DiraChart MDS item reference
Q0500CSection Qv1.20.1Manual page Q-15
Information source for Q500B
This item is referenced against CMS MDS source materials. Verify coding against the current CMS RAI Manual, item set instructions, and facility documentation before submission.
Quick codingAnswer Codes
Use the item-specific response choices below when structured codes apply.
Response format: Coded response
Q0500. Return to Community
EnterCode B. Ask the resident (or family or significant other or guardian or legally authorized representative only if resident is unable to
[ ] understand or respond): “Do you want to talk to someone about the possibility of leaving this facility and returning to live
and receive services in the community?”
0. No
1. Yes
9. Unknown or uncertain
EnterCode ¢. Indicate information source for Q0500B
[ ] 1. Resident
2. Family
3. Significant other
4. Legal guardian
5. Other legally authorized representative
9. None of the above
Item-specific instructionsCoding Guidance
Review what the item asks, how to choose the response, and what should be verified before submission.
RAI Manual v1.20.1Steps for Assessment
: Interview Instructions
1. At the initial Admission assessment and in subsequent follow-up assessments (as applicable),
make the resident comfortable by assuring them that this is a routine question that is asked of
all residents.
2. Ask the resident if they would like to speak with someone about the possibility of returning
to live and receive services in the community. Inform the resident that answering yes to this
item signals the resident’s request for more information and will initiate a contact by
someone with more information about supports available for living in the community. A
successful transition will depend on the resident’s preferences and choices and the services,
settings, and sometimes family supports that are available. In many cases individuals
requiring long term care services, and/or their families, are unaware of community based
services and supports that could adequately support individuals in community living
situations. Answering yes does not commit the resident to leaving the NH at a specific time;
nor does it ensure that the resident will be able to move back to the community. Answering
no is also not a permanent commitment. Also inform the resident that they can change their
decision (i.e., whether or not they want to speak with someone) at any time.
3. Explain that this item is meant to provide the opportunity for the resident to get information
and explore the possibility of different settings for receiving ongoing care. This step will help
the resident clarify their discharge goals and identify important information for the LCA or,
in some instances may indicate that the resident does not want to be referred to the LCA at
this time. Also explain that the resident can change their mind at any time.
4. If the resident is unable to communicate their preference either verbally or nonverbally, the
information can then be obtained from family or a significant other, as designated by the
individual. If family or significant others are not available, a guardian or legally authorized
representative, if one exists, can provide the information.
5. Ask the resident if they want information about different kinds of supports that may be
available to support community living. Responding “yes” will be a way for the individual—
and their family, significant other, or guardian or legally authorized representative—to obtain
additional information about services and supports that would be available to support
community living. It is simply a request for information, not a request for discharge.
Q0500: Return to Community (cont.)
Manual page Q-15RAI Manual v1.20.1Coding Instructions
for Q0500B, Ask the resident (or family or significant other
or guardian or legally authorized representative only if resident is unable to understand
or respond): “Do you want to talk to someone about the possibility of
leaving this facility and returning to live and receive services in the
community?”
A response code of 1, Yes, for this item indicates a desire to learn about home and community
based services, it is not a request for discharge.
•
Code 0, No: if the resident (or family or significant other, or guardian or legally
authorized representative) states that they do not want to talk to someone about the
possibility of returning to live and receive services in the community.
•
Code 1, Yes: if the resident (or family or significant other, or guardian or legally
authorized representative) states that they do want to talk to someone about the
possibility of returning to live and receive services in the community.
•
Code 9, Unknown or uncertain: if the resident cannot understand or respond and
the family or significant other is not available to respond on the resident’s behalf and a
guardian or legally authorized representative is not available or has not been appointed by
the court.
Coding Instructions for Q0500C, Indicate information source for
Q0500B
•
Code 1, Resident: if the resident is the source for completing this item.
•
Code 2, Family: if a family member is the source for completing this item because the
resident is unable to respond.
•
Code 3, Significant other: if a significant other of the resident is the source for
completing this item because the resident is unable to respond.
•
Code 4, Legal guardian: if a legal guardian of the resident is the source for
completing this item because the resident is unable to respond.
•
Code 5, Other legally authorized representative: if a legally authorized
representative of the resident is the source for completing this item because the resident is
unable to respond.
•
Code 9, None of the above: if the resident cannot respond and the family,
significant other, guardian, or legally authorized representative does not exist or cannot
be contacted or is unable to respond (Q0310A = 9).
Q0500: Return to Community (cont.)
Manual page Q-15RAI Manual v1.20.1Coding Tips
•
A “yes” response to item Q0500B will trigger follow-up care planning and contact with
the facility’s designated LCA.
•
Follow-up by the LCA is expected in a “reasonable” amount of time. Each state has its
own policy for follow-up. It is important to know your state’s policy. The level and type
of response needed by an individual is determined on a resident-by-resident basis. Some
States may determine that the LCAs can make an initial telephone contact to identify the
resident’s needs and/or set up the face-to-face visit/appointment. However, it is expected
that most residents will have a face-to-face visit. In some States, an initial meeting is set
up with the resident, facility staff, and LCA together to talk with the resident about their
needs and community care options.
•
Some residents will have a very clear expectation and some may change their
expectations over time. Residents may also be unsure or unaware of the opportunities
available to them for community living with needed services and supports.
•
The SNF/NH should not assume that the resident cannot transition out of the SNF/NH
due to their level of care needs. The SNF/NH and the resident should talk with the LCA
to see what options are available for living and receiving services in the community.
•
Return to community questions may upset residents who cannot understand what the
question means and result in them being agitated or saddened by being asked the
question. If the resident’s documented level of cognitive impairment is such that the
resident does not understand Q0500, a family member, significant other, guardian and/or
legally appointed decision-maker for that individual should be asked the question.
•
When Q0500B is answered 1 or 9, a care area trigger requires a return to community care
area assessment (CAA) and CAA 20 provides a step-by-step process for the facility to
use in order to provide the resident an opportunity to discuss returning to the community.
Q0500: Return to Community (cont.)
Manual page Q-15 MDS item matrixAssessment Applicability
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