social worker and woman filling out forms

Discussing Return to Community Living: Best Practices for MDS Section Q

Originally presented on March 21, 2019

Suzanne de Beaumont, MPH

Project Director Open Doors Transition Center
New York Association on Independent Living

Robin Chiaravalle, LMSW
Director of Social Work
Warren Center Rehabilitation and Healthcare

Coordination, collaboration and knowledge of current supports and services are key to providing quality, cost effective health care. Federal requirements such as the Olmstead decision and 2016 guidance from the US Department of Health and Human Services emphasize the importance of ensuring that individuals living in institutions have the opportunity to learn about community resources available to support independent living. In New York State, the Open Doors program is the Local Contact Agency responsible for educating nursing home residents on their community-based options and facilitating transitions for residents wishing to return to their communities.

The Minimum Data Set (MDS), a mandated quarterly assessment administered to all nursing home residents, includes Section Q, which assesses the interest of residents in discussing options to return to community living. The requirements of Section Q are often misinterpreted, resulting in confusion about this part of the MDS, and missed opportunities for referral to the Local Contact Agency. This webcast will review the intent of Section Q and provide an in-depth discussion of the MDS Section Q questions to assist in referral to Open Doors. By sharing best practices in administering Section Q and making Local Contact Agency referrals, the information will help long-term care staff optimize patient outcomes and assist facilities in meeting their responsibility in meeting the Olmstead decision.

Note: Participants are encouraged to watch the recorded Public Health Live! webcast, “The Money Follows the Person Program: Facilitating Return to Community-based Settings,” which aired on February 16, 2017. 

Learning Outcome:
As a result of this activity, the learner will enhance or gain knowledge and ability to more effectively recognize the intent of the MDS Section Q, and administer best practices in completing Section Q.

Learning Objectives:
After watching the webcast, participants will be able to:

  • Identify the steps to take when an individual expresses interest in returning to community living from an institution;
  • Explain the proper administration of the MDS  Section Q interview with nursing home residents; and 
  • Describe when a referral to the Local Contact Agency is appropriate.

Target Audience
Nurses, social workers, and discharge planning staff, physicians, medical directors, care managers, and other health care professionals working in long-term care facilities and community-based organizations supporting independent living.

To Obtain Continuing Education Credits: 
Each participant interested in CE credits must complete an evaluation and post-test, which is available above under "Evaluation, Post-test & CE Credits". A score of 80% and above on the post-test will generate a certificate indicating the requested credits.

Please note: CPHCE cannot recreate lost certificates. Enter your e-mail address carefully in the system to have your certificate sent to you.

The planners, moderator, and presenters have disclosed no financial arrangements or affiliations with any commercial entities whose products, research or services may be discussed in this activity.

No commercial funding has been accepted for this activity.

Continuing Medical Education Credits

The School of Public Health, University at Albany is accredited by the Medical Society of the State of New York (MSSNY) to provide continuing medical education for physicians.

The School of Public Health, University at Albany designates this enduring material for a maximum of 1.0 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Continuing Medical Education Credits are offered until March 31, 2022.

Continuing Nurse Education Contact Hours

The University at Albany School of Public Health is approved as a provider of nursing continuing professional development by the Northeast Multistate Division, an accredited approver of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

This offering is approved for 1 nursing contact hour(s).

Nursing Contact Hours are offered until February 28, 2022.

Certified Health Education Specialist Contact Hours

Sponsored by the School of Public Health, University at Albany, SUNY, a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is designated for Certified Health Education Specialists (CHES®) and/or Master Certified Health Education Specialists (MCHES®) to receive up to 1 total Category I contact education contact hours. Maximum advanced-level continuing education contact hours available are 0. Continuing Competency credits available are 1. Provider ID# 99086.

Continuing Education Contact Hours are offered until March 31, 2022.

Social Work

University at Albany, School of Social Welfare, Social Work Continuing Education Program is recognized by the New York State Education Department’s State Board of Social Workers as an approved provider of continuing education for Licensed Social Workers - #0011

This offering is approved for 1 social work self-study continuing education hour.

Social Work continuing education hours are offered until March 31, 2022. 

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CPHCE offers online MDS Training! Available here: