Understanding and Coding MDS 3.0 Item Q0490: Resident's Preference to Avoid Being Asked

Understanding and Coding MDS 3.0 Item Q0490: Resident's Preference to Avoid Being Asked

Introduction

Purpose:
Respecting a resident's wishes and preferences is fundamental in delivering person-centered care within long-term care facilities. There are situations where a resident may prefer not to be asked about certain topics, such as discussions related to discharge planning or returning to the community. MDS Item Q0490, Resident’s Preference to Avoid Being Asked, documents whether a resident has expressed a desire to avoid being asked about their preference regarding community discharge. This article provides detailed guidance on how to correctly code this item to ensure accurate documentation and compliance with CMS standards.

What is MDS Item Q0490?

Explanation:
MDS Item Q0490, Resident’s Preference to Avoid Being Asked, is part of Section Q, which addresses the resident’s participation in assessment and goal setting, particularly concerning their interest in returning to the community. This item records whether the resident has expressed a preference to avoid being asked about their potential return to the community. Recognizing and honoring this preference is critical for maintaining the resident’s autonomy and ensuring that their care plan respects their wishes.

Accurate documentation of the resident’s preference to avoid certain discussions is essential for tailoring the care approach to the resident’s comfort level and ensuring that staff members respect their boundaries.

Guidelines for Coding Q0490

Coding Instructions:
To correctly code Item Q0490, follow these steps:

1. Discuss Preferences with the Resident: Engage in a conversation with the resident to understand their feelings about being asked questions related to returning to the community. This discussion should be handled sensitively, ensuring that the resident feels comfortable expressing their true preferences.
2. Select the Appropriate Response:
   • 0: No - Select this code if the resident has not expressed a preference to avoid being asked about returning to the community.
   • 1: Yes - Select this code if the resident has expressed a preference to avoid being asked about returning to the community.
3. Enter the Response in Item Q0490: Record the selected response in Item Q0490. Ensure that this preference is documented in the resident’s care plan so that all staff members are aware of the resident’s wishes and can respect them during care planning and discussions.
4. Document Any Additional Details: If the resident has provided specific reasons for their preference or if any additional considerations should be taken into account, document these details in the care plan to guide interactions with the resident.

Example Scenario:
A resident indicates during a care planning meeting that they find discussions about returning to the community stressful and prefer not to engage in such conversations. The MDS Coordinator documents this preference in Item Q0490 by selecting code 1 ("Yes"). This ensures that the resident's care plan reflects their desire to avoid these discussions, and staff are informed to respect this preference.

Best Practices for Accurate Coding

Documentation:
Maintain thorough documentation of the resident’s expressed preference to avoid being asked about returning to the community. This documentation should support the coding of Item Q0490 and ensure that the resident’s care plan aligns with their wishes.

Communication:
Ensure effective communication with the interdisciplinary care team about the resident’s preference. This ensures that all team members are aware of and respect the resident’s desire to avoid certain discussions, providing a consistent approach to care.

Training:
Provide regular training to staff on how to sensitively address residents’ preferences and how to document these preferences accurately. Staff should be equipped to handle discussions about sensitive topics in a way that honors the resident’s autonomy and comfort.

Conclusion

Summary:
MDS Item Q0490 is essential for documenting a resident’s preference to avoid being asked about their interest in returning to the community. By accurately coding this item and ensuring clear documentation, healthcare professionals can support resident-centered care while maintaining compliance with CMS regulations. Following the guidelines and best practices outlined in this article will help ensure that the resident’s preferences are respected and that their care plan is aligned with their comfort and wishes.

Click here to see a detailed step-by-step on how to complete this item set 

Reference

CMS's Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.19.1, October 2024. Refer to [Chapter 3, Page 3-19] for detailed guidelines on the CAA process and the importance of documenting the resident's preference to avoid being asked about returning to the community.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item Q0490: Resident’s Preference to Avoid Being Asked was originally based on the CMS's Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.19.1, October 2024. Every effort will be made to update it to the most current version. The MDS 3.0 Manual is typically updated every October. If there are no changes to the Item Set, there will be no changes to this guide. This guidance is intended to assist healthcare professionals, particularly new nurses or MDS coordinators, in understanding and applying the correct coding procedures for this specific item within MDS 3.0. The guide is not a substitute for professional judgment or the facility’s policies. It is crucial to stay updated with any changes or updates in the MDS 3.0 manual or relevant CMS regulations. The guide does not cover all potential scenarios and should not be used as a sole resource for MDS 3.0 coding. Additionally, this guide refrains from handling personal patient data and does not provide medical or legal advice. Users are responsible for ensuring compliance with all applicable laws and regulations in their respective practices.