In the dynamic world of nursing home care, ensuring the well-being of residents while managing financial stability is a constant challenge. Today, we’ll explore a valuable tool in this endeavor – the PHQ-2 TO 9© – and its pivotal role in both delivering quality care and influencing reimbursement under the Patient-Driven Payment Model (PDPM).

Understanding the PHQ-2 TO 9©

The Patient Health Questionnaire-9, or PHQ-2 TO 9©, is a widely used screening tool for depression, and in the context of nursing homes and PDPM, it takes on even greater importance. This nine-question self-report tool is designed to screen for symptoms of depression in residents. It provides a standardized severity score and a rating for evidence of a depressive disorder. The PHQ-2 TO 9© covers various aspects of depression, including mood fluctuations, sleep patterns, and appetite changes, among others.

Why is the PHQ-2 TO 9© Important in Nursing Homes?

      • PDPM Reimbursement: PDPM categorizes residents into payment groups, and the clinical assessments, including the PHQ-2 TO 9©, can influence the placement of residents into the appropriate category. Accurate assessment is crucial to ensure that residents receive the care they need, and that you are appropriately reimbursed for that care.
        • Staff who are conducting interviews should follow guidance in Appendix D of the RAI, Interviewing to Increase Resident Voice in MDS Assessments. This guidance should be reviewed routinely, along with Steps for Assessment for conducting the PHQ-2 to 9. Interview techniques to include “disentangling” and “unfolding” will be important as, on average, indicators of moderate to severe depression (total severity score = ≥10) identified though the PHQ-2 to 9© will increase the daily PDPM reimbursement by approximately $40.00 per PPS day in order to provide the care and services that residents experiencing moderate to severe depression require.
      • Quality Measures: Depression management is a vital component of quality care, and the PHQ-2 TO 9© is utilized to assess and monitor this aspect. Effectively addressing depression can enhance your facility’s ‘Percentage of Residents Who Have Depression Symptoms’ quality measure. This measure utilizes two questions from the PHQ-2 TO 9© and considers the total severity score.
      • Resident Well-being: Beyond reimbursement, the PHQ-2 TO 9© ensures that residents receive the best care possible. Depression, if left untreated, can exacerbate other health issues. The PHQ-2 TO 9© allows you to identify and address these risks early, enhancing overall resident well-being.

Strategies for Success

Completing the PHQ-2 TO 9© effectively is crucial for accurate assessment and quality care in nursing homes under PDPM. Here are some best practices for completing the PHQ-2 TO 9©:

      1. Complete Timely: You should attempt to conduct the interview with ALL residents. The interview should be conducted and documented during the 7-day look-back period of the Assessment Reference Date (ARD).
      2. Establish a Trusting Relationship: Begin by establishing a trusting and empathetic relationship with the resident. Make them feel comfortable and ensure their privacy during the assessment. A relaxed and open atmosphere can lead to more honest responses.
      3. Explain the Purpose: Clearly explain the purpose of the PHQ-2 TO 9© assessment to the resident. Let them know that it helps in understanding the severity of their symptoms and tailoring the care they receive.
      4. Encourage Honesty: Stress the importance of honest responses. Let residents know that their answers will help in providing the most appropriate care for them.
      5. Ensure Privacy: Conduct the assessment in a private and confidential setting to respect the resident’s privacy. This will also encourage them to be more open in their responses.
      6. Document Thoroughly: Accurate documentation is essential. Record the resident’s responses to each PHQ-2 TO 9© question and the overall score. Document any relevant comments or observations.
      7. Regular Monitoring: Use the PHQ-2 TO 9© as a tool for ongoing monitoring of a resident’s mental health. Regular assessments can help track changes in symptoms and guide treatment adjustments. After an initial assessment, follow up with residents at appropriate intervals, especially if they have a high PHQ-2 TO 9© score or exhibit concerning symptoms. Consistent follow-up is vital for effective care.
      8. Collaborate with Multidisciplinary Team: Share the PHQ-2 TO 9© results with your multidisciplinary care team. Collaborate on developing and implementing individualized care plans based on the assessment findings.
      9. Ongoing Training: Ensure that staff members involved in PHQ-2 TO 9© assessments receive ongoing training in administering and interpreting the tool accurately. Stay up-to-date with best practices in mental health care.
      10. Respect Autonomy: Respect the resident’s autonomy when developing care plans. Involve them in decision-making regarding their treatment and care interventions.
      11. Embrace Quality Improvement: Consider implementing quality improvement initiatives centered on mental health care, including depression management.


In the journey to provide exceptional care while navigating the complexities of PDPM reimbursement, the PHQ-2 TO 9© emerges as a vital tool. Its effective use ensures that residents receive the best care possible, while also contributing to the financial stability of your nursing home under PDPM. It is vital that staff completing the screening tool understand the RAI Guidelines for completion and the upcoming changes that go into effect on October 1, 2023, which are available at:

Contact Proactive for assistance in driving MDS accuracy and effective care planning through training, mentorship, interim MDS completion and consulting partnerships.




Written By: Shelly Maffia, MSN, MBA, RN, LNHA, QCP, CHC, CLNC, CPC
Director of Regulatory Services

Was this article helpful? Access weekly insights when you sign up for our weekly newsletter!