Re-Creative Resources
By Kimberly Grandal, BA, CTRS, ACC, Executive Director
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Executive Director
Re-Creative Resources
About Kim

Kimberly Grandal, Founder
and Executive Director of Re-
Creative Resources, Inc., is a
strong advocate for the field of
Therapeutic Recreation and
Activities, with over fifteen
years of experience working
with the elderly in numerous
management and consultant
positions.  She is an Activity
Consultant Certified and a
Certified Therapeutic
Recreation Specialist. Kim is a
member of the New Jersey
Activity Professionals
Association and the New
Jersey/Eastern Pennsylvania
Therapeutic Recreation

In 1990, Kim graduated from
William Paterson University
with a BA in Sociology and
later studied gerontology
courses at Union County
College and Therapeutic
Recreation courses at Kean
University. Throughout her
career, Kim has been the
Director of Therapeutic
Recreation for several long-
term care facilities, including
one of NJ’s largest.

In 2006, Kim founded Re-
Creative Resources Inc. She is
a speaker for various state and
local activity associations such
as NJAPA, MOCAP, and
NJACA, as well as the Society
of Licensed Nursing Home
Administrators of NJ. She also
offers lectures for Re-Creative
Resources Inc., local colleges,
and community groups, and
provides consultation and
support to numerous facilities
in the state.

Kim is the editor and writer for
the “The Rec-Room", a
monthly newsletter published
by her company. In addition,
she writes monthly articles for
the Activity Directors Office
newsletter, and has contributed
articles to Creative Forecasting
Magazine, and The
Continuing Care Insite

Kim is a recipient of the
Kessler Institute of
Rehabilitation 1997 Triumph
of the Human Spirit Award.  
Her passion is to promote the
field of Therapeutic
Recreation and Activities and
to unite Recreation Therapists
and Activity Professionals. Kim
currently serves on the NJAPA
board as the Chairperson for
the Legislation Committee.
Resources Inc.

Re-Creative Resources, Inc. is
committed to enhancing the
lives of long-term care
residents through the use of
Therapeutic Recreation. We
provide a variety of services
such as Therapeutic
Recreation seminars,
in-services, resources, form
development, program analysis
and development,
consultation, and support for
activity professionals and
recreational therapists. A
selection of downloadable
training materials and forms
are available for your
convenience as well as a free
job posting site.
Subscribe to Kimberly's Newsletter
See Kim's You-Tube videos (Click Here)
More MDS 3.0 Q and A for Section F Preferences
for Customary Routine and Activities
By Kimberly Grandal, CTRS, ACC/EDU

1) We have a resident that is confused but she was able to answer the interview
questions. Now I am having a conflict with Social Services. She said we shouldn’t
interview when the resident is confused. Do you have advice or the right answer for me?
Should we interview residents with confusion? I believe why not try. They still may be
able to answer questions about their likes and dislikes. Any advice would help.
In terms of residents with cognitive impairment, the answer lies with the coding of
B0700 (Makes Self Understood) . If the resident codes a 0 (understood) ,1 (usually
understood) or 2 (sometimes understood) , then you conduct the interview. If the
resident codes a 3 (rarely/never understood), then you do not interview the resident.
Your next step is to attempt to interview the family or significant other.

2) Is Section F on the Quarterly?
Typically, section F is not on the Quarterly, however be sure to check with your facility
and state regulators. Your state may have different rules. For example, I was recently
informed that in the state of South Dakota they are required to complete the full item set
for quarterly assessments.  The CAA's, care planning, etc. are not done, but the full item
set is completed. So be sure to check your state regulations!

3) Since we no longer have to do a quarterly MDS for activities, do you think we should
still be doing a quarterly assessment on each resident or does a quarterly progress
note suffice?

I would think a quarterly note would be ok-you'd identify if there were any changes in the

4) Section F interviews only need to be completed initially, annual and significant
changes?  This is what I am being told.  Since the RAI manual is so big can you maybe
direct me to the page number or chapter as to where it says this?
It doesn't say in the RAI manual that section F is only provided with the comprehensive
assessment: admission, annual, significant change and significant change of prior
correction. Believe me, it was the first thing I tried to find. It does say what a
comprehensive assessment is and when that is offered (as indicated by the 4 times I
just noted). I believe that is written in the assessment chapter of the RAI. Since section
F is only shown to be on the comprehensive assessment and not on quarterlies, PPS's
and such, then this is a logical assumption. Although, I, like you, would like to see it
officially written in the RAI manual.

5) Is there a place where we can direct questions directly to CMS to answer?
Questions regarding the "MDS 3.0 RAI Manual" should be directed to Please note that CMS will not be providing an
individualized response to each inquiry; however, CMS will make sure the issues or
comments are addressed in the upcoming MDS 3.0 training sessions or updates to the
information provided on this page.

6) In the section F interview, what do I do with the blank boxes if the resident codes
three "9"s and I skip to do the Staff Assessment? Do I leave the unasked questions

No-you code a dash (-) in the unasked questions, otherwise it looks like you just didn't
complete the section.

7) I know what triggers the CAA, but I don't know how to fill in the notes or how to fill in
the explanation, it’s all very confusing for me.

Did you do the RAP's for the 2.0? If so, then the process is the same.   Is your facility
using the CAA Resources? If so, simply use the 4 page CAA Resources for activities
and check off the areas that apply to the resident. Use that information gathered to write
a narrative at the end of the CAA Resources describing why the resident triggered (or
potential reasons).  

If you are not using the actual CAA resources checklists that CMS provided, then use
the CAA resources information to write your CAA summary. I love the CAA Resources
checklist because it really makes you look at many possible reasons why the resident
triggers for activities. Is it a health reason such as pneumonia? Is it because the
resident is a short term stay and has no interest in activities? Is it a cognitive deficit, and
so on. The point is to work through the CAA resources (or whatever additional
assessment tool you have decided to use), to find out potential causes and reasons
why the resident triggered. Residents typically trigger in activities because of some
other reason-the underlying cause (mood, behavior, cognition, lack of resources,
shyness, lack of interest, health reasons and diagnosis, need for leisure education,
medications, pain, availability, etc. Use the CAA resources to help determine that
underlying cause. Try it on one resident, checking off each box in the left side of the CAA
resource check list. In the right column write how you know that information. Was it in
the medical record, or perhaps you observed it or a family or resident told you. It's a very
helpful tool. It will also help you determine if you going to care plan or not.

8) Dear CMS,   There has been much controversy and confusion over the "little pleasure
or interest in doing things", found in section D0500 (A) and D0200 (A). The concern is
with the word "things". This question is triggering activities quite often and there is
major concern as to what the intent of the question is. If the term "things" does indeed
refer to activities (recreational), then the question should be asked in such that manner.
The resident should be made aware that the question refers to activities. I am
assuming that things is referring to activities because of the relation to the answer has
to triggering activities.   On behalf of the Activity profession, I am asking you to please
clarify the meaning of the term "things"? Thank you for your consideration.  Kim Grandal,

Specific "things" are defined by the resident. They might be activities such as visiting
others, drawing, reading, dancing, conversing with others, maybe the resident used to
braid her grandaughter's hair when she visited and now she doesn't want to, etc. It may
also refer to wanting to do "things" not necessarily activities with others. The
question on the PHQ-9 cannot be rewritten to include the word "activities" as the PHQ-9
is validated and tested tool as it is currently displayed on the MDS 3.0.  

Teresa M. Mota, RN, CALA MDS
Help Desk

For more MDS 3.0 education, news and resources for Activity and Recreation
Professionals visit

About the Author
Kimberly Grandal, Founder and Executive Director of Re-Creative Resources, Inc., is a
strong advocate for the field of Therapeutic Recreation and Activities, with over 18 years
of experience in various management and consultant positions. She is an Activity
Consultant Certified and a Certified Therapeutic Recreation Specialist. Kim founded Re-
Creative Resources Inc. in 2006 and provides seminars for various local, state and
national activity associations. She also offers lectures for Re-Creative Resources Inc.
and provides online webinars. In addition, Kim provides consultation and support to
numerous facilities in the state and nationwide and writes for numerous online sources.

Permission to Use
Permission granted to print this article for non-commercial purposes only, as long as
the source of information is retained. No portion of this article may be altered.  Contact
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