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


The RAI defines a significant change as a major decline or improvement in a client’s status that:


1. Will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions.


2. Impacts more than one area of the client’s health status.


3. Requires interdisciplinary review and/or revision of the care plan due to changes in interventions currently in place.


Refer to Table 11.5 for characteristics of a significant change according to the RAI.


A new RAI is required within 14 days for readmitted clients, unless no significant condition change has occurred.


If a facility discharged a client without the anticipation of that client returning, but that client is readmitted anyway for some reason, that client will require a brand-new RAI (MDS, CAA, care plan) within 14 days of their new admission date. This typically occurs when a client’s current facility bed has not been reserved for them while they are out of the facility.


If a client returns to a facility following a temporary absence for hospitalization or therapeutic leave, it is considered a return to the facility. Facilities are not required to assess a client who is readmitted unless a significant


change in the client’s condition has occurred during the time of the client’s absence. In most situations the event that caused a hospital admission will be considered a significant change for the client. Thus, a new comprehensive assessment using the RAI will be warranted/needed. In these situations, follow the procedures for


Table 11.5 Characteristics of a Significant Change SIGNIFICANT DECLINE


• Client’s ability to make decisions for themselves declines


• Change in client’s mood or an increase in the symptom frequency


• Any change in ADL physical functioning area such as from limited assistance to extensive assistance


• Client’s incontinence pattern changes or there is placement of a catheter


• Unplanned weight loss (>5% change in 30 days or >10% change in 180 days)


• Client begins to use trunk restraint or a chair that prevents rising when it was not used before


• Overall deterioration of client’s condition Source: CMS, 2023c


Nutrition Fundamentals and Medical Nutrition Therapy SIGNIFICANT IMPROVEMENT


• Any improvement in an ADL physical functioning area such as a change from limited assistance to independent


• Decrease in the number of areas where behavioral symptoms are coded as being present and/or the frequency of a symptom decreases


• Client’s ability to make decisions for themselves improves


• Client’s incontinence pattern improves • Overall improvement of client’s condition


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