The quality of long-term care has long been a concern among consumers, providers of care, policy makers, and payers. In 1986 the Institute of Medicine (IOM) issued a study entitled, "Improving the Quality of Care in Nursing Homes."16 The focus of the study was to examine ways to improve the regulation of nursing homes to improve quality of care. A core theme that emerged from that study was the need to standardize assessment and care planning for nursing home residents.
Congress subsequently passed a law in 1987 that required the development of the MDS to ensure that each nursing home resident receives, at regular specified intervals, a comprehensive assessment and care plan designed to meet his/her needs. CMS (formerly known as the Health Care Financing Administration (HCFA)) developed the MDS based on input from various disciplines. The MDS assessment includes more than 583 items that are used by facilities in performing comprehensive assessments of their residents. Thirteen domain areas are included in the MDS assessment: past medical history and medically defined conditions, medical status, functional status, physical and sensory impairments, nutritional status, special treatments or procedures, psychosocial status, discharge potential, dental condition, activities potential, rehabilitation potential, cognition, and drug therapy.17
Nationwide electronic collection of the MDS began in the 1990s. As required by statute for assessment and care planning, the MDS is required to be completed shortly after admission, annually, and quarterly thereafter. It is also required upon a significant change in the resident's condition. In most states, a shorter form is used for quarterly assessments than for the more comprehensive admission and annual assessments.