Understanding and Coding MDS 3.0 Item E0200C: Other Behavioral Symptoms Not Directed Toward Others

MDS 3.0 Item E0200C: Other Behavioral Symptoms Not Directed Toward Others

Introduction

Purpose: Behavioral symptoms in long-term care residents are not always directed toward others; they can also manifest in self-destructive or socially inappropriate behaviors. MDS Item E0200C focuses on identifying whether a resident has exhibited other behavioral symptoms not directed at others, such as pacing, self-harm, or repetitive movements, over the past seven days. Accurate coding of this item is essential for understanding the resident’s emotional and psychological state and developing care plans that address these behaviors.

What is MDS Item E0200C?

Explanation: MDS Item E0200C is part of Section E: Behavioral Symptoms. It assesses whether the resident has exhibited behavioral symptoms that are not directed toward others but still represent problematic behavior. These symptoms might include pacing, disrobing in public, self-harm, or repetitive movements, which may indicate underlying cognitive, emotional, or physical issues. Identifying these behaviors allows care teams to address the root causes and implement effective strategies to improve the resident’s quality of life.

Guidelines for Coding MDS Item E0200C

Coding Instructions: To code MDS Item E0200C, staff must assess whether the resident has exhibited any behavioral symptoms that are not directed toward others during the past seven days. These behaviors include:

• Pacing or wandering
• Public disrobing or inappropriate exposure
• Self-harm (e.g., hitting or scratching oneself)
• Repetitive behaviors (e.g., rocking, tapping, or rubbing)

The coding options are:

• 0 - Behavior not exhibited: The resident has not shown any behavioral symptoms not directed toward others in the past seven days.
• 1 - Behavior of this type occurred 1 to 3 days: The resident exhibited such behaviors on 1 to 3 days during the past seven days.
• 2 - Behavior of this type occurred 4 to 6 days: The resident exhibited such behaviors on 4 to 6 days during the past seven days.
• 3 - Behavior of this type occurred daily: The resident exhibited such behaviors every day during the past seven days.

Example Scenario: If a resident has been pacing the hallways without purpose or rocking repetitively on two separate days over the past week, you would code E0200C as 1 - Behavior of this type occurred 1 to 3 days. If the behavior occurred nearly every day, you would code 3 - Behavior of this type occurred daily.

Best Practices for Accurate Coding

Observation: Carefully observe the resident’s behavior over the seven-day assessment period. Pay attention to non-verbal cues and patterns of behavior that are not directed at others but are still concerning, such as pacing, self-injury, or socially inappropriate actions.

Documentation: Record specific examples of these behavioral symptoms, noting the frequency and any potential triggers, such as boredom, confusion, or discomfort. Accurate documentation helps inform the resident’s care plan and ensures that these behaviors are addressed properly.

Communication: Share observations with the interdisciplinary care team to determine the underlying causes of these behaviors. This can involve exploring cognitive issues, emotional distress, or unmet physical needs. Behavioral interventions, environmental modifications, or additional support may be needed.

Training: Provide ongoing training for staff on recognizing and managing these behaviors. Staff should learn strategies to address the underlying causes of behaviors not directed at others, such as creating calming environments, reducing stressors, or engaging the resident in appropriate activities.

Conclusion

Summary: MDS Item E0200C is crucial for assessing other behavioral symptoms not directed toward others, such as pacing, self-harm, or repetitive movements. Accurate coding based on staff observations ensures that these behaviors are identified and addressed early, helping to create effective care plans that improve the resident’s emotional and physical well-being.

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

Reference

This guide is based on the CMS's Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.19.1, October 2024, Page E-7.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item E0200C: "Other Behavioral Symptoms Not Directed Toward Others" 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. Additionally, this guide refrains from handling personal patient data and does not provide medical or legal advice.