Returning to the Community: Track MDS Section Q Referrals Through the Local Contact Agency

Preserve the resident's question

A long-stay resident may want to learn about community living without knowing whether it is possible. That interest deserves a real response rather than a premature discharge date or an assumption that the current placement is permanent.

42 CFR 483.21(c)(1)(vii) requires documentation that the resident was asked about interest in information on returning to the community, relevant referrals, planning updates from referral information and, when community discharge is deemed infeasible, who made that determination and why.

Use the current Section Q

The October 2026 RAI manual, version 1.20.11, explains resident choice, Q0610 referral and Q0620 reasons a referral was not made. It identifies the state-designated local contact agency and state point of contact as resources the facility should know.

Use the complete item instructions for the actual assessment; this guide does not select an individual resident's MDS code. In particular, an old template labeled Q0600 should not substitute for the current instrument and instructions.

Work an unanswered referral to a useful result

A fictional resident asks to discuss community options. The facility records the interest and sends an authorized referral to the designated LCA. The first message is accepted by a shared inbox but produces no contact with the resident.

The coordinator follows up through the state-designated route and discovers that the LCA needed a current contact preference. With the appropriate authorization, the facility supplies it, confirms that the resident receives a discussion of options and records the resulting information. The resident identifies accessible housing and reliable support as unresolved dependencies.

The team updates the care and discharge-planning records with those dependencies and the agreed next steps. It does not enter a discharge date simply because the LCA contact occurred. Nor does it close the resident's interest as “not feasible” because the first email went unanswered.

The finished trace contains the resident's expressed interest, actual referral, follow-up, contact, information received and planning response. Each event has its own date and source.

Distinguish recommendations from requirements

The RAI care-area resource recommends initiating LCA contact within approximately ten business days and appropriate follow-up if contact does not occur. It explicitly says the ten-business-day interval is a recommendation, not a requirement, and recognizes resident-specific circumstances and available supports.

A facility may choose a more specific internal service target through its reviewed process, but it should label that target honestly. A software alert must not present a local target as a federal violation or allow an urgent resident need to wait merely because the target has not expired.

When no referral is made, preserve the actual reason and apply current Section Q instructions. An existing active LCA relationship, the resident's preference and an unknown agency are different situations. They should not all become a generic “referral declined” status.

Keep feasibility decisions explainable

Qualified staff, the resident and relevant partners evaluate options using actual care needs, supports and community resources. The RAI manual cautions against raising expectations before more information is available. If transition is determined infeasible, document who made that determination and why, and keep the resident informed through the appropriate process.

For a platform buyer, the unanswered-inbox example tests whether assessment, social services and discharge planning can carry a resident's question through to a meaningful response. That is a distinct upstream job from producing a discharge summary after a destination and date are already known.