Finding Gertrude: The resident's voice in Minimum Data Set 3.0

Abstract

Purpose: The new Minimum Data Set 3.0 was designed to improve the assessment process by requiring nursing home (NH) staff to attempt to interview residents with scripted questions to assess subjective states such as pain, mood, and cognitive functioning. Although the case has been made that resident self-report is important, it is unknown whether facilities are doing so in practice. We examined the frequency of attempts to interview residents to elucidate the types of residents able to be interviewed about their clinical conditions and facility characteristics related to the likelihood of attempt.

Design and methods: Data come from Minimum Data Set 3.0 annual assessments for 757,044 residents in 15,030 NHs during 2011-2012 and the 2011 Online Survey, Certification, and Reporting database. Hierarchical generalized linear models were conducted to test the association between resident and facility characteristics and the attempt rate of resident interview for 3 clinical domains (cognition, mood, and pain).

Results: Over 83% of long-stay residents attempted all 3 self-report clinical items. The rates of attempt for mood, cognition, and pain were 88%, 89%, and 92%, respectively. Results from hierarchical generalized linear models suggest that certain resident characteristics are related to the likelihood of participating in interviews, in particular neither having a diagnosis of dementia nor cognitive impairment, not exhibiting signs of delirium, nor a documented prognosis of 6 months or less to live. Residents in smaller, chain-affiliated nursing homes with fewer Medicare residents and fewer assessments per administrative nurse and registered nurse were more likely to attempt the resident interview items.

Implications: This article documents the high rate of NH residents' participation in interviews about their clinical states. Furthermore, we identify types of residents for whom additional investigation into ways to achieve higher rates of participation is required and facility resources that are related to the likelihood of high rates of attempt.

Keywords: MDS; Nursing home; long term care.

Figure 1

Facility Average Rate of Annual Assessments Missing at Least One Resident Interview