0
Behavior not exhibited
if rejection of care consistent with goals was not
exhibited in the last 7 days.
DiraChart MDS item reference
E0800Section Ev1.20.1Manual page E-14
Rejection of Care—Presence & Frequency
Item Rationale
Quick coding
Answer Codes
Use the item-specific response choices below when structured codes apply.
Response format: Coded response
1
Behavior of this type occurred 1-3 days
if the resident rejected care consistent with goals 1-3 days during the 7-day look-back period, regardless of the
number of episodes that occurred on any one of those days.
2
Behavior of this type occurred 4-6 days, but less than daily
if the resident rejected care consistent with goals 4-6 days during the 7-day look-back
period, regardless of the number of episodes that occurred on any one of those days.
3
Behavior of this type occurred daily
if the resident rejected care consistent with goals daily in the 7-day look-back period, regardless of the number of
episodes that occurred on any one of those days.
Item-specific instructions
Coding Guidance
Review what the item asks, how to choose the response, and what should be verified before submission.
Steps for Assessment
1. Review the medical record.
2. Interview staff, across all shifts and disciplines, as well as others who had close interactions
with the resident during the 7-day look-back period.
3. Review the record and consult staff to determine whether the rejected care is needed to
achieve the resident’s preferences and goals for health and well-being.
4. Review the medical record to find out whether the care rejection behavior was previously
addressed and documented in discussions or in care planning with the resident, family, or
significant other and determined to be an informed choice consistent with the resident’s
values, preferences, or goals; or whether that the behavior represents an objection to the way
care is provided, but acceptable alternative care and/or approaches to care have been
identified and employed.
5. If the resident exhibits behavior that appears to communicate a rejection of care (and that
rejection behavior has not been previously determined to be consistent with the resident’s
values or goals), ask them directly whether the behavior is meant to decline or refuse care.
DEFINITIONS
REJECTION OF CARE
Behavior that interrupts or
interferes with the delivery or
receipt of care. Care rejection
may be manifested by
verbally declining or
statements of refusal or
through physical behaviors
that convey aversion to or
result in avoidance of or
interfere with the receipt of
care.
INTERFERENCE WITH
CARE
Hindering the delivery or
receipt of care by disrupting
the usual routines or
processes by which care is
given, or by exceeding the
level or intensity of resources
that are usually available for
the provision of care.
E0800: Rejection of Care—Presence & Frequency (cont.)
•
If the resident indicates that the intention is to decline or refuse, then ask them about the
reasons for rejecting care and about their goals for health care and well-being.
•
If the resident is unable or unwilling to respond to questions about their rejection of care
or goals for health care and well-being, then interview the family or significant other to
ascertain the resident’s health care preferences and goals.
Coding Instructions
•
Code 0, behavior not exhibited: if rejection of care consistent with goals was not
exhibited in the last 7 days.
•
Code 1, behavior of this type occurred 1-3 days: if the resident rejected care
consistent with goals 1-3 days during the 7-day look-back period, regardless of the
number of episodes that occurred on any one of those days.
•
Code 2, behavior of this type occurred 4-6 days, but less than daily: if
the resident rejected care consistent with goals 4-6 days during the 7-day look-back
period, regardless of the number of episodes that occurred on any one of those days.
•
Code 3, behavior of this type occurred daily: if the resident rejected care
consistent with goals daily in the 7-day look-back period, regardless of the number of
episodes that occurred on any one of those days.
Coding Tips
and Special Populations
•
The intent of this item is to identify potential behavioral problems, not situations in which
care has been rejected based on a choice that is consistent with the resident’s preferences
or goals for health and well-being or a choice made on behalf of the resident by a family
member or other proxy decision maker.
•
Do not include behaviors that have already been addressed (e.g., by discussion or care
planning with the resident or family) and determined to be consistent with the resident’s
values, preferences, or goals. Residents who have made an informed choice about not
wanting a particular treatment, procedure, etc., should not be identified as “rejecting
care.”
MDS item matrixAssessment Applicability
See where this item applies across Nursing Home, Swing Bed, discharge, required-use, OBRA, and program or policy columns.
16 relationships7 groups+
Assessment Applicability
See where this item applies across Nursing Home, Swing Bed, discharge, required-use, OBRA, and program or policy columns.
Nursing Home Subsets
Swing Bed Subsets
Shared NH/SB Subsets
OBRA Stand Alone Assessments
OBRA Admission A=01, B=99, F=99, G=^, H=0
MDS Item Matrix v1.20.1 v4
OBRA Quarterly A=02, B=99, F=99, G=^, H=0
MDS Item Matrix v1.20.1 v4
OBRA Annual / Sig Chg A=03, B=99, F=99, G=^, H=0 A= 04, B=99, F=99, G=^, H=0
MDS Item Matrix v1.20.1 v4
OBRA Discharge A=99, B=99, F=10, 11, G=1, 2, H=0
MDS Item Matrix v1.20.1 v4
Program and Policy Use
D/C Items (Only when A0310F = 10 or 11)
Item Subset Required Use ISC Skip Patterns
Official CMS source
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Reference details
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