The Care Areas Assessment (CAA) process is the framework for decision-making after the MDS assessment has been completed, and serves as the link between the MDS and the Care Plan. The CAA process helps the interdisciplinary team evaluate the resident holistically, and to identify strengths, weaknesses, and comorbidities that will potentially impact the resident’s function, choices, and goals.  CAAs also address important care considerations such as palliative care needs. Specific MDS coding items known as Care Area Triggers (CATs), will identify care areas that need further assessment.  It is important to note that the CAT is just a starting point to identify why the CAA triggered for review.   The IDT should conduct an in-depth review of the CAA to identify relevant causes, risk factors, and complications in order to develop a person-centered plan of care with appropriate interventions that address the concerns identified in the Care Area Assessment.  “Interpreting and addressing the care areas identified by the CATs is the basis of the Care Area Assessment process,” per the RAI manual page 4-2.

There are 20 Care Area Assessments that address concerns that commonly impact nursing home residents, they include: (1) Delirium (2) Cognitive Loss/Dementia (3) Visual Function (4) Communication (5) Activity of Daily Living (ADL) Functional / Rehabilitation Potential (6) Urinary Incontinence and Indwelling Catheter (7) Psychosocial Well-Being (8) Mood State (9) Behavioral Symptoms (10) Activities (11) Falls (12) Nutritional Status (13) Feeding Tubes (14) Dehydration/Fluid Maintenance (15) Dental Care (16) Pressure Ulcer/Injury (17) Psychotropic Medication Use (18) Physical Restraints (19) Pain and (20) Return to Community Referral

CAA Process Failure Case Study Example:

Tips for CAA Process Improvement

The CAA process enables the IDT to develop accurate, thorough and relevant care plans to provide care in accordance with the resident’s preferences and goals.  If not implemented properly, a facility may not recognize risk factors such as the risk for infection, leaving the plan of care incomplete to meet the care needs of the resident.

The following action steps could potentially have altered these negative outcomes:

      • Conduct a thorough assessment by reviewing all relevant information –not just the items identified by the coding of MDS items. When using the Review Indicators Worksheet provided in the RAI and built into most MDS software, it is important go beyond the checked items  identified based on the MDS coding.  For example, in the Urinary Incontinence and Indwelling Catheter care area, the software will check the box for “neurogenic bladder” if that diagnosis is coded in I1550. However, if the resident has inadequate urine or certain anticholinergic medications, the boxes should be manually checked and assessed as contributing or risk factors.
      • A thorough review of the medical record is critical.
      • Gathering information from the resident or the resident’s representative is also essential for a complete Care Area Assessment.
      • There should be a clear link between the care plan and the problems, risk factors, strengths, and needs that you identified in the CAA.

The Care Area Assessment is crucial to a well-developed plan of care. Thoroughly completing CAAs allows the IDT to identify clinical factors that need further investigation to ensure risk factors, resident specific strengths and preferences are included in the care plan. When carried out correctly, the CAA process can help avoid deficiencies in areas such as F684 Quality of Care and will improve resident outcomes.

We invite you to join us for our next session in the Survey Success! Avoiding Top Citations series which will review the #5 top citation nationally, F684 Quality of Care with an emphasis on understanding and applying the Interpretive guidance. Discussion will include:

      • actual citation examples
      • reviews of immediate jeopardy citations
      • strategies for successfully managing the survey process, and understanding the critical element pathways used to guide surveyor investigations
      • and implementing survey preparedness activities





Brandy Hayes, RN, RAC-CT
Clinical Consultant

Learn more about the rest of the Proactive team.