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The purpose of the MDS is two-fold: (1) it is a gross assessment of functional status and, more importantly, (2) it serves as the basis by which specific intervention protocols are triggered. It is in relation to the second objective that the MDS can be thought of as a functional assessment tool being used as an indicator of clinical status, rather than the more typical situation where clinical status is used as a proxy of functional status. It includes a section on Vision Patterns that evaluates three areas the designers of the MDS have termed: Vision, Visual Limitations/Difficulties, and Visual Appliances.
Visual Appliances subsection evaluates whether prosthetic devices such as spectacles, contact lenses, or low vision devices are present. The subsection is assessed as: (1) yes or (2) no. As an example, the MDS assessment of someone with adequate visual acuity, no visual field deficit, and wearing glasses would be 0/c/1. That is, "O" indicates adequate visual acuity; "c" indicates no visual limitations and difficulties; and "1" indicates that a prosthetic device is present. The MDS assessment is required to be completed within 14 days of admission to the facility. It is typically generated through nursing home staff meetings and preadmission sessions with family and staff. Social workers, nursing staff, the activity director, and dietary staff usually attend these meetings. The MDS is intended to be a measure of the resident's status during the past 7 days. The actual plan of care for the resident is developed as a result of the MDS assessment and must be completed within 7 days after the MDS assessment. Understanding the roles of the MDS, RAP, and care plan is crucial in understanding how care is delivered to a nursing home resident. All care to a particular resident is directed to addressing deficiencies or problems detected within the MDS and RAP system. Changes or deficiencies in the MDS trigger specific interventions that are to be addressed through the care plan. Timetables are laid out for addressing problems noted. The RAP (See Appendix) details specific courses of action for each assessed problem indicated by the MDS. The RAP serves as a crucial bridge between the problems and needs identified by the MDS and the actual plans for care that are developed. In the case of vision, one RAP intervention is a call for professional evaluation by an optometrist or ophthalmologist. Vision care services are not currently mandated in long term care facilities. Unless a deficiency is documented on the MDS or triggered through RAP, residents are not required to receive any vision care services.
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