In response to the Omnibus Reconciliation Act of 1987 mandate for the development of a national resident assessment system for nursing facilities, a consortium of professionals developed the first major component of this system, the Minimum Data Set (MDS) for Resident Assessment and Care Screening. A two-state field trial tested the reliability of individual assessment items, the overall performance of the instrument, and the time involved in its application. The trial demonstrated reasonable reliability for 55% of the items and pinpointed redundancy of items and initial design of scales. On the basis of these analyses and clinical input, 40% of the original items were kept, 20% dropped, and 40% altered. The MDS provides a structure and language in which to understand long-term care, design care plans, evaluate quality, and describe the nursing facility population for planning and policy efforts.

Estimates of the prevalence of disruptive behavior in the nursing home are presented based upon a representative sample of nursing home residents from intermediate care and skilled nursing facilities (ICF and SNF) in Rhode Island. Results indicate that 26.4% of residents had engaged in some form of disruptive behavior within two weeks prior to assessment. Abusiveness (physical and verbal) and noisiness were identified as the most prevalent behavior types (11.6% and 10.2%, respectively). Given the similarity of Rhode Island nursing home residents to nursing home residents nationally, these estimates may be considered as estimates for the national nursing home population. Older residents and those with greater physical and cognitive impairments were more likely to exhibit behavior problems. Although disruptive behavior seems to be associated with the dementing process, cognitively intact residents also demonstrated these behaviors. These findings suggest that an etiology of disruptive behavior should include both physiological as well as social and psychological factors.

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