Understanding and Coding MDS Item D0500F1: PHQ Staff Assessment - Feeling Bad About Self (Presence)

MDS 3.0 Item D0500F1: PHQ Staff Assessment - Presence of Feeling Bad About Self

Introduction

Purpose: Recognizing feelings of low self-worth or guilt in residents is essential for addressing mental health concerns, including depression, in long-term care. MDS Item D0500F1 focuses on whether staff have observed the resident feeling bad about themselves, thinking they are a failure, or feeling that they have let themselves or others down. Accurate coding of this item helps identify mood disorders early, enabling timely interventions to improve residents' emotional and mental health.

What is MDS Item D0500F1?

Explanation: MDS Item D0500F1 is part of the staff assessment for mood under Section D: Mood. This item is used when the resident is unable or unwilling to complete the mood interview (PHQ-9), and staff observations are recorded. It asks whether staff have observed the resident expressing feelings of self-doubt, guilt, or failure during the past two weeks. Recognizing these signs is crucial for assessing mental well-being and for ensuring that appropriate interventions are in place.

Guidelines for Coding MDS Item D0500F1

Coding Instructions: To code MDS Item D0500F1, staff members should assess whether they have observed the resident showing signs of feeling bad about themselves, feeling like a failure, or believing they have let themselves or others down over the past two weeks. The coding is binary:

• 0 - No: The resident has not shown signs of feeling bad about themselves or feeling like a failure.
• 1 - Yes: The resident has shown signs of feeling bad about themselves or feeling like a failure.

Example Scenario: If staff notice that a resident has been expressing regret about their past actions or feeling inadequate or worthless over the past two weeks, you would code D0500F1 as 1 - Yes. If there have been no such signs, the coding would be 0 - No.

Best Practices for Accurate Coding

Observation: Staff should consistently monitor the resident’s behavior and emotional expressions over the two-week period. Observing signs such as negative self-talk, regret, or expressions of guilt can help in coding accurately.

Documentation: Record specific examples of resident behavior that indicate feelings of low self-worth. Document any verbal or non-verbal cues that show the resident’s mood, such as statements like “I always make mistakes” or physical behaviors that suggest withdrawal or self-blame.

Communication: Share observations with the interdisciplinary team to ensure that potential depression or emotional distress is addressed appropriately. This may involve therapeutic interventions or additional mental health support.

Training: Ensure staff are regularly trained on identifying and documenting signs of emotional distress, including self-criticism and feelings of failure, and on the importance of accurate documentation and coding for better care outcomes.

Conclusion

Summary: MDS Item D0500F1 helps identify residents who may be experiencing feelings of self-doubt, guilt, or failure—significant indicators of depression. Accurate coding based on staff observations ensures that these mental health concerns are detected early, allowing for interventions that can support the resident’s emotional 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 D-21.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item D0500F1: "PHQ Staff Assessment - Presence of Feeling Bad About Self" 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 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. Additionally, this guide refrains from handling personal patient data and does not provide medical or legal advice.