Section S

Massachusetts State-Specific Items

S0170.  Advanced Directives - For those items with supporting documentation in the medical record, check all that apply:

A.  Guardian

B.  DPOA-HC

C.  Living Will

D.  Do Not Resuscitate

E.  Do Not Hospitalize

F.  Do Not Intubate

G.  Feeding Restrictions

H.  Other Treatment Restrictions

Z.  None Of The Above

S0171.  Health Care Proxy

A.  Does resident have a health care proxy?       0.  No       1.  Yes

B.  Has health care proxy been invoked?      0.  No      1.  Yes

S0172.  Goals Of Care

A.  On admission, was documentation received by the facility from the referring provider that a discussion of goals of care with the resident or legal healthcare representative occurred?      0.  No      1.  Yes

If you answered `yes' to question S0172A, in which setting(s) did the discussion take place? (check all that apply):

B.  Hospital

C.  Previous Nursing Home

D.  Home without Home Health Services

E.  Home with Home Health Services

F.  PCP Office

G.  Other

S0173. Goals Of Care

Is there documentation in the medical record that a discussion of goals of care with the resident or legal healthcare representative and the attending clinician occurred since the last non-admission comprehensive OBRA assessment was completed?      0.  No      1.  Yes      9.  Not Applicable

S0173. Goals Of Care 

Is there documentation in the medical record that a discussion of goals of care with the resident or legal healthcare representative occurred since the last comprehensive OBRA assessment was completed? (answer "9" if this is an admission assessment) 0. No 1. Yes 9. Not Applicable 

S6230. Has Resident Received Antipsychotic 

Has this resident received an antipsychotic medication since the ARD of the last OBRA assessment, or, if this is an admission assessment, since the Entry Date (A1600)? (if you answer "no", skip questions S6232, S6234, S6236, and S2060) 0. No 1. Yes 

S6232. Is Resident Currently Receiving Antipsychotic 

Is the resident currently receiving an antipsychotic medication? (if you answer "no", skip questions S6234 and S6236) 0. No 1. Yes 

S6234. Attempt to Reduce Amount of Antipsychotic 

Has an attempt been made to reduce the total amount of antipsychotic medication the resident receives since the ARD of the last OBRA assessment, or, if this is an admission assessment, since the Entry Date (A1600)? (if you answer "no", skip question S6236) 0. No 1. Yes 

S6236. Was Reduction in Antipsychotic Maintained 

Was the reduction in the total amount of antipsychotic medication that the resident receives maintained? 0. No 1. Yes 

S2060. Resident Centered Care - For this resident, are any of the non‐pharmacological resident centered care techniques supported by the programs listed below included in the individualized resident centered care approach? Check all items that apply: 

A. Oasis

B. Habilitation Therapy

C. Hand in Hand

D. Consistent Assignment

E. Other

Z. None of the above