When is it appropriate to use staff interviews on the MDS?




For the four interviews on the MDS (BIMS, PHQ2/9, Activities, and Pain), direct resident input should be the primary approach as observations may be misleading. For instance, the RAI manual notes in its discussion of the BIMS that “Without an attempted structured cognitive interview, a resident might be mislabeled based on their appearance or assumed diagnosis” (C-1). Similarly, directions for the PHQ2/9 and pain interview state that obtaining information “directly from the resident, sometimes called ‘hearing the resident’s voice,’ is more reliable and accurate than observation alone…” (D-1, J-4).

Prior to the interviews, those completing the sections are queried whether the interview should be conducted (questions C0100, D0100, F0100 and J0200). In each instance, the option 0. No. is qualified that the “resident is rarely/never understood” allowing the interviewer to move on to the staff interview (section F includes an exception which will be addressed below). This reflects the language found in B0700 where it is defined: “if, at best, the resident’s understanding is limited to staff interpretation of highly individual, resident-specific sounds or body language (e.g., indicated presence of pain or need to toilet)” (B-8). While this language is beneficial for a definition, it should be noted that completion of interviews is not contingent on the answer given at B0700 (C-2, D-2, F-2, J-5). In other words, the interview must be attempted.

Every opportunity must be offered to hear the resident’s voice such that “If the resident needs or requires an interpreter, complete the interview with an interpreter. If the resident appears unable to communicate, offer alternatives such as writing, pointing, sign language, or cue cards” (C-1 with similar language at D-2, F-1 and J-5).

Noting the qualifiers reviewed here, if a resident can be interviewed, but the interview was not completed within the look-back period, then the respective “should” question (C0100, D0100 and J0200) needs to be answered 1. Yes. and the interview dashed. With section F, however, there is an interim step. In this case when a resident is unable to be interviewed, the interview must be attempted with “family or significant other who knows the resident well” (F-1). Only after this has been attempted may the activities interview move to the staff version.


Christopher Calo, RN, BSN, RAC-CT
MDS Consultant

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