Nursing homes and healthcare facilities must conduct a comprehensive, accurate, standardized reproducible assessment of each resident’s functional capacity using the Resident Assessment Instrument (RAI) specified by CMS. This assessment must include identification and demographic information, customary routine, cognitive patterns, communication, vision, mood and behavior patterns, psychological well-being, physical functioning and structural problems, continence, disease diagnosis and health conditions, dental and nutritional status, skin conditions, activity pursuit, medications, special treatments and procedures, discharge planning, and documentation of participation in assessment. The assessment must be conducted within 14 calendar days after admission, when there is a significant change in the resident’s status, and not less than once every 12 months. The RAI process must be used to develop a comprehensive care plan, provide appropriate care and services, and modify the care plan and care/services based on the resident’s status. Nursing homes and healthcare facilities must gather and analyze supplemental information based on triggered Care Area Assessments, participate in resident interviews, and have a system in place to ensure assessments are conducted in accordance with specified timeframes.

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