MDS Alert
Determine Discharge Potential For The Dying Patient
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Coding discharge potential at Q1 for a resident at the end of life can be tricky. How would you code the following example?
Mrs. D is a 67-year-old widow with end-stage metastatic cancer to the bone with pathological fractures. Currently her major problems are pain control and confusion secondary to narcotics. Mrs. D periodically calls out for someone to take her home to her own bed. Her daughter is unwilling and unable to manage her hospice care at home. Because of the fractures, Mrs. D is totally dependent in all ADLs except eating (she can hold a straw).
Coding Discharge Potential
Q1a. Resident expresses/indicates preference to return to the community
Coding Options: 0 (No) 1 (Yes)
Q1b. Resident has a support person who is positive towards discharge
Coding Options: 0 (No) 1 (Yes)
Q1c. Stay projected to be of short duration - discharge projected within 90 days (do not include expected discharge due to death).
Coding Options:
0 (No) 1 (within 30 days) 2 (within 31-90 days)
3 (discharge status uncertain)
Answer:
a. Resident expresses/indicates preference to return to the community 1 (Yes)
b. Resident has a support person who is positive towards discharge
0 (No)
c. Stay projected to be of short duration - discharge projected within 90 days (do not include expected discharge due to death).
0 (No)
Rationale for coding: Although Mrs. D is near death, you should apply a code of "0" (No). This MDS item instructs you "do not include expected discharge due to death."
Source: RAI user's manual (most current version), p. 3-208.
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