Minimum Data Set (MDS) for Nursing Home Resident Assessment

The provision of appropriate care in nursing facilities requires comprehensive knowledge of residents' strengths, weaknesses, and problems. As one feature of the Omnibus Budget Reconciliation Act of 1987 (OBRA 87), the U.S. Congress sought to ensure the availability of such information by mandating a national resident assessment system, including a uniform set of items and definitions for assessing all residents in [Page 772]nursing facilities in the United States. The need for uniform resident assessment in long-term care had been long recognized. A 1986 study by the national Institute of Medicine (IOM) focused on how to improve nursing home regulation and identified uniform resident assessment as a cornerstone of any effort to improve quality. Indeed, this recommendation, along with a host of others in the Institute's report, formed the basis for many of the nursing home reform provisions in OBRA 87, requiring each certified nursing facility to conduct a comprehensive, accurate, standardized, reproducible assessment of each resident's functional capacities.

In 1988, the Health Care Financing Administration (HCFA) (now the Centers for Medicare and Medicaid Services [CMS]) contracted with the Research Triangle Institute, the Hebrew Rehabilitation Center for the Aged, Brown University, and the University of Michigan to develop and evaluate a uniform resident assessment system. The resident assessment instrument that emerged was designed as a minimum data set (MDS) of items, definitions, and response categories aimed at providing a comprehensive assessment. In addition, the resident assessment protocols (RAPs), which are part of the resident assessment instrument (RAI), provide guidelines for more in-depth assessment of 18 conditions that affect the functional well-being of nursing home residents (e.g., falls, urinary incontinence, cognition difficulties, and use of restraints).