Pre-Admission Screening Resident Review (PASRR)
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Transcript Pre-Admission Screening Resident Review (PASRR)
Do I Need a “Bock”?
Pre-Admission Screening
Resident Review (PASRR)
Elizabeth Damers, LPC, LSW
Director of Case Management
Medical Center of South Arkansas
Objectives
Describe the purpose and criteria for a PASRR level I review
Identify patients who are and are not PASRR clients
Understand how to complete a PASRR level I application
Discuss how to request a hospital discharge exemption
What is the purpose of a PASRR Level I
screening?
To confirm if a person has severe Mental Illness (MH), Intellectual
Disability (ID), or a Developmental Disability (DD).
Prevent admission of persons with MH, ID, or DD to a nursing home
if there is a less restrictive option.
Determine if a Level II review is necessary.
Criteria: Who needs a PASRR Level I
screening?
A PASRR Level I must be completed and submitted to Bock
Associates for any person with a diagnosis of serious MH, ID, DD, or
is or has recently been homicidal or suicidal (a danger to self or
others):
Before
Before
admission to a nursing home
an identified PASRR client returns to a nursing home
after a significant change in behavior resulting in admission to
an inpatient psychiatric hospital
Identify patients who are and are not
PASRR clients - the DMS-787 form
Every person who is a potential nursing home admission should have a
787 completed BEFORE they are admitted to the nursing home.
Red flags that should trigger more digging:
Behaviors
Medications
“Young” persons on disability
Inability to sign their name
Mental Retardation/Developmental
Disability
1. Does the individual have a diagnosis OR history of Mental
Retardation OR a related condition?
Mental Retardation
Cerebral Palsy
Autism
Epilepsy/Seizure
Other (Traumatic Brain Injury, Spina Bifida, Down Syndrome)
Mental Retardation/Developmental
Disability cont.
Did the Mental Retardation develop before the individual reached the age of
18? Yes or No
Did the Developmental Disability (TBI, Seizures) develop before the
individual reached the age of 22? Yes or No
If the TBI or Seizures began after the age of 22 (stroke, MVA, etc) be
sure to mark No and add a note (“post stroke at 57y/o”)
Digging:
Did he/she go to a special school? Attend special classes?
Has he/she ever attended a “workshop” to go to work?
Has he/she ever attended insert the name of your local DDS program?
Did he/she have seizures when he/she was a child/in school?
Mental Retardation/Developmental
Disability cont.
2. Has the individual received services from an agency that serves
persons with MR/DD? Yes or No
Digging: use names of area group homes, agencies, programs
If yes, please provide the name and addresses of this agency. (Include
ICF/MR)
Hint: if they don’t know the exact name, write down what they know
and the name of the city/state.
Mental Retardation/Developmental
Disability cont.
3. Is there presenting evident (cognitive or behavioral) that may indicate
the presence of MR/DD? Yes or No
A. If yes, does the condition result in substantial functional
limitations in three or more of the following areas of major life
activity? Yes or No
Self Care
Learning
Mobility
Independent Living Language
Self-Direction
Hint: ask in simple terms (i.e. can he/she stay home alone; does he/she
drive; can he/she shop alone; does he/she need help with bathing,
dressing)
Mental Retardation/Developmental
Disability cont.
4. Does the individual’s behavior or recent history indicate s/he is a
danger to self (suicidal or self-injurious) or others (combative)? Yes or No
If yes, comment
Mental Illness
1. Does the individual have a diagnosis or history of mental illness? Yes or
No
Schizophrenia Schizoaffective
Delusional (Paranoid)
Somatoform
Psychosis
Major Depression Bi-Polar D/O
Panic or Anxiety
Other (PTSD, Personality Disorder, etc.)
Digging:
Have you ever seen a doctor at (use the name of your community MH center)
Have you ever been in the hospital for depression or your nerves?
Have you ever taken medicine for your nerves or depression?
Have you ever been to the State Hospital?
Mental Illness cont.
2. Has the individual been prescribed any psychotropic medications on a
regular basis in the absence of a confirmed mental disorder? Yes or No
If yes, please list medications (and why)
Amitriptyline-insomnia
Ativan-anxiety caused by oxygen hunger
Remeron-loss of appetite due to ______
Celexa-chronic pain
Ritalin-narcolepsy
Zyprexa-behavioral manifestations of Alzheimer’s
Mental Illness cont.
3. Is there any presenting evidence of disturbance in the orientation,
affect, mood, or behavior that suggests mental illness? Yes or No
Hint: this is a question to trigger you to observe and consider the
person’s affect, mood, or behavior.
Mental Illness cont.
4. Has the individual received treatment within the last two years by any
of the following caregivers? Yes or No
Mental Hospital
Hospital Psych Unit
Digging
Has he/she been in a hospital to have his/her Dementia diagnosed?
Have you ever been in the hospital for your nerves or depression?
Mental Illness cont.
5. List the name and address of any individual or agency providing diagnosis
of treatment for MI. Important, please list.
Hint: use this area to give information. Give dates if available.
If the person has a MH diagnosis, when/where did they receive it?
First and last Inpatient psychiatric hospitalization
Who is treating them (Community MH Center, private psychiatrist)
Did their PCP start the medication?
Why did they start taking the medication? (illness, loss, loss of
independence)
Ever seen a Psychiatrist for Inpatient treatment? Outpatient treatment?
Mental Illness cont.
Helpful statements:
PCP began ____ for symptoms of depression related to ____ (death
of spouse, decreased socialization due to health, loss of
independence, spouses health problems, financial stress, family
stress, etc)
No history of Inpatient care by a psychiatrist
No history of Outpatient care by a psychiatrist
PCP now manages meds with good symptoms control
Mental Illness cont.
6. Does the individual’s behavior or recent history indicate s/he is a
danger to self (suicidal or self-injurious) or others (combative)? Yes or No
If yes, comment
(Yes, the same question again)
Mental Illness cont.
7. Is there a diagnosis of Dementia, OBS, Alzheimer’s or any related
organic disorders. If yes, complete DMS-780 form. Yes or No
Section III
Only a person with POA or Guardianship can sign the forms for the
patient.
The patient can sign with a mark or initials if he/she is having difficulty
signing their whole name and staff can sign as witness.
If the patient is “unable to sign” write an explanation of why (paralysis
or some other physical condition that prevents them from holding a pen).
Two persons should witness.
Dementia Diagnosis Substantiation
DMS-780
Dementia as a stand alone diagnosis IS NOT criteria for a PASRR Level I
screening unless he/she is considered to be suicidal or homicidal.
Psychotropic medications prescribed to treat the behavioral
manifestations of Dementia are not a stand alone criteria for a PASRR
Level I screening
If the patient has had a recent admission to a geropsych unit, they may
need a PASRR Level I screening (if they were admitted because they were
a danger to themselves or others)
Dementia Diagnosis Substantiation
DMS-780 cont.
Section I
Dementia Diagnosis: Alzheimer’s, Dementia due to Alcohol, etc
The diagnosis was made on the basis of: (check all that apply)
Discuss the behavior, history or physical findings that lead to the
Dementia diagnosis: confusion, disorientation, wandering, loss of
ability to perform ADL’s, loss of communication skills, etc
When was the diagnosis of Dementia first made? (Approximate date)
month and year or just year will suffice
Dementia Diagnosis Substantiation
DMS-780 cont.
Section II
Does the individual’s current behavior indicate that he/she is a danger
to self (suicidal or self-injurious) or to others (combative)? Yes or No
Does the individual have a diagnosis, history or other evidence of one
of the Serious Mental Illnesses listed below? Yes or No (how did you
answer the 787?)
Is Mental Illness the primary diagnosis? Yes or No
Did the Mental Illness exist prior to the onset of Dementia? Yes or
No
Nursing Home Admission Criteria
DHHS-703
To meet nursing home admission criteria, a person must be
determined functionally disabled, by a licensed medical professional,
in one or more of the following:
Functionally disabled is impairment in one or more of the following:
Activities of daily living
Transferring/Locomotion
Eating
Toileting
Cognitive impairment
Medical Condition
Nursing Home Admission Criteria
DHHS-703 cont.
Use the 703 to explain why the person needs to be in the nursing
home.
List month/date of hospitalizations in the past 6 months
List the Reasons for hospitalization (Diagnosis)
State how much assistance is needed with transfers and ambulation.
If the patient is continent, do they need help with transfers to the
commode, help with pericare?
If the patient is incontinent, do they need someone to change their
diaper, provide pericare?
If the patient has a foley, do they need someone to empty the foley?
Nursing Home Admission Criteria
DHHS-703
Explain assistance needed to eat. (Set up is no longer enough
assistance)
Give details of dressing changes.
Give details for confusion or needs supervision. (wandering, forgets to
eat, needs frequent reorientation)
Other Medical Conditions. List medical problems.
Medication/Treatments: list names of meds and send a MAR
Therapies: If the person is going for SNF, what therapies will they
recive?
DME: what DME is the patient using?
Nursing Home Admission Criteria
DHHS-703
RN/Counselor Comments
What was the patient’s prior level of function? ADL’s, Mobility, Cognitive
Function
What caused a change in their level of function? Extended hospitalization,
post surgery, post stroke
What is the patient’s care needs? Continued therapy, IV Abx, Monitoring
during medication adjustment, nutritional support, wound care
Is family available or able to provide the needed assistance?
Does the patient plan to return home when they regain their prior level of
function?
Nursing Home Admission Criteria
DHHS-703
Status of Major Impairment? Improving Stable Deteriorating
Prognosis
Diagnosis A & B
what medical condition(s) requires nursing home care?
A person CANNNOT go to a nursing home because they have a
mental health diagnosis.
Exempted Hospital Discharge
A PASRR client can be exempt from a Level II screening prior to
admitting to a nursing home IF:
The client is being admitted to a nursing facility after receiving
acute inpatient care at a hospital; AND
The client requires nursing facility care for the condition for which
s/he received care in the hospital; AND
The attend physician upon signing this document has certified to
the nursing facility that the applicant is likely to require less than
thirty (30) days of nursing facility services.
Exempted Hospital Discharge
If your patient is a PASRR client or you think they may be a PASRR
client and they plan to enter the nursing home for <30 days, send a
HED form with your PASRR packet. Note on your fax cover sheet that
you included the HED form.
Submitting a PASRR Level I application
Fax cover sheet with your contact information and fax number
703
787
780 (if appropriate)
HED (if appropriate)
History & Physical
Psychological Evaluation
MAR
Discharge summary from previous hospitalizations
Power of Attorney or Guardianship papers
IQ and Adaptive Behavior testing if the person is ID/DD
Determination
You will be notified via fax of the outcome of the review by Bock
Associates and OLTC (if a PASRR client)
Bock Associates tries to process all Level I packets received by 3:00pm
the same day.
If you think you might not need to send in the PASRR Level I, CALL and
talk to Steve or Bliss.
Contact Information
Bock Associates
221 West 2nd Street, Suite 607
Little Rock, AR 72201
State Project Director-Bliss Beeman, RN
Clinical Associate-Steve Tam, RN
Administrative Assistant-Viki DeClerk
Phone 501-374-2559
Fax 501-374-2541
[email protected]
Website: bock-associates.com
Questions?