The MDS (Minimum Data Set) is a tool for implementing standardized assessment and for facilitating care management in nursing homes (NHs) and non-critical access hospital swing beds (SBs). Its content has implications for residents, families, providers, researchers and policymakers. 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 standard protocols used in other settings.
See our Rebalancing the Long-Term Care System page for related information.
Transitions and Long-Term Care: A Look at MDS 3.0 Section Q and Money Follows the Person (January 30, 2012)
The Administration on Aging hosted a webinar giving an overview of MDS 3.0 Section Q and Money Follows the Person and detailing how these programs affect the aging network.
* To access the recording, click on the link and scroll down to the bottom of the webpage
The Impact of MDS 3.0/Section Q Implementation
Since the implementation of MDS 3.0 in October 2010, the Ombudsman Resource Center and the Administration on Aging (AOA) has been seeking information regarding the impact of MDS 3.0, specifically Section Q, on residents and the Ombudsman program. The Center solicited information through quarterly questionnaires and shared information with the Ombudsman network, AOA, and the Centers for Medicare and Medicaid Services (CMS). The information gathered from these questionnaires will be used by NORC, AOA, and CMS to provide support and training to ombudsman programs and entities designated as local contact agencies as they assist residents in transitioning out of nursing homes.
- Step by Step Referal Guide
- SLTCO RESPONSE SUMMARY: NORC QUESTIONNAIRE, MAY 2012
- LLTCO RESPONSE SUMMARY: NORC QUESTIONNAIRE, MAY 2012
- SLTCO RESPONSE SUMMARY: NORC QUESTIONNAIRE, JUNE 2011
- LLTCO RESPONSE SUMMARY: NORC QUESTIONNAIRE, JUNE 2011
- LLTCO and SLTCO COMMON THEMES: NORC QUESTIONNAIRE, JUNE 2011
- SLTCO RESPONSE SUMMARY: NORC QUESTIONNAIRE, MARCH 2011
- LLTCO RESPONSE SUMMARY: NORC QUESTIONNAIRE, MARCH 2011
- Survey Overview Presentation
- Common Themes
- December 2010 SLTCO Section Q Questionnaire Highlights
- December 2010 SLTCO Section Q Questionnaire Results.
Your Discharge Planning Checklist: For patients and their caregivers preparing to leave a hospital, nursing home, or other health care setting
This discharge planning checklist from the Centers for Medicare and Medicaid Services provides consumers and their families with information about transitioning between care settings.
MDS 3.0 a New Era, an October 2010 PowerPoint Presentation by CMS's Thomas Dudley, MS, RN
Fact Sheet for Long-Term Care Ombudsmen: MDS 3.0 Section Q (November 2010)
MDS 3.0 Overview Conference Call (October 2010)
Information Brief: Changes in the MDS 3.0 for Long-Term Care Ombudsman (September 2010)
This document, by Sara Hunt, MSSW, NORC Consultant, provides long-term care ombudsmen with information about the primary changes in the updated version (3.0) of the Minimum Data Set (MDS). The MDS 3.0 will be used by certified nursing facilities beginning in October 2010. This document focuses on the changes that are most applicable to ombudsman advocacy, educational and empowerment activities with residents and families. The information presented in this document is not a comprehensive list of all of the changes from the previous version, the MDS 2.0. For a more thorough understanding of the resident assessment and care planning process and how ombudsmen can use these as advocacy tools, refer to Using Resident Assessment and Care Planning As Advocacy Tools: A Guide for Ombudsmen and Other Advocates. Additional resources are included under Resources in this document.
CMS Presentation on MDS 3.0 and Section Q from the 2010 Annual State Ombudsman Training Conference
CMS presented on the implementation of nursing home (NH) minimum data set (MDS), version 3.0 and Section Q, which asks a resident’s expectations about transitioning out of a facility. The session provided information on the impact of the MDS 3.0 Section Q and the ombudsman program’s unique role in this process. Ombudsmen will have the opportunity to work with partners across many LTC settings as they advocate for NH consumers who want to talk with a community agency to learn about community care and supports. Ombudsman will provide information to State NH surveyors if referral and/or discharge planning issues are identified.
Presenter: Mary Beth Ribar, MS, RN, Centers for Medicare and Medicaid Services, Center for Medicaid & State Operations, Division of Advocacy & Special Initiatives
- Section Q PowerPoint Presentation
- Overview and Context MDS 3.0 Section Q PowerPoint Presentation
- Section Q Information Sheet
- Section Q Questions and Answers
- Money Follows the Person Brochure
Your Right to Get Information About Returning to the Community Brochure
CMS has released a new brochure for residents about returning to the community. It is related to Section Q in that it explains to the resident why they are being asked by facility staff whether they want more information about the possibility of returning to the community. There is a place in the back of the brochure for contact information for the long-term care ombudsman program. Copies of the brochure can be obtained from the CMS website. It is CMS Product No. 11477. Users will be asked to create a username and password. Residents and families can ask for a copy by calling 1-800-MEDICARE. The brochure can also be downloaded and printed. If referencing the brochure in an article or other text, use this short URL http://go.usa.gov/xTe.
Money Follows the Person: Impediments to Implementation: A Fact Sheet on Program Start up, Capacity and Access
Developed by NASUAD. The Money Follows the Person Rebalancing Demonstration Program (MFP) was designed to assist states in rebalancing their long-term care systems, and to help Medicaid beneficiaries transition from institutions to the community. Since its inception, MFP has faced many barriers to implementation, most of which have resulted in the program transitioning fewer individuals than originally anticipated. In efforts to clarify the origin and impact of these early problems and ongoing capacity and access challenges, NASUAD prepared a fact sheet, outlining some of the most commonly-reported programmatic complications, such as the unanticipated consequences of statutory compliance and a lack of accessible, affordable housing for MFP participants.
Interviewing Vulnerable Elderly (VIVE)
CMS uses this video in its training related to the MDS 3.0. CMS has now made the video available for instant viewing on YouTube. DVDs are available from CMS and can be ordered by going through the CMS website. It is CMS Product No. 11479-CD.
Gladys & Linda Return to the Community
A 10-minute video of two recently transitioned nursing home residents provide perspectives on returning to home after being admitted to a nursing home. Other transition and MFP YouTube videos are available at this CMSHHSgov YouTube channel.
CMS Training Materials
IncludeMDS 3.0 coding training slides, instructor guides, training aides, MDS 3.0 RAI Manual updates and link to CMS internal and external websites.
Community Living Initiative
Includes the most up-to-date point of contact list and Section Q&A document, best practice tools and links to CMS Section Q training, brochure and videos resources. This site also includes a May 20, 2010, CMS letter to State Medicaid Directors, which provides information on new tools for community integration as well as to remind states of existing tools that remain strong resources in state efforts to support community living.
MDS 3.0 for Nursing Homes and Swing Bed Providers Webpage
Contains information about the MDS 3.0
MDS 3.0 Training Materials
Provides MDS 3.0 coding training slides, instructor guides, training aides, MDS 3.0 RAI Manual updates and links to CMS internal and external websites