1. Resident Assessment Instrument - Minimum Data Set (RAI-MDS) 2
Resident Assessment Instrument - Minimum Data Set (RAI-MDS) Presentation to Family Councils’ Durham Wednesday, October 22, 2008
Soo Ching Kikuta, RN, MScN, Business Lead, LTCH CAP
Jennifer Ratcliff, Communications Lead, LTCH CAP

2. Presentation Overview
Part A: Resident Assessment Instrument - Minimum Data Set 2.0 (RAI-MDS 2.0)
Part B: Long-Term Care Homes Common Assessment Project (LTCH CAP) 2

3. Part A: Resident Assessment Instrument- Minimum Data Set (RAI-MDS) 2.03 3

4. Alberta Resident Classification System (ARCS)
External Classifier
Assess Nursing and Personal Care Needs of Resident
Output - FUNDING
Home Case Mix Measure (CMM)
Sum of care levels of all A to G residents in the home
Home Case Mix Index (CMI)
Snapshot - annually
Relative number used for funding
Based on 8 indicators: eating, toileting, transferring, dressing, potential for injury, ineffective coping, urinary continence bowel continence 4

5. ARCS and RAI-MDS 2.0 (Examples)
Funding tool
Focuses and rewards disability - no incentive with financial penalty to do rehabilitation, and preventative care
Participates by selected registered staff members in the process - no interdisciplinary team involvement
Funding output: CMI and CMM by home and provincial
No linkage to resident care, care planning or quality improvement
A clinical tool that enhances the assessment, develops an effective care plan, and improves resident care
Values restorative, enablement, rehabilitation, health promotion and prevention
Requires involvement of the resident, family/significant others and care team members
Builds-in monitoring system and can generate multiple output reports for tracking and monitoring of resident care progress and improvement quarterly
Multiple applications: care plan development, quality improvement, accreditation, benchmarking, data quality, funding, resource allocation, strategic planning, performance evaluation 5

6. Ontario RAI-MDS 2.0 Implementation in Long-Term Care Homes
625 Homes (77,228 beds)
35% of homes in Ontario are using RAI-MDS 2.0 (representing 217 homes across all LHINs)
100% of home participation has been voluntary 6

7. interRAI Countries Nordic Countries North America Canada, USA Europe
Iceland, Norway, Sweden,
Denmark, Finland
North America Canada, USA
Europe
Netherlands, Germany,
Switzerland, France,
UK, Italy, Spain,
Czech Republic,
Poland, Estonia
Middle East
Israel
Pacific Rim
Japan, China, Taiwan, Hong Kong,
South Korea, Australia,
New Zealand 7

8. RAI-MDS 2.0 Instrument Adoption in Canada8

9. The Core Function of RAI-MDS
Designed as a clinical tool that enhances the assessment, develops an effective care plan, and improves resident care
Records information in a standardized, holistic and interdisciplinary assessment tool (Minimum Data Set - MDS)
Identifies the majority of a resident’s strengths, needs and preferences to guide the staff in developing a more comprehensive, appropriate and individualized care plan
Captures residents’ care needs over 24 hours 9

10. RAI-MDS 2.0 Model Assessment Case Mix/ Resource Utilization Groups
Minimum
Data Set
Outcome
Measurement
Scales
Resident
Assessment
Protocols (RAPs)
Triggers
Quality
Indicators
Plan of Care 10

11. The MDS Assessment
The MDS assessment tool has 19 sections with over 450 assessment items in the categories of:
Oral/Nutritional Status
Oral/Dental Status
Skin Condition
Activity Pursuit Patterns
Medications
Special Treatments and Procedures
Discharge Potential and Overall Status
Assessment Information
U. Medication List
Identification Information
Cognitive Patterns
Communication/Hearing Patterns
Vision Patterns
Mood and Behaviour Patterns
Psychosocial Well-Being
Physical Functioning and Structural Problems
Continence
Disease Diagnoses
Health Conditions 11

12. Resident Assessment Protocols (RAPs)
RAPs are potential or actual problems that may require further assessment. There are 18 RAPs triggered by specific resident responses from one or a combination of MDS elements:
Activities
Falls
Nutritional status
Feeding tubes
Dehydration/fluid maintenance
Dental care
Pressure ulcers
Psychotropic drug use
Physical restraints
Delirium
Cognitive loss/dementia
Visual function
Communication
ADL function/rehabilitation
Urinary incontinence and indwelling catheter
Psychosocial well-being
Mood state
Behavioral symptoms 12

13. From Home Software: Reports Outcome Scales Quality Indicators
Resource Utilization Groups (RUGs)
RAI-MDS 2.0
outputs
RAI-MDS 2.0 assessment data is to be submitted electronically to Canadian Institute for Health Information (CIHI) quarterly. 13

14. Outcome Scales
Derived from MDS data (no extra work - it is calculated by the software, real time data!)
Aggregates information on resident needs and outcomes
Can be used to evaluate the resident’s clinical status at present and change over time
Comparative reports (by unit, resident, program and Home) 14

15. Outcome Scales Scale Measures Cognitive Performance Scale (CPS)
Level of cognition
Depression Rating Scale (DRS)
Level of depression
Activity of Daily Living (ADL Short Form, ADL Long Form, ADL Hierarchy)
ADL performance
Changes in Health, End-Stage Disease and Signs and Symptoms Scale (CHESS)
Predictor of mortality
Index of Social Engagement (ISE)
Degree of social engagement
Pain Scale
Prevalence of pain 15

16. Quality Indicators (QIs)
Flagging or identifying exemplary care and potential care concerns
Not direct measuring of quality
Monitoring resident’s risk or condition change and progress over time
Identifying residents for review 16

17. Quality Indicators (QIs)
There are 24 QIs for long-term care homes
New fractures
Falls
Behavioural symptoms affecting others
Symptoms of depression
Depression with no antidepressant
therapy
Use of nine or more medications
Cognitive impairment
Bladder or bowel incontinence
Occasional or frequent bladder or bowel incontinence without a toileting plan
Indwelling catheters
Fecal impaction
Urinary tract infections
Weight loss
Tube feeding
Dehydration
Bedfast residents
Decline in late-loss ADLs
Decline in ROM
Anti-psychotic use in the absence of psychotic or related conditions
Anti-anxiety / hypnotic use
Hypnotic use more than two times in last week
Daily physical restraints
Little or no activity
Stage pressure ulcers 17

18. Resource Utilization Groups (RUGs)
Upon completion of the MDS, the software automatically classifies residents into groups
There are 7 major groups, further divided into 44 distinct subcategories
These groups classify residents according to their clinical and diagnostic characteristics and resource utilization 18

19. Resource Utilization Groups (RUGs III)19

20. Multiple Uses for Data Collected at Point of Care
e.g. Are we getting the best outcomes for our health care dollars? How effective are our services? What are the priorities for quality improvement?
Clinical
Decision-making
Clinical & Utilization
Research
Public
Accountability
e.g. What are the outcomes of care? Do our residents achieve their health goals? What resources were used?
e.g. Do Ontarians' have equitable access to quality health services and how do we compare with other provinces?
Operational &
Strategic
Management
RAI-MDS 2.0 Assessment 20

21. Benefits: Residents and Family Members
Encourages resident and family involvement
Respects the value of helping residents achieving their highest level of functioning and quality of life
Offers a holistic interdisciplinary assessment of resident care needs and the development of a focused, individualized care plan
Flags actual and potential resident care needs in a timely fashion 21

22. What Families have said:
“We were very impressed with the Home. We have noticed Mum is much happier, especially in bed, and is not complaining of pain as much. She is not on as many medications. The Home explained everything they were doing. They treat her like family”.
“My brother felt like someone was finally paying attention to him. I noticed small improvements - he could walk on the carpet or out on the deck and he was able to dress himself. I was told what was being done and when I knew about his depression, I could watch out for signs of it and tell the staff”.
“The variability in the care delivery worried me. RAI-MDS makes a big difference. It helps the staff give the same level of care, regardless of which PSW is on shift. When someone is new, they can quickly be better informed”. 22

23. Benefits: Care Providers
Provides a common resident care approach in assessment and care planning
Increases awareness regarding residents’ strengths, symptoms, needs and preferences
Provides access to real time clinical information of residents; pinpoints underlying conditions unseen or yet to emerge
Helps to improve clinical practice by:
- Tracking resident-specific outcomes and
- Monitoring resident change over time
Improves resident teaching - related to ‘readiness for discharge’ 23

24. What Care Providers have said:
“I must emphasize how important the family involvement is, they are truly a part of the care team and we need their information to help us form the best possible care plan… they provide a wealth of information and are key in the care plan development process.”
- RAI Coordinator 24

25. Benefits - Administration or Executives
Enables informed decisions to be made regarding staffing, resource allocation, risk management, program planning, strategic planning and utilization by connecting RAI-MDS information with other management information
Contains clinical data to benchmark with other homes, has ability to identify and learn from industry leaders and sharing of best practices
Provides timely access to performance information to evaluate the home and track record of evidence
Improves staff training related to evidence of clinical performance 25

26. What Management has said:
“(MDS) has enabled the resident and family to have greater input into the plan of care. The plan of care becomes more personalized. The front line staff feel that they have a greater say about the resident.”
- Nursing Home Manager 26

27. Benefits - Health Care System
Informs public reporting on health system performance - empowers the consumer
Enhances the availability of consistent, comprehensive and quality data in an open and transparent approach
Improves confidence of the long-term care sector
Enhances information, aids benchmarking, policy development and sector planning 27

28. Lessons Learned - Benefits
“The implementation of RAI MDS increases team communication”
“Residents appreciate their added involvement in the assessment”
“With the implementation of RAI MDS 2.0 processes, we improve the co-ordination of resident assessment and interdisciplinary team meetings because MDS provides a common language”
“Our PSWs are feeling more engaged and valued by their increased participation in assessment”
“The MDS has uncovered underlying clinical conditions resulting in proactive treatment for residents”
“All discipline documentation is centralized…reduces discrepancies in documentation…and a more holistic view of the resident”
“Better care plan and more individualized”
“Given the high turnover of staff…the MDS assessment…helps safeguard and protect our residents….newly hired employees…may miss important assessment, however the MDS [is] foolproof” 28

29. Part B: Long-Term Care Homes Common Assessment Project (LTCH CAP)29 29

30. Local Health Integration Networks
Continuing Care e-Health
Program Footprint
Local Health Integration Networks
Program Streams
CCAC
CSS
CMH & A
LTCH
Common
Assessments
HC CAP
(CIAT)
CMH CAP
(CMHCA)
LTCH CAP
(RAI MDS)
HC CAP
(LSAS)
Business Systems
CSS MIS
CMH&A
MIS
FSMS
LTCH
MIS
CSS HRIS
CMH&A
HRIS
Architecture & Integration Standards Security, Privacy & Risk Management
Project Legend
CAP = Common Assessment Project CCM = Common Case Management
CIAT = Common Intake Assessment Tool CMH&A = Community Mental Health & Addictions
CSS = Community Support Services HC = Home Care
FSMS= Financial & Statistical Mgmt Systems HRIS = Human Resources Information System
LSAS = Long Stay Assessment Software LTCH = Long-Term Care Home
MIS = Management Information Systems RAI-MDS = Resident Assessment Tool Min. Data Set
Completed project
Project Rolling Out
Project in pilot 30

31. Implementation Timelines
Phase 6
Phase 7
Phase 8
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
09/10 31

32. Project Implementation Model

33. Requested Participants
Education Modules
Module
Description
Requested Participants
Training Day 1a
Home Preparation *
Administrator, DOC,
RAI Coordinator & Backup 1 1b
RAI Coordinator Forum (RAI Coordinator & Backup)
RAI Coordinator and Backup 2
Assessment (Coding)
DOC, RAI-C and Backup 3
Data Submission
4 hrs.
Web-X 4
RAI Outputs/Reports*
Administrator, DOC, RAI-C and Backup 5
Data Quality Management
2 hrs. 6
RAPs and Care Planning
Total Training Days = 6 days; 6 hours Web-X
Timeline = 9-12 Months 33

34. Regional Training and Support Teams34

35. Implementation Support
Site Visit
Implementation Toolkit
Designated RAI Educator
AIS
DART
CIHI User’s Manual
Phone Support
RAI-MDS Nutritional Care Resource Guide
Regional
Teleconference Support
Mentorship Program 35

36. Implementation Support
Implementation Toolkit: training, presentations, tools, checklists
60 Minutes audio presentations
Continuous training schedule
Project e-Newsletter
Frequently Asked Questions for Coding and Data Submission
Discussion Boards for Homes
On-Line Web Portal 36

37. Implementation Support
In-person help desk or
Operating 8:30 a.m. – 4:30 p.m. Monday to Friday
(with password)
Support Centre 37

38. Contact information
Long-Term Care Homes Common Assessment Project or 38

39. Questions? 39