Recently, there was a perception that the 2010 regulations changed the 3 day discharge window and that any scores could be gathered in those 3 days (similar to admission) to provide the greatest value of the lowest scores to upload to the PAI. Mediware was asked why we continue to use a contiguous 24 hour window within the 3 day discharge window to gather the final discharge scores.
Since we were asked by more than one client, we decided to ask the CMS Help desk if there was a change for the assessment data gathered at discharge.
On July 6, 2011, the CMS Help Desk responded, “The IRF PAI Training Manual, version last updated in 2004, provides the most recent guidance to the discharge assessment time frame.” Further, Susanne Seagrave, Ph.D, of CMS, stated, “The policy referred to in the question has not changed. IRFs must continue to follow the guidance provided in the manual on this issue.”
When discharges are planned, we have seen facilities incorporate a “performance” or “graduation” day, encouraging patients and staff to re-validate functional capabilities. By specifying an exact day, it guarantees that all staff are challenging the patient to perform before assisting too eagerly, thereby providing the most valid score the patient is capable of performing. This improves success in providing sufficient information in a contiguous 24 hour period in the discharge window for all areas of assessment. This celebration and re-validation provides the IRF PAI coordinator a full set of data to draw the values needed to upload to the PAI.