Source anchor
CMS MDS 3.0 RAI Manual v1.20.1 is the governed baseline currently attached to this lookup item.
Item Rationale
CMS MDS 3.0 RAI Manual v1.20.1 is the governed baseline currently attached to this lookup item.
7 matrix group(s) are already attached for review on this item.
4 governed answer row(s) are attached for this item.
Item Rationale
Use this item when the facility is completing content tied to Section E and needs to stay anchored to v1.20.1.
This page is grounded in CMS MDS 3.0 RAI Manual v1.20.1. Review the exact text and locators before treating the item as final reference content.
New onset of behavioral symptoms warrants prompt evaluation, assurance of resident safety, relief of distressing symptoms, and compassionate response to the resident. Reversible and treatable causes should be identified and addressed promptly. When the cause is not reversible, the focus of management strategies should be to minimize the amount of disability and distress.
Identification of the frequency and the impact of behavioral symptoms on the resident and on others is critical to distinguish behaviors that constitute problems—and may therefore require treatment planning and intervention—from those that are not problematic. These behaviors may indicate unrecognized needs, preferences, or illness. Once the frequency and impact of behavioral symptoms are accurately determined, follow-up evaluation and interventions can be developed to improve the symptoms or reduce their impact. Subsequent assessments and documentation can be compared to baseline to identify changes in the resident’s behavior, including response to interventions.
1. Review the medical record for the 7-day look-back period.
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, including family or friends who visit frequently or have frequent contact with the resident.
3. Observe the resident in a variety of situations during the 7-day look-back period.
Code 0, behavior not exhibited: if the behavioral symptoms were not present in
the last 7 days. Use this code if the symptom has never been exhibited or if it previously has been exhibited but has been absent in the last 7 days.
Code 1, behavior of this type occurred 1-3 days: if the behavior was exhibited
1-3 days of the last 7 days, regardless of the number or severity of episodes that occur on any one of those days.
Code 2, behavior of this type occurred 4-6 days, but less than daily: if
the behavior was exhibited 4-6 of the last 7 days, regardless of the number or severity of episodes that occur on any of those days.
Code 3, behavior of this type occurred daily: if the behavior was exhibited
daily, regardless of the number or severity of episodes that occur on any of those days.
Code based on whether the symptoms occurred and not based on an interpretation of the behavior’s meaning, cause or the assessor’s judgment that the behavior can be explained or should be tolerated. Code as present, even if staff have become used to the behavior or view it as typical or tolerable. Behaviors in these categories should be coded as present or not present, whether or not they might represent a rejection of care. Item E0200C does not include wandering.
1. Every morning, a nursing assistant tries to help a resident who is unable to dress themself. On
the last 4 out of 6 mornings, the resident has hit or scratched the nursing assistant during attempts to dress them.
Coding: E0200A would be coded 2, behavior of this type occurred 4-6
days, but less than daily.
Rationale: Scratching the nursing assistant was a physical behavior directed toward
others.
2. A resident has previously been found rummaging through the clothes in their roommate’s
dresser drawer. This behavior has not been observed by staff or reported by others in the last 7 days.
Coding: E0200C would be coded 0, behavior not exhibited.
Rationale: The behavior did not occur during the look-back period.
3. A resident throws their dinner tray at another resident who repeatedly spit food at them
during dinner. This is a single, isolated incident.
Coding: E0200A would be coded 1, behavior of this type occurred 1-3 days
of the last 7 days.
Rationale: Throwing a tray was a physical behavior directed toward others.
Although a possible explanation exists, the behavior is noted as present because it occurred.