MDS News and Guidance

Decoding the MDS 3.0: What is Happening with Social Determinants of Health?

Polaris Group Profile
Polaris Group
August 7, 2023
August 7, 2023
Polaris Group Profile
Polaris Group
August 7, 2023

This blog is part of Polaris Group's Decoding the MDS 3.0 series which will explore the changes occurring in specific MDS sections.

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On October 1, 2023, the new MDS 3.0 will become effective and present major changes to many sections and revised coding procedures. Facilities will need to prepare now for the changes occurring in various sections. This blog is part of Polaris Group's Decoding the MDS 3.0 series which will explore the changes occurring in specific MDS sections.

Social Determinants of Health: What are they and why do facilities need to care about them?

Social Determinants of Health (SDoH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

As highlighted in Healthy People 2030, examples of SDoH include housing, transportation, neighborhood safety, job opportunities, education, income, food access, and literacy.

Given that nursing home residents are most likely retired and living in a community/facility setting where they most often do not need to worry about transportation, job opportunities, or access to food, why should nursing homes concern themselves with assessing social determinants of health?

SDoH shape health across the lifespan. Resident current health status is influenced by SDoH factors over their entire life. For example, residents who grew up in food deserts, a geographic area with reduced access to healthy food, are 3 times more likely to have diabetes. A better understanding of the circumstances that contribute to the resident’s current health status allows facilities to provide better person-centered care, a CMS goal of MDS 3.0.

What changes can you expect in MDS 3.0 to reflect SDoH?

Changes to Section A: Race, Ethnicity, and Transportation

In the current MDS, race and ethnicity are lumped together. In MDS 3.0, ethnicity is split from race and new assessment questions have been added. Item A1005 will now ask residents if they are of Hispanic, Latino/A, or Spanish origin.

TIP: This is a self-report item that can only be answered by the resident or their family. It cannot be coded based on other resources, records, or assumptions. This item also allows for multiple selections for residents of mixed ethnicity. Like ethnicity, race (new item A1010), is also a self-report question.

TIP: Medical record documentation can be used to code this if the resident is unable to respond and no family member can provide a response. Transportation (new item A1250) is only required on the start and end of a Medicare stay. This item inquires about transportation access to medical appointments and non-medical meetings in the last 6 months to one year.

TIP: Use information from the transportation question to better understand resident needs, barriers to care, and facilitate connections with community resources upon discharge for effective care management.

Changes to Section B: Health Literacy

Low health literacy interferes with communication between a resident and their health care providers. Lower levels of health literacy can also impact a resident’s ability to understand and follow treatment plans leading to lower rates of adherence and worse health outcomes. In Section B, item B1300 will assess resident self-reported health literacy by asking the resident how often they need someone to help when reading instructions or other written materials from a doctor or pharmacist. The resident will respond with the frequency of assistance required (e.g. never, rarely, sometimes, often, always).

TIP: Use the information regarding resident health literacy to tailor education to their level of literacy to maximize treatment adherence.

Changes to Section D: Social Isolation

The MDS 3.0 has a new item (D0700) for social isolation. Social isolation refers to the actual or perceived lack of contact with other people. Social isolation is critical to assess since it predicts mortality and worse health outcomes such as risk for re-hospitalization. In this self-report item, residents should be asked how often they feel lonely or isolated from those around them.

TIP: This item is strictly self-report and no other data sources can be used to code the response. Facilities can benefit from assessing social isolation because it allows for identification of residents who feel lonely and would benefit from engagement efforts and social activities.

Recommendations from Polaris

You don’t have to wait until September to change policies and make sure staff are trained. In fact, it would be enormously challenging to implement, teach, and educate staff on all of the MDS changes at one time. Set aside time now to consider how you will implement SDoH assessment for residents and to train staff on new interview techniques and coding procedures.

We know your nurse educators and leadership teams are busy with day to day “fires” and there are significant changes in MDS 3.0. Let Polaris Group consultants help and support your teams. Our expert consultants can provide staff training in these new MDS changes to prepare you for October.

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