5.2 MDS 3.0 Section F: Preference Interviews

5.2 MDS 3.0 Section F: Preference Interviews

Quick Answer: MDS 3.0 Section F gathers resident-specific choices for customary daily routines (F0400) and activities (F0500) using a standardized importance scale. Interviews must be attempted for all residents who can communicate, utilizing proxy responses or staff observations (F0800) only when standard interviews are impossible.

Structure of MDS 3.0 Section F

MDS 3.0 Section F, titled Preferences for Customary Routine and Activities, is designed to capture the resident's voice regarding their daily routines and leisure preferences. The Centers for Medicare & Medicaid Services (CMS) mandates that this section be used to guide the development of individualized, person-centered care plans. Section F is divided into two primary sub-sections:

1. F0400: Daily Preferences: This contains eight items evaluating the importance of daily choices. These choices are crucial for maintaining a resident's dignity and self-determination. They include:
   • Choosing what clothes to wear.
   • Caring for personal belongings.
   • Choosing between different bath types (e.g., tub, shower, bed bath).
   • Having snacks between meals.
   • Staying up past 8:00 p.m.
   • Having family or close friends involved in care discussions.
   • Having private use of a telephone.
   • Having a place to lock personal belongings.
2. F0500: Activity Preferences: This contains eight items focusing on leisure and recreation. These items include:
   • Having books, newspapers, or magazines to read.
   • Listening to preferred music.
   • Being around animals or pets.
   • Keeping up with the news.
   • Doing things with groups of people.
   • Doing favorite activities.
   • Going outside for fresh air when the weather is good.
   • Participating in religious services or practices.

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Standard Interview Protocols and Coding Options

To ensure standardized data across all nursing homes, Section F uses a strict gatekeeper logic and a defined coding scale.

The gatekeeper item is F0300 (Should the Interview for Daily and Activity Preferences be Conducted?). The coder must determine if the resident is capable of completing a preference interview. The interview should be attempted for all residents who can communicate, even if they have moderate to severe cognitive impairment. The coding for F0300 is:

• Code 0 (No): The resident is rarely or never understood (based on communication assessments) and no family member or significant other (proxy) is available to complete the interview. If coded 0, the system skips directly to F0700/F0800 (Staff Assessment).
• Code 1 (Yes): The resident is at least sometimes understood or a family/significant other proxy is available.

For both F0400 and F0500, the interviewer asks, "While you are in this facility, how important is it to you to..." and codes the responses using the following standard scale:

• 1 - Very important: The preference is a high priority.
• 2 - Somewhat important: The preference is meaningful, and opportunities should be provided.
• 3 - Not very important: The preference is a low priority but should be respected if requested.
• 4 - Not important at all: The resident has no interest in this area; staff should not pressure them.
• 5 - Important, but can’t do or no choice: The resident values this preference, but physical limitations, clinical precautions, or facility operational barriers prevent them from participating.
• 9 - No response/non-responsive: The resident was unable or refused to choose a rating.

Interviews are deemed incomplete if the resident does not respond (Code 9) or is unable to answer three or more items across F0400 and F0500 combined. In such cases, the primary respondent (F0600) is coded as 9 (Interview could not be completed), and the facility must proceed to the F0700/F0800 Staff Assessment pathway. F0800 is a checklist completed by staff based on direct observations of the resident's daily routines and activity participation during the 7-day look-back period. Staff observation should look for positive and negative behavioral indicators during the assessment period rather than relying on prior historical records.

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Interview Strategies for Cognitively Impaired Residents

Cognitive impairment should never be used as an excuse to skip the resident interview. Research shows that individuals with dementia can express consistent, stable preferences if the interview is conducted properly. The following strategies must be employed:

• Sensory Optimization: Ensure the resident is wearing functional glasses and hearing aids. Conduct the interview in a quiet, private area free of background noise (such as televisions, cart wheels, or loud talking).
• Visual Aids: Use large-print response cards displaying the options (Very Important, Somewhat Important, etc.). Pointing to the words helps residents who have word-finding difficulties or receptive aphasia.
• Simplifying Language: If the resident struggles with the four-point scale, simplify the question. Ask, "Do you like to go outside?" If they say yes, ask, "Is it very important or somewhat important to you?" Break complex questions into manageable prompts.
• Pacing and Processing Time: Allow at least 15 to 20 seconds for the resident to process and formulate a response. Rushing the interview will cause anxiety and lead to non-responses.

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Managing Proxy Responses

When a resident cannot complete the interview and a family member/significant other serves as primary respondent (F0600 coded 2), a family member or significant other must be interviewed.

• Instruction to the Proxy: The interviewer must clearly instruct the proxy to answer based on the resident's lifelong routines and values, not their own. For example, say: "I want you to think about what your mother valued before she came to the facility. How important was it to her to have snacks between meals?"
• Proxy Qualification: The proxy must be someone who knows the resident's preferences well (e.g., spouse, adult child, close friend). A casual visitor or temporary guardian who does not know the resident’s history should not be used.
• Resolving Conflicts: If a proxy's answers contradict current staff observations (e.g., family says the resident "hates music," but staff observe the resident smiling and clapping during music therapy), the clinical team must document this discrepancy and adjust the care plan to prioritize the resident's current lived experience.