CHAPTER 11 | Apply Standards of Nutrition Care & Review Effectiveness of the Nutrition Care Plan


be reported using a standardized format to ensure that institutional licensure and reimbursement for services can universally be recorded and assessed throughout the country. That standard format is referred to as the Resident Assessment Instrument (RAI).


The Nursing Home Reform Act of 1987 requires nursing facilities that receive funding from Medicare and/or Medicaid to use the RAI (Hawes et al., 1997). The RAI is a solution-oriented process that helps healthcare team members assess and plan high-quality care by looking at the whole person’s care and quality of life. It uses an interdisciplinary approach combining the input of multiple disciplines as well as the client’s wishes for their own care.


The RAI consists of three parts: * The Minimum Data Set (MDS) * The Care Area Assessment (CAA) * The RAI Utilization Guidelines


The facility must conduct a comprehensive assessment of a client within 14 calendar days after admission or re-admission if there is a significant change in condition (CMS, 2024c). A comprehensive assessment using the RAI is not required if a client is readmitted to the facility after a temporary absence (hospitalization) and there was no significant change in the client’s condition. The RAI must also be completed no less than once every 12 months. Significant changes in condition will be discussed in the later part of this chapter.


Timeliness and accuracy of completion of the RAI is essential. A delayed RAI document can be detrimental in a few ways (CMS, 2023b):


* Compromising the client’s care due to inaccurately documented data


* Financial penalties to the facility due to untimely submission


* Increased liability to the facility due to retaliation from meeting regulatory requirements


Depending on the facility’s policy, the CDM, CFPP may be asked to complete parts of this form, so it is important to understand the state-specific rules where they are employed. The RAI will be reviewed in detail so the CDM, CFPP will understand the flow of the work and be prepared to complete the documentation if their state allows.


Glossary


RAI Required by nursing homes who participate in Medicare and Medicaid programs. A tool that assesses client strengths and needs, and creates an individualized plan of care


297


Putting it


into Practice Refer to the Supplemental Materials for answer.


2. What are some ways to develop a person-centered care plan for clients?


Nutrition Fundamentals and Medical Nutrition Therapy


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