The MDS and Willy Wonka… chocolate anyone?

February is a great month. It is a transition month in many parts of the country, from winter to the beginnings of spring. The sun is in the sky just a bit longer every day, and doesn’t forget the usual observances. There’s Groundhog Day, Valentine’s Day, President’s Day. It’s Black History Month and American Heart Month. 

There are also many lesser-known special days set aside in February, like Random Acts of Kindness Day, Periodic Table of the Elements Day, and Public Sleeping Day.

But did you know that February is also Celebration of Chocolate Month and that February 1 is Dark Chocolate Day? Well, now you do. I recently discovered this, and I know I plan to celebrate in future years.

I love chocolate in almost anything, especially dark chocolate. Sweet, rich, creamy, semisweet chocolate! I remember as a kid watching the original “Willy Wonka and the Chocolate Factory.” Remember the chocolate bar that Charlie bought that had the golden ticket in it? I was more interested in the chocolate than in the golden ticket.

It’s interesting what piques our individual interests and tastes. Many of us “MDS types” sort of fell into this career path, not by choice but by necessity. I confess that was me. Tired of nights, weekends and holidays at the hospital, I needed a break. Now, 23 years later, I can’t imagine doing anything else. 

So, with the sweet sentiments of this luscious month on my mind, I have been thinking about what it is about the RAI process that is so attractive to me and so many like me. I think much of it has to do with the fact that the RAI process is the nursing process. Do you nurses remember the old acronym, ADPIE? Assess, Diagnose, Plan, Implement, Evaluate. It was what I was taught and what resonated with me as a nursing student. 

I remember reading the RAI manual for the first time all those years ago and thinking, this is great! It fit me. Of course, it was a smaller paperback version then, but the foundation hasn’t changed with the accumulated added complexities over the years. We assess with the MDS, diagnose through critical thinking with the CAAs, plan with care plan development, implement the care plan and the process cycles as we evaluate with the OBRA schedule of assessments.  

In many ways, like Charlie’s golden ticket, all that’s been added to the MDS since OBRA ’87 is simply an adjunct to the basic goodness of the RAI process. Standardized assessment and care planning was designed to make quality patient care a requirement of participation and is the foundation… the delicious chocolate, if you will. 

Let’s savor that. It’s so easy to get caught up in the glamor of the golden ticket of PDPM and Five-Star ratings that we lose the simplicity of what the RAI was originally designed to do.

I confess, I’m guilty. I love the hunt for the golden nuggets of PDPM and state case mix, as well as the thrill of seeing a Five-Star rating improve. But, perhaps a return to the basics will make the other parts of the process much more valuable. 

We are in unprecedented times. Quality MDS coordinators are hard to come by. New MDS coordinators are expected to hit the ground running with all pistons firing at full speed. The pressure is intense, and burnout is inevitable. A return to the basics might just be the ticket to MDS coordinator satisfaction and longevity. We are nurses, after all.

I am not saying that the residuals accomplished by a well thought out, accurate, timely MDS assessment are not important. They absolutely are. 

What I am saying is that an accurately completed, critically thought-out RAI should lead to the desired representation in the Five-Star, PDPM and case mix. Shouldn’t it? If our MDS coordinators were given the latitude to really understand and complete the RAI as it was designed, then the adjunct “golden tickets” would invariably be found.

I really enjoy teaching all things MDS. As a Master Teacher with AAPACN, I regularly have the opportunity to teach advanced students. However, when I see a new MDS nurse begin to understand the value of what they do and how an honest understanding and utilization of the nursing process is what the RAI is all about, I am delighted. 

In the end, Charlie’s golden ticket was just a wrapping that allowed a fuller experience of the magical Willy Wonka chocolate factory and the confectionary delights that were produced there. Ultimately, it was Charlie’s basic honesty that won the day and afforded him and his family the grand prize of owning the chocolate factory.

February is a great month. Enjoy the special days, and the chocolate. There is much to savor. Honestly, the reward can be truly satisfying.

Joel VanEaton, BSN, RN, RAC-CT, RAC-CTA, is a master teacher and the executive vice president of PAC Regulatory Affairs and Education at Broad River Rehabilitation.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.