Understanding and Coding MDS Item D0500F2: PHQ Staff Assessment - Feeling Bad About Self (Frequency)

Understanding and Coding MDS Item D0500F2: PHQ Staff Assessment - Feeling Bad About Self (Frequency)

Introduction

Purpose:
MDS Item D0500F2, "PHQ Staff Assessment: Feeling Bad About Self - Frequency," is part of the Patient Health Questionnaire (PHQ-9) Staff Assessment in the MDS 3.0 assessment. This item documents how often a resident shows signs of feeling bad about themselves, which can include expressions of guilt, low self-esteem, or worthlessness. These feelings are often indicators of depression and can greatly impact a resident’s well-being. Coding this item accurately helps ensure that residents struggling with self-worth issues receive timely mental health support.

What is MDS Item D0500F2?

Explanation:
MDS Item D0500F2 is part of Section D (Mood) in the MDS 3.0, specifically within the PHQ-9 Staff Assessment of Resident Mood. This section is completed when residents are unable to self-report their mood, allowing caregivers to document depressive symptoms based on observed behaviors.

For Item D0500F2, staff assess the frequency of behaviors or expressions that indicate the resident feels bad about themselves, such as frequent self-critical remarks or visible signs of low self-esteem. Understanding the regularity of these symptoms provides insight into the severity of the resident’s mental health challenges.

• Relevance: Observing the frequency of self-worth issues is vital, as persistent low self-esteem can influence a resident’s engagement in activities and overall mood, impacting their quality of life.
• Importance: Accurate coding of D0500F2 helps ensure that residents displaying regular signs of low self-worth receive appropriate mental health support to address underlying issues.

Guidelines for Coding MDS Item D0500F2

Coding Instructions:

1. Observe the Resident’s Behavior and Expressions:
   Staff should observe the resident’s behavior and statements for signs of low self-worth, such as frequent apologies, self-critical comments, or withdrawal from activities due to perceived inadequacies. These observations should be collected over the last two weeks.

2. Scoring the Frequency of Feeling Bad About Self:

   • Code 0 (Never) if the resident has not shown any signs of feeling bad about themselves or low self-worth in the past two weeks.
   • Code 1 (1–2 days) if the resident has shown signs of feeling bad about themselves on 1–2 days over the past two weeks.
   • Code 2 (3–4 days) if the resident has exhibited low self-worth on more than half of the days in the past two weeks.
   • Code 3 (5–7 days) if the resident has shown signs of low self-esteem or feeling bad about themselves nearly every day in the past two weeks.

3. Documentation Requirements:
   Accurately document the frequency of observed self-critical or low self-worth behaviors in the MDS under Item D0500F2. Supporting examples, such as “expressed guilt multiple times throughout the week,” can provide context for the coding decision.

4. Verify Observations Across the Care Team:
   Collect observations from staff members across various shifts who interact closely with the resident, ensuring consistent reporting. Cross-referencing staff observations helps confirm the frequency of self-worth issues.

Example Scenario:
Mr. Thompson has been observed expressing negative self-comments and apologizing excessively for minor issues almost every day for the past two weeks. He frequently avoids group activities, stating he “doesn’t deserve to participate.” In this case, code 3 (5–7 days) for D0500F2 to indicate a high frequency of self-worth concerns.

Best Practices for Accurate Coding

Observe Consistently Over Time:
Monitor the resident’s behavior and verbal expressions during various daily interactions, including social activities and caregiving tasks, to ensure accurate observation of self-worth issues.

Engage the Full Care Team:
Seek feedback from multiple caregivers who interact with the resident to capture a complete picture of mood-related behaviors. Consistent input from all staff members can help identify patterns and ensure accurate coding.

Training for Recognizing Low Self-Worth:
Provide training to staff on identifying subtle signs of low self-esteem and frequent self-critical comments. Proper training enhances the accuracy of observations and ensures timely identification of residents who may need mental health support.

Conclusion

MDS Item D0500F2 is essential for assessing the frequency of low self-worth or guilt in residents who cannot self-report. By documenting these observations accurately, caregivers can help identify residents who may need mental health support and provide the appropriate interventions to improve their quality of life. Recognizing and addressing persistent self-worth issues can positively impact residents’ mental health and engagement in daily activities.

Click here for a detailed step-by-step link for this item set

Reference

For more detailed guidelines on coding MDS Item D0500F2, refer to the CMS’s Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.19.1, October 2024, Chapter 3, Section D, Page 3-17.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item D0500F2: "PHQ Staff Assessment - Feeling Bad About Self (Frequency)" 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.