The Care Area Assessment (CAA) process is one of three components of the Resident Assessment Instrument (RAI). Another component, the MDS, identifies actual or potential areas of concern, and the remainder of the RAI process supports efforts to further assess Care Area Triggers (CATs) in order to identify whether the findings represent a problem or risk requiring further intervention, as well as the causes and risk factors related to the triggered area. Interpreting and addressing the care areas identified by the CATs is the basis of the CAA process and can help provide additional information for the development of an individualized care plan. (CMS, 2023)

Understanding CAAs

CAAs are required for OBRA comprehensive assessments (Admission, Annual, Significant Change in Status, or Significant Correction of a Prior Comprehensive) and are not required for stand-alone Medicare PPS Assessments. According to the RAI, when implemented properly, the CAA process should help staff:

      • Consider each resident as a whole, with unique characteristics and strengths that affect their capacity to function;
      • Identify areas of concern that may warrant interventions;
      • Develop, to the extent possible, interventions to help improve, stabilize, or prevent decline in physical, functional, and psychosocial well-being, in the context of the resident’s condition, choices, and preferences for interventions; and
      • Address the need and desire for other important considerations such as advanced care planning and palliative care; e.g., symptom relief and pain management.

There are twenty Care Areas that reflect conditions, symptoms, and other areas of concern that are common in nursing home residents and are commonly identified or suggested by MDS findings:

1.       Delirium2.       Cognitive Loss/Dementia
3.       Visual Function4.       Communication
5.       Activity of Daily Living (ADL) Function/Rehabilitation Potential6.       Urinary Incontinence and Indwelling Catheter
7.       Psychosocial Well-Being8.       Mood State
9.       Behavioral Symptoms10.   Activities
11.   Falls12.   Nutritional Status
13.   Feeding Tubes14.   Dehydration/Fluid Maintenance
15.   Dental Care16.   Pressure Ulcer/Injury
17.   Psychotropic Medication Use18.   Physical Restraints
19.   Pain20.   Return to Community Referral


Care Area Triggers (CATs) & October 2023 Changes

Not all triggers identify deficits or problems. Some triggers indicate areas of resident strengths and can suggest possible approaches to improve a resident’s functioning or minimize decline. (CMS, 2023)

With the removal of Section G from federally required assessments effective October 1st, 2023, several CATs have been revised. The Care Areas of ADL Function/Rehabilitation Potential, Falls, Pressure Ulcer/Injury, and Urinary Incontinence currently use data triggers from Section G. With the October update, data triggers for these areas will transition to Section GG.

How to Prepare for the Coming Changes

Given that Section GG data is more granular, it is important that MDS nurses and IDT members familiarize themselves with the changing CAT logic. The specific data elements triggering the CAAs should be identified and further evaluated to determine care planning needs. For example, the Care Area for Urinary Incontinence can be triggered if the resident is coded as needing assistance with Toileting hygiene and/or Toilet transfer, either or both requiring specific approaches to care. Because MDS 3.0 trigger logic is complex, please refer to the CAT Logic tables within each CAA description (RAI, Section 4.10) for detailed information on triggers.

Are you unsure if your team will be prepared for the October 2023 MDS changes?  Join us July 19th for a virtual workshop covering the significant updates coming to the RAI. Learn more and register

Proactive also offers expert MDS support to guide your facility through regulatory, reimbursement and departmental changes—learn more about SNF/LTC MDS consulting partnerships with Proactive

Written By: Eleisha Wilkes, RN, GERO-BC, RAC-CTA, RAC-CT, DNS-CT
Clinical Consultant

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