The Nursing Home Minimum Data Set Assessment Instrument: Manifest Functions and Unintended Consequences--Past, Present, and Future

Abstract

The Minimum Data Set (MDS) is a uniform instrument used in nursing homes to assess residents. In January 2008, the Centers for Medicare and Medicaid Services published a draft of a new MDS-version 3.0. This article traces the instrument's development and the design decisions that shaped it, discusses the MDS's manifest functions-data collection intended to drive quality improvement and the unintended consequences of its use-paper compliance and diminished attention to resident quality of life, and examines the revised version to gauge its success in meeting the instrument's objectives. Although results of the national evaluation of MDS 3.0 are promising, the revisions, especially those pertaining to quality-of-life assessment and the use of resident interviews and standardized assessment procedures, raise questions for future consideration. Additionally, past research suggests that the MDS's impact on quality-of-care improvement will be limited unless efforts are directed toward resolving the industry's persistent struggles with staffing, survey effectiveness, and the development of feasible care processes. MDS 3.0 seems most likely to achieve its potential if it operates within a multifaceted quality improvement framework.

Feasibility of a web-based dementia feeding skills training program for nursing home staff

“…11, 12, 31, 45 In this study, the NH staff in the intervention group responded differently to the resident’s aversive behaviors after training. By learning that feeding behaviors should not be viewed as “aversive” or “resistive”, but rather viewed as a form of communication indicative of preferences, the staff’s responses involved spending more time with subsequent increased meal intake by the residents (e.g., turning head away may indicate a preference for fluid versus the food being offered at the time; offer the fluid, and the meal will likely continue).…”

Screening for Geriatric Depression in Residential Care Facilities: A Systematic Narrative Review

“…It, along with the DRS embedded in the earlier version MDS 2.0 that is used now in Canadian nursing homes, are the only two instruments out of the nine reviewed that are used for mandatory screening for depression in residential care facilities in the United States and Canada. The Mood Questionnaire is currently the most robust and effective scale, owing to its excellent performance in detecting depression in older adults regardless of cognitive status, its simple response format, brevity, strong agreement with the DSM-IV-TR diagnostic criteria, and its availability in a self-report and observational versions (Rahman & Appelbaum, 2009;Saliba & Buchanan, 2008;Saliba, Jones, et al, 2012).…”

Development of the psychometric property of a Minimum Data-Set-Based Depression Rating Scale for use in long-term care facilities in Taiwan

“…Furthermore, this standardized assessment tool should provide useful guidance and assist nurses in deciding on a care plan, help managers to determine resource consumption, and help the government with reimbursing service costs (Robison et al, 2002). Based on the MDS-DRS data, resource consumption and quality indicators can be generated to guide interventions and serve as data sources for LTC payment systems (Rahman & Applebaum, 2009). The assessment of depressive symptoms at any early stage among institutionalized residents is more important than making the diagnosis of depression.…”