Understanding and Coding MDS Item D0500B2: PHQ Staff Assessment - Feeling Down, Depressed (Frequency)

MDS 3.0 Item D0500B2: PHQ Staff Assessment - Frequency of Feeling Down or Depressed

Introduction

Purpose: Evaluating the frequency with which a resident exhibits signs of feeling down or depressed is crucial in identifying the severity of depression, particularly when the resident is unable or unwilling to self-report. MDS Item D0500B2 focuses on how often staff have observed that the resident has been feeling down, depressed, or hopeless over the past two weeks. Accurate coding of this item helps in assessing the resident's mental health and in planning appropriate care interventions.

What is MDS Item D0500B2?

Explanation: MDS Item D0500B2 is part of the staff assessment for mood under Section D: Mood. This item asks staff to assess how frequently they have observed that the resident has shown signs of feeling down, depressed, or hopeless during the past two weeks. It is used when the resident cannot or does not complete the mood interview (PHQ-9), and staff observations are recorded. Understanding the frequency of these depressive symptoms is essential for determining the severity of the resident’s condition and for guiding care planning.

Guidelines for Coding MDS Item D0500B2

Coding Instructions: To code MDS Item D0500B2, the staff member assesses how often they have observed that the resident has been feeling down, depressed, or hopeless over the past two weeks. The coding is based on the frequency of these observations:

• 0 - Not at all: The resident has not shown signs of feeling down, depressed, or hopeless.
• 1 - Several days: The resident has shown signs of feeling down, depressed, or hopeless on several days.
• 2 - More than half the days: The resident has shown signs of feeling down, depressed, or hopeless on more than half of the days.
• 3 - Nearly every day: The resident has shown signs of feeling down, depressed, or hopeless nearly every day.

Example Scenario: If a staff member observes that a resident has been withdrawn, appearing sad or expressing feelings of hopelessness on five out of the last fourteen days, you would code D0500B2 as 1 - Several days. If these signs have been present nearly every day, the appropriate code would be 3 - Nearly every day.

Best Practices for Accurate Coding

Observation: Staff should carefully monitor and document the resident’s behavior and emotional expressions throughout the two-week period. Accurate and consistent observation is essential for capturing the frequency of these symptoms.

Documentation: Thorough documentation of the resident's behavior is crucial. Staff should record specific examples of interactions or behaviors that indicate the resident is feeling down or depressed, and note how often these behaviors occur. This documentation supports the coding decision and informs the care plan.

Communication: Share observations about the resident’s mood with the interdisciplinary team to ensure that any signs of depression are addressed comprehensively. This may include discussing potential interventions such as counseling, medication adjustments, or changes to the resident’s daily activities.

Training: Provide regular training for staff on recognizing and documenting signs of depression, particularly the frequency of feelings of being down or hopeless. Training should emphasize the importance of accurately noting the frequency of these symptoms to ensure proper coding and care planning.

Conclusion

Summary: MDS Item D0500B2 is essential for assessing the frequency of a resident’s feelings of being down, depressed, or hopeless, which are significant indicators of depression. Accurate coding of this item based on staff observations ensures that mood disorders are detected and addressed promptly, leading to better mental health outcomes for residents.

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 D-17.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item D0500B2: "PHQ Staff Assessment - Frequency of Feeling Down or Depressed" 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.