Because Care Area Assessments (CAAs) are not submitted to CMS, and the Resident Assessment Instrument (RAI) manual offers little guidance on how to complete a CAA when compared to the Minimum Data Set (MDS) instructions, CAAs are a segment of the RAI that is easy to overlook and underutilize. With many other duties and concerns to manage on a daily basis, the Interdisciplinary Team (IDT) may view the CAA process as an inconvenience and tend to skimp on reviewing the components of the triggered CAA. However, when triggered CAAs are worked through, developed, and utilized as a basis for developing a comprehensive care plan, each triggered CAA can be an invaluable component of the RAI. When the IDT utilizes the CAA to support development of a comprehensive care plan, the resident is the beneficiary of a cohesive and effective plan to provide care that supports the resident’s safety, participation in cares, and engagement in activities they find meaningful – and supports staff in monitoring for changes in the resident’s needs.
What are CAAs?
Developing a person-centered, holistic, and effective care plan is based on a thorough investigation of the resident’s strengths and needs, as well as the resident’s personal preferences and goals for their care. This process starts with resident interviews and observations recorded in the health record, then coded into the MDS. Once the comprehensive MDS is coded, Care Area Assessments are “triggered” based on individual responses or combinations of responses to items on the MDS. These triggered care areas identify potential or actual problems the resident may experience that may need further investigation by the IDT.
A triggered CAA serves as a flag for the IDT to stop and examine the resident’s particular situation and how their medical conditions, cognitive abilities, functional abilities, and psychosocial needs impact that resident’s care needs. The CAA also prompts the IDT to consider how the resident might benefit from referrals to support health and psychosocial needs and possible rehabilitative interventions. Additionally, the CAA presents the opportunity to incorporate the resident and/or representative’s perception of each triggered area’s impact on the resident.
The Centers for Medicare and Medicaid (CMS) has developed 20 CAAs to address problems that are common to nursing home residents; these are integrated into the RAI as part of the comprehensive MDS. Every CAA is a rigorous tool that supports the IDT to examine these areas of concern, and is grounded in current clinical standards of practice such as evidence-based or expert-endorsed research and clinical practice guidelines. Each CAA is intended to help the IDT review potential causes, risk factors, and complications that triggered the care area condition, and supports the IDT members to exercise critical thinking skills in developing an effective care plan for that area.
CAA Components
Each CAA consists of three components:
- Triggering conditions are pieces of information drawn from the MDS, the health record, and resident/representative interviews. The CAA is utilized as a tracking record to identify where specific triggering information is located in the health record as well as resident input.
- Analysis of findings is a synthesis of the triggers and how they impact or could potentially impact the resident.
- Care plan considerations are an evaluation of whether the triggered area is a problem or potential problem for the resident, which leads to a determination of whether a care plan should be developed to support the resident. The IDT creates a care plan that incorporates the CAA triggers into the care plan problems. Development of resident-centered care plan goals should be based on the resident’s goals related to the triggers/problems – to improve, maintain/prevent decline, avoid complications and/or support palliative measures. Approaches or Interventions are created to support the care plan goals, based on how the resident prefers care be delivered.
Build a Solid Foundation
CAAs provide a MDS-prompted framework to develop a thorough examination of each resident’s unique strengths and needs, as well as what constitutes each resident’s best quality of life based on their own goals and preferences. While CAAs focus on MDS-prompted investigations, there is the possibility that a resident has needs that may not be part of the initial CAA development process. The problems or concerns may not have been addressed on the MDS, or the needs may be unique to the resident; they could also be related to facility policy. In such cases, the same investigative procedure, goal development, and interventions or approaches would need to be implemented based on the resident’s needs, goals, and preferences to create a care plan that fits the resident’s situation.
Through CAA development and careful consideration of any resident needs not addressed on the MDS, the IDT can synthesize findings related to the resident’s medical conditions, cognitive abilities, functional abilities, psychosocial needs, and preferences into a workable, holistic care plan that supports the resident’s safety, participation in care, and engagement in activities they find meaningful. This process also helps the IDT monitor for changes in the resident’s needs and adjust the care and support provided on an individual basis. A great care plan is a solid foundation for guiding staff to support each resident’s highest quality of life.
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