Section F is critical to creating a patient-centered care plan.

The RAI Manual states, “A lack of attention to lifestyle preferences can contribute to depressed mood and increased behavior symptoms.”  However, are we utilizing the interview for daily and activity preferences appropriately to ensure that we reduce depression and behavior symptoms? Remember that behavior does directly corelate with two quality measures:

  • Percentage of long-stay residents who have symptoms of depression.
  • Prevalence of Behavior Symptoms Affecting Others.

Improving these measures also helps reduce hospitalization and improve function.

The RAI Manual also states that hearing the resident’s voice is important to patient centered and high-quality care. Activity preferences are key for ensuring that the residents continue to find meaning in their lives. This will help them to engage with therapy services and daily care activities, leading to better patient outcomes and has the potential to reduce pressure injuries, hospitalizations, and falls.

Important things to consider for the daily and activity preferences interview:

  • Encourage resident to state all activity preferences even from prior to their admission. While these may not be coded on the MDS, they should be considered in planning care and discharge.
  • When a resident gives a long or indirect answer, it is beneficial to explore their answers to fully understand their meaning.
  • “echo” or summarize the resident’s statements to ensure that you are understanding the main themes of their answers. This will give residents the chance to confirm or correct your understanding.
  • Ensure that the resident can hear and understand you. Some resident’s benefit from hearing and seeing the question in writing.
  • Conduct the interview in a quiet and private setting. Sit and face the resident so they do not feel rushed.
  • You can break the interview into smaller pieces if a resident becomes tired. This will ensure that they can still thoroughly answer all the questions.
  • Explain to the resident that these questions are important for high quality care and quality of life.
  • Encourage the resident to state their desires regardless of their current actual or perceived physical limitations.
  • Include friends and family to further support the resident’s preferences.

Remember that the RAI Manual states, “Resident preferences may be influenced by many factors in a resident’s physical, psychological and environmental state, and can be challenging to truly discern.” However, once they are identified they can be applied to care to improve quality.

Ways to use Section F Resident Preferences to develop a holistic and person-centered approach

  • Evaluate items that the resident deemed important and ask further questions- this interview is not meant to be absolute or all inclusive. It is meant to begin an ongoing dialogue with staff and residents.
  • Pay attention to details that the resident states are important.
  • Identify physical barriers that may prevent the resident from engaging in preferred activities. Care planning will help the resident to overcome these barriers.
  • Consider flexing meal times to accommodate resident preferences.
  • Support social connections with family and friends.
  • Support resident decisions. Make accommodations as needed.
  • Provide variety of books, magazines, music, crafts, and games to see what the resident decides to engage in. Staff should make time to play games with resident’s interested in this.
  • Make arrangements for residents to go outside or be near windows when outdoor activities are preferred.
  • Allow for and support religious preferences and activities.
  • Consider the inclusion of pet therapy.

We may not be placing the importance on this interview that it deserves. Facilities that consider preferences do have reduced behaviors and improved mood in their residents. This improved care ultimately leads to an improvement in the quality measures, especially those that directly relate to mood, psychiatric medications, and behaviors. Therefore, this interview is a tool that should be utilized to effectively improve care. Could your facility be missing out on these ways to improve quality measures?

Additional Resources:

https://downloads.cms.gov/files/mds-3.0-rai-manual-v1.17.1_october_2019.pdf

National Partnership to Improve Dementia Care in Nursing Homes at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/National-Partnership-to-Improve-Dementia-Care-in-Nursing-Homes

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