LifeActivity 1 – Interpret CodingIn This Activity You Will Review each vignette and associated coding You will use the following resources:- Participant workbook: Activity One—vignettes 1 and 2- RAI-MDS 2.0 guidelines found on page 6- RAI CODE critical-thinking strategy found on page 7- Example – Average Time Involved in Activities (N2) on page 13- RAI-MDS 2.0 User’s Manual As a group, document your rationale for the coding of each vignette Present your findings and participate in discussions Time allotted: 15 minutesCIHICIHI2014-20159

Coding RAI-MDS 2.0 Experienced Assessors – Cognitive and Mental Healthand Quality of LifeVignette 1: Mr. T—F1, F2 and F3Mr. T has been a widower for 20 years. He worked as a landscape architect before he retired.He was admitted to Rainbow LTC home two years ago following a CVA resulting inright-sided paralysis. Mr. T shares a semi-private room with Mr. B, a younger resident with abrain injury.Mr. T spends most of his time in his room working on his laptop. He has stated to staff that hewould like to finish writing his book before he dies. He has asked to be moved to a private roomwhen one becomes available. Communication between him and his roommate is challenging;he says he has no quiet time as his roommate has frequent visitors and is noisy at night. Mr. T’sson has tried to communicate with him using Skype, but Mr. T refused, saying he is upset thathis son sold the family home and moved to South America with his family rather than caring forhim at home.He is an experienced gardener and had enjoyed volunteering at the local chapter of theHorticultural Society prior to admission. He has not done any gardening this summer. He saysit’s not the same without Frank, who was a volunteer at the facility. Mr. T had developed afriendship with Frank, and when Frank moved to Edmonton with his daughter four months ago,Mr. T stopped going to the garden. He says he misses Frank very, very much. This was the onlygroup activity he attended and enjoyed.CIHICIHI2014-201510

Coding RAI-MDS 2.0 Experienced Assessors – Cognitive and Mental Healthand Quality of LifeReview the responses and document your rationale for coding of the items in F1, F2 and F3 forMr. T.Rationale:Rationale:CIHICIHI2014-201511

Coding RAI-MDS 2.0 Experienced Assessors – Cognitive and Mental Healthand Quality of LifeRationale:Important NoteIn the Index of Social Engagement (ISE), all items from Section F1 (Sense ofinitiative/involvement) are used in the calculation of this outcome scale.CIHICIHI2014-201512

Coding RAI-MDS 2.0 Experienced Assessors – Cognitive and Mental Healthand Quality of LifeExample—N2Average Time Involved in Activity Pursuits (N2)The past 7 days, Mrs. B woke up around 7 a.m. She listened to the news on TV until the PSWcame in to assist her with morning care. Once in her wheelchair, she pushed herself to thedining room for breakfast. At 9 a.m. she went to the activity room and participated in groupexercise led by the recreation therapy assistant. At 10 a.m. the nurse gave Mrs. B hermedications, followed by a dressing change to her right foot. By 11 a.m., Mrs. B sat inher recliner chair and knitted.After lunch, she took a one-hour nap. She had the volunteer wake her up for the 2 p.m. activity(cooking and music sessions). Mrs. B spent her afternoons in the lounge chatting with otherresidents or sitting outside on the patio feeding birds.After supper, Mrs. B napped as usual and got up when her husband arrived. Just before he leftat 10 p.m., he helped her with undressing and getting her in bed. On his way out, he notified thenurse so Mrs. B’s HS medications could be administered.Code 0 (Most—more than 2/3 of the time)Rationale: Mrs. B was actually involved in activity pursuits more than two-thirds of the availablefree time she had in the last seven days. She was asleep approximately 11 out of 24 hours. She received nursing care/treatments or was engaged in ADL activities approximately 6out of 24 hours. This left her approximately 7 out of 24 hours to pursue various activities.She used most of these 7 hours participating in group activities (exercise, music and cookingsessions) and being involved in one-on-one activities (watching TV, knitting, reading and feedingbirds). She was also involved in chatting with other residents in the afternoons and visiting with herhusband in the eveningCIHICIHI2014-201513