All Hands on Deck: How Staffing Pressures Have Challenged Overextended MDS Coordinators

Persistent staffing shortages have put some MDS coordinators at a difficult crossroads.

More and more are being called to fill in on the nursing home floor and assist in patient care. On one hand MDS coordinators are registered nurses and often have years of experience in direct care, but for some it’s not how they want or think they should be spending their time on the job.

Saber Healthcare’s Cheryl Newbury, for example, has spent 25 years as a nurse before moving to the more organizational and data-driven role of MDS coordinator.

She decided to become an MDS coordinator for a “less physically demanding” role.

“I was ready to get out of [patient care work] and do something less hands-on,” Newbury told Skilled Nursing News.

The specialty position hasn’t been immune to turnover itself either and the reliance on MDS coordinators for clinical care may be further exacerbating the crisis that created the problem in the first place. Furthermore, the work MDS coordinators do when coding and filling out assessments is not easily duplicated.

It typically takes Minneapolis-based Health Dimensions Group a few months to get a newly hired MDS coordinator comfortable enough where they feel like they’re not having to ask questions on a consistent basis, Heather Haberhern, HDG’s vice president of clinical reimbursement, told SNN.

“We do have a number of MDS coordinators that have been pulled to work the floor and so they’re trying to balance the completion of assessments with needing to pick up a night shift which causes some discontent,” Haberhern explained. “They feel like their role is to be the MDS coordinator, but they want to be a team player and help out the building.”

For Newbury it can feel as if everything is just “piling on.”

“We want to do our MDS and our care plans and we don’t want to get pulled to the floor, we just want to do our thing and we’re being forced to do clinical stuff as well as MDS stuff,” she said.

An MDS coordinator’s role remains vital to a facility’s financial health, especially with proposed Medicare cuts looming for nursing homes and margins only getting tighter for facilities.

Newbury is responsible for documentation, assessing care plans and restorative outcomes, while also checking orders and making sure facilities get the reimbursement they earn.

“The big challenge is MDS coordinators are being pulled more and more to the floor to cover med passes, which leaves a lot of money on the table [when other MDS tasks aren’t getting done],” she said.

Backing up the MDS process

Timely completion of MDS assessments has also become a challenge for providers. By not completing interviews on time or missing information in the MDS assessments, it can have a negative impact on reimbursement for facilities.

One way Health Dimensions Group has been able to ensure timely completion of their reports and assessments is by backing up the MDS process.

The company supports its MDS coordinators from a regional standpoint with someone off-site to help complete reports quickly and efficiently, according to Haberhern.

Consulting firms like the Polaris Group and Zimmet Healthcare Services Group have seen MDS documentation fall months behind due, in part, to those nurses being called to the floor more.

For some of the small operators, Haberhern admits the challenge becomes a little trickier.

“It’s all hands on deck,” Haberhern said. “I think the smaller companies, the ones with one SNF, [it’s about] trying to find the right partner from a consulting standpoint that might be able to step in and either provide training or education to the team.”

Outsourcing and using MDS “floaters” has become one strategy operators have used to avoid delays in their MDS processing but Haberhern believes that comes with its own challenges.

“We’re getting it done from a compliance standpoint but we don’t know that we’re capturing everything that we need to,” she said.

To ensure better accuracy moving forward, the company plans to implement a “scrubber” in the next month to help catch any errors or missed reimbursement opportunities.

An additional regional staff member will also be hired to help analyze reports from multiple buildings.

Haberhern suggested leaning on other team members, like members of the therapy team, to get information plugged in.

Health Dimensions Group has also looked at providing more remote MDS coordinators for its communities, and while Haberhern believes that can be a helpful solution when options are limited, it doesn’t replace having someone in the building that is able to put “all the pieces together” and take a look at the resident.

Doing remote MDS work also requires a strong base of communication, according to Haberhern.

As she explained, one of the sections of the assessment – Section GG – must be completed within the first three days of a resident’s stay, followed by an interdisciplinary assessment and a discussion about the resident’s performance.

Not having someone in the building that works with the team to make sure that they know when the assessments are due and when they need to be completed can make things tougher, Haberhern said.

In a perfect world Haberhern thinks MDS coordinators need both an open and closed door policy where there can be some balance between meeting with patients and working with staff directly, in addition to getting their documentation done without delay.

“We’ve talked about having MDS coordinators that have a computer on wheels that can sit at the nurse’s station, but I don’t think that’s the answer,” she added.

Ideally, MDS coordinators spend at least “some time” with a resident before filling out an MDS assessment so they can get to know them and their medical history, she said.

Haberhern thinks the right strategy amid worsening staffing shortages is to have MDS coordinators focus on “what they do best.” But there must also be an understanding from an operational standpoint about the complexity of completing an assessment.

For Newbury, working with and communicating her workload and limitations with her superiors has been key.

“I have a wonderful DON who really tries to maintain that separation and we have a very good relationship and communicate well,” she said. “[MDS coordinator] is generally a salaried position so you’re working way more than 40 hours a week for a 40-hour pay and you have to be there on weekends and evenings on call.”

The skills required to be a good MDS nurse have also evolved over the course of Covid, Newbury added.

“You have to have really good clinical skills. Research is very important and being able to reference and code and I don’t think a brand new nurse with no experience would be able to do it,” she said.

Replacing MDS coordinators has proven to be a difficult task for Health Dimensions Group as well — the company currently has two on-site coordinator openings that its trying to fill through remote work.

“We’re finding that when we do fill those positions it’s not with anyone who has experience and so we’re training them from the beginning and laying the foundation, but we’re really having to give a lot of training and education upfront to get them established and comfortable with the coding of the assessments,” Haberhern said.