Section J1400 has one question that is answered yes or no: Does the resident have a condition or chronic disease that may result in a life expectancy of less than 6 months?

According to Page J-23 of the RAI manual, this question is on the MDS because these residents have special needs and may benefit from palliative or hospice services in the nursing home. Additionally, care planning should be based on the resident’s preferences for goals and interventions of care whenever possible.

Many people do not realize, however that the physician is not required to write “less than six months to live” in all cases. Here are the steps for assessment:

1. Review the medical record for documentation by the physician that the resident’s condition or chronic disease may result in a life expectancy of less than 6 months, or that they have a terminal illness.
2. If the physician states that the resident’s life expectancy may be less than 6 months, request that he or she document this in the medical record. Do not code until there is documentation in the medical record.
3. Review the medical record to determine whether the resident is receiving hospice services.

Coding instructions then state:

  • Code 0, no: if the medical record does not contain physician documentation that the resident is terminally ill and the resident is not receiving hospice services.
  • Code 1, yes: if the medical record includes physician documentation: 1) that the resident is terminally ill; or 2) the resident is receiving hospice services.

If the physician documents “terminally ill” he or she must be aware of the MDS definition, which is found on page J-24:

“Terminally Ill” means that the individual has a medical prognosis that his or her life expectancy is 6 months or less if the illness runs its course.

If the resident is receiving hospice services, the RAI manual says “under the hospice program benefit regulations, a physician is required to document in the medical record a life expectancy of less than 6 months, so if a resident is on hospice the expectation is that the documentation is in the medical record.

Why all the caveats? It may be because many who care for those with terminal conditions believe that documenting any specific life expectancy in weeks or months is akin to giving a death sentence. So, CMS did allow the phrase