Q0490: Resident’s Documented Preference to Avoid Being Asked Question Q0500B

For Quarterly, Correction to Quarterly, and Non-OBRA Assessments. (A0310A=02, 06, or 99)

Item Rationale

This item directs a check of the resident’s clinical record to determine if the resident and/or family, etc. have indicated on a previous OBRA comprehensive assessment (A0310A = 01, 03, 04 or 05) that they do not want to be asked question Q0500B until their next comprehensive assessment. Some residents and their families do not want to be asked about their preference for returning to the community and would rather not be asked about it. Item Q0490 allows them to opt-out of being asked question Q0500B on Quarterly (non-comprehensive) assessments. If there is a notation in the clinical record that the resident does not want to be asked again, and this is a Quarterly assessment, then skip to item Q0610, Referral. Q0500B is, however, mandatory on all comprehensive assessments.

Note: Let the resident know that they can change their mind about requesting information regarding possible return to the community at any time and should be referred to the LCA if they voice this request, regardless of schedule of MDS assessment(s). If this is a comprehensive assessment, do not skip to item Q0610, continue to item Q0500B.

Coding Instructions for Q0490, Does the resident’s clinical record document a request that this question (Q0500B) be asked only on comprehensive assessments?

• Code 0, No: if there is no notation in the resident’s clinical record that they do not want to be asked Question Q0500B.

• Code 1, Yes: if there is a notation in the resident’s clinical record to not ask Question Q0500B except on comprehensive assessments.

Unless this is a comprehensive assessment (A0310A=01, 03, 04, 05), skip to item Q0610, Referral. If this is a comprehensive assessment, proceed to the next item, Q0500B.

Coding Tips

• Carefully review the resident’s clinical record, including prior MDS 3.0 assessments, to determine if the resident or other respondent has previously responded “No” to item Q0550A. If this is a comprehensive assessment, proceed to item Q0500B, regardless of the previous responses to item Q0550A.

Examples

1. Resident G is a 45-year-old individual weighing 300 pounds who is cognitively intact. They have congestive heart failure and shortness of breath requiring oxygen at all times. Resident G also requires 2 person assistance with bathing and transfers to the commode. They were admitted to the NH 3 years ago after their adult child who was caring for them passed away. During their Quarterly assessment, the NH social worker discussed options in which they could be cared for in the community but Resident G refused to consider leaving the NH. During the review of their clinical record, the assessor found that on their last MDS assessment, Resident G stated that they did not want to be asked again about returning to community living, that they have friends in the NH and really like the activities.

Coding: Q0490 would be coded 1, Yes, skip to Q0610; because this is a Quarterly assessment. If this was a comprehensive assessment, then proceed to the next item Q0500B.

Rationale: On their last MDS 3.0 assessment, Resident G indicated their preference to not want to be asked again about returning to community living (0. No on Q0550A).

2. Resident R is an 82-year-old widowed individual with advanced Alzheimer’s disease. They have resided at the nursing home for 4½ years and their family requests that they not be interviewed because they become agitated and upset and cannot be cared for by family members or in the community.

Coding: Q0490 would be coded 1, Yes, skip to Q0610.

If this is a comprehensive assessment proceed to the next item, Q0500B.

Rationale: Resident R’s family requests that they opt out of the return to the community question because they become agitated when asked about return to community. They are only asked with comprehensive assessments.