Surprise! CMS Did It Again and What We Need To Do To Fix It.
Are you beginning to feel like it is never going to end? Guess what? It isn’t. The latest data coming out of CMS indicates there has been a decline in the functional domain points that agencies are earning. The general feeling among OASIS-C experts is that when OASIS –C came out, most of us were so focused on the major changes in the wound care sections that we failed to pick up on the smaller changes in the functional areas.
While much of the wording looked the same, upon closer scrutiny it turns out these minor changes make huge differences in the scoring and, consequently, the points and the dollars. For those of you who read the Home Health Line newsletter, the July 12, 2010 issue gives excellent examples of how substantial these changes really are.
What is clear to me is that an assessment is not an interview. Our nurses and therapists must read the responses and be clear on the intent and meaning of each response. Most importantly, the assessing home health clinician must watch the patient demonstrate their functional ability.
Somewhere along the way, when OASIS came out in 1997, our home health clinicians lost the idea of how an assessment is done. In its basic form, an assessment is about asking questions. However, it is mostly about observations validated by a patient’s responses. Clinicians must ask a patient to walk to the bathroom and show you where their medications are kept. You must ask what each medication is, what it is used for, and how often it is to be taken. When I was working in the field, some of my most interesting answers came from those kinds of questions.
But it’s not just about the answers. It’s about your observation of how those answers are achieved. How does the patient walk to get their medication? Does he need to hold onto a wall or furniture, or can he make it safely across the room independently? Can she safely get in and out of the bathtub? Can she touch her head, trunk, or toes? Without these observational specifics, you will not get an accurate assessment.
Sadly, as seniors try to hang on to their independence, they tend to mask their capabilities. I guarantee you if you ask a patient if they can bathe themselves, they will tell you yes. If you ask if they are incontinent, they are just as likely to tell you no. Assessments are about getting a true read that, in the long run, will help your patient live a better, fuller life.
A good home health clinician uses all of his or her senses to complete an assessment. You need your ears, nose and eyes, as well as touch to get a full read on your patient. I feel like a broken record when I talk to field staff about the proper way to complete an assessment. Often, I’m told it takes too long to complete OASIS as it is, and making a patient walk around to do functional activities just makes it even longer.
The truth is, doing it properly actually shortens your assessment time. While you are completing your observational assessment, you can also gather information on the majority of your functional elements. This streamlining of information allows you to complete an assessment without spending additional time questioning your patient.
It all goes back to Benner’s novice-to-expert definitions. More than ever before, home health clinicians need to be experts. All of us who work in home health must help staff to achieve this level of expertise. If we do, it will increase their satisfaction with their work as well as the financial wellbeing of our agencies.
Category: Education & Training, Ginny's Blog