The Care Areas Assessment (CAA) process is the framework for decision-making after the MDS assessment has been completed, and serves as the link between the MDS and the Care Plan. The CAA process helps the interdisciplinary team evaluate the resident holistically, and to identify strengths, weaknesses, and comorbidities that will potentially impact the resident’s function, choices, and goals.  CAA’s also address important care considerations such as palliative care and advanced care planning.

The MDS identifies Care Area Triggers (CATs), as areas that need further assessment. The IDT should analyze each CAT to identify relevant causes, risk factors, and complications in order to develop a person-centered plan of care with appropriate interventions that address the concerns identified in the Care Area Assessment.  “Interpreting and addressing the care areas identified by the CATs is the basis of the Care Area Assessment process,” per the RAI manual page 4-2.

There are 20 Care Area Assessments that address concerns that commonly impact nursing home residents, they include: (1) Delirium (2) Cognitive Loss/Dementia (3) Visual Function (4) Communication (5) Activity of Daily Living (ADL) Functional / Rehabilitation Potential (6) Urinary Incontinence and Indwelling Catheter (7) Psychosocial Well-Being (8) Mood State (9) Behavioral Symptoms (10) Activities (11) Falls (12) Nutritional Status (13) Feeding Tubes (14) Dehydration/Fluid Maintenance (15) Dental Care (16) Pressure Ulcer/Injury (17) Psychotropic Medication Use (18) Physical Restraints (19) Pain and (20) Return to Community Referral

CAA Process Failure Case Study Example:

Mrs. J was admitted to the facility from home under hospice care. She had been receiving hospice services at home as well. She admitted with an indwelling foley catheter related to terminal care. Indwelling catheter is a Care Area Trigger for The Urinary Incontinence and Indwelling Catheter CAAs. However, the RAC/MDS Coordinator did not include risk of infection when completing the CAA. Mrs. J’s plan of care did not communicate to staff the need for monitoring related to UTI. Mrs. J had several charting entries during the month that indicated dark foul-smelling urine, weight loss, and a condition change. The facility failed to assess the resident and contact the physician until later in the month when the physician ordered a UA, the sample was obtained and an antibiotic ordered, the resident passed away the following day. Facility was cited with F684 Quality of Care.

Tips for CAA Process Improvement

The CAA process enables the IDT to develop accurate, thorough and relevant care plans to provide care in accordance with the resident’s preferences and goals.  If not implemented properly, a facility may not recognize risk factors such as the risk for infection, leaving the plan of care incomplete to meet the care needs of the resident.

The following action steps could potentially have altered these negative outcomes :

      • Ensure a thorough assessment by reviewing all indicators on the CAA work sheets– not just the checked items. For example, in the Urinary Incontinence and Indwelling Catheter care area, the software will check the box for “neurogenic bladder” if that diagnosis is coded in I1550. However, if the resident has inadequate urine or certain anticholinergic medications, the boxes would need to be manually checked and assessed as risk factors.
      • A thorough review of the medical record is essential.
      • Gathering information from the resident or the resident’s representative is also essential to having all the building blocks for a complete Care Area Assessment.
      • There should be a clear link between the care plan and the problems, risk factors, strengths, and needs that you identified in the CAA.

In summary, the Care Area Assessments is crucial to a well-developed plan of care. Thoroughly completing CAAs allows the IDT to identify clinical factors that need further investigation to ensure risk factors, resident specific strengths and preferences are included in the care plan. When carried out correctly, the CAA process can help avoid deficiencies in areas such as F684 Quality of Care and will improve resident outcomes.

We invite you to join us for our next session in the Survey Success! Avoiding Top Citations series which will review the #5 top citation nationally, F684 Quality of Care with an emphasis on understanding and applying the Interpretive guidance. Discussion will include:

      • actual citation examples
      • reviews of immediate jeopardy citations
      • strategies for successfully managing the survey process, and understanding the critical element pathways used to guide surveyor investigations
      • and implementing survey preparedness activities





Brandy Hayes, RN, RAC-CT
Clinical Consultant

Learn more about the rest of the Proactive team.