Introduction

Residential care has been the mainstay of long-term care delivery systems in industrialized countries for decades. However, changes in acute care financing; individuals' preferences for remaining in the community; and the ageing of the elderly population mean that individuals with increasing frailty and impairments occupy these long-term care facilities. Most long-term care systems have evolved idiosyncratically as countries have faced different demographic imperatives and responded to different regulatory and medical-care systems. The need to characterize the needs of the population of long-term care users and the types and quality of services they receive has come to the forefront as the acuity of long-term care facilities has increased and as countries attempt to rebalance these budgets in order to provide more community support.

This chapter describes the development of a comprehensive clinical and functional assessment instrument – the nursing home Resident Assessment Instrument (RAI), more commonly known as the Minimum Data Set (MDS). This was designed in the United States on the basis that the proper provision of the complex care needed by frail older persons is predicated upon a comprehensive clinical assessment and it is the absence of such that underlies deficient quality of care. Originally intended as a clinical care planning tool, this minimum set of clinical and demographic data on all nursing home residents has been adapted as a vehicle for determining payment levels and to monitor the quality of care.