Behind the scenes of every nursing home admission are two formal assessments that most families never hear named, yet which shape the entire experience: the PASRR screening before admission, and the MDS assessment after. Together they determine what care your parent is deemed to need, what specialized services they're entitled to, how their care plan is built, and even how much the facility gets paid to care for them. Understanding them turns you from a bystander into an informed advocate.
PASRR: the pre-admission screen
PASRR stands for Preadmission Screening and Resident Review. It is a federal requirement for anyone seeking admission to a Medicaid-certified nursing facility, regardless of who is paying. Its purpose is to make sure that people with serious mental illness or intellectual and developmental disabilities are not inappropriately placed in nursing homes when their needs would be better served elsewhere — and, if a nursing home is appropriate, that they receive the specialized services their condition requires.
PASRR works in two levels:
- Level I is a screen applied to everyone, identifying whether the person may have a serious mental illness or intellectual disability.
- Level II is a more in-depth evaluation triggered when Level I flags a possible condition. It determines whether nursing facility placement is appropriate and what specialized services the person needs.
Why this matters to families: if your relative has a mental health condition or a developmental disability, PASRR is the mechanism that is supposed to guarantee they get the right specialized services and aren't simply warehoused. If you have a relative in this situation, ask whether a Level II evaluation was done and what specialized services it recommended — and then make sure the facility is actually delivering them.
The MDS: the comprehensive assessment that drives care
Once admitted, every resident of a Medicaid- or Medicare-certified nursing home is assessed using the MDS — the Minimum Data Set. Despite the modest name, the MDS is a comprehensive, standardized assessment of the resident's physical, cognitive, psychological, and functional status. It covers mobility, activities of daily living, continence, cognition and mood, nutrition, skin condition, pain, medications, and much more.
The MDS is completed on admission, at regular intervals, and whenever there is a significant change in the resident's condition. It is not a one-time form; it is the ongoing clinical portrait of the resident that the facility is required to maintain.
Why the MDS shapes everything
The MDS matters for three concrete reasons families should understand:
- It drives the care plan. The problems and needs identified in the MDS are supposed to flow directly into the resident's individualized care plan — the document that dictates what care they actually receive day to day. An MDS that accurately captures a resident's pain, fall risk, or nutritional needs leads to a care plan that addresses them. An MDS that misses or understates them leads to gaps.
- It triggers protections and services. Certain MDS findings automatically flag areas that require further clinical review, and the assessment is how issues like pressure-ulcer risk, weight loss, or worsening cognition get formally recognized and acted upon.
- It determines payment. The MDS feeds the system that sets how much Medicare and Medicaid pay the facility for a given resident. This creates an incentive families should be aware of: because the assessment affects reimbursement, there is a built-in pressure to code residents in ways that maximize payment — which is neutral when accurate, but a problem if a resident is coded as needing more (or, at times, less) than they actually do.
How families can use this knowledge
Attend the care-plan meeting. Residents and families have the right to participate in care planning. The care plan is the practical output of the MDS, and the meeting is where you can confirm that the assessment captured your relative accurately and that the plan addresses what matters. Come with specifics: falls, pain, appetite, mood, engagement.
Ask whether the MDS reflects reality. If you see your relative in daily pain but the care plan doesn't mention pain management, ask whether the MDS captured it. If they've lost weight, ask whether the assessment flagged it and what the plan is. You are, in effect, quality-checking the clinical portrait the whole system runs on.
Request a reassessment after any change. A significant change in condition — a fall with injury, a new diagnosis, a decline in eating or mobility — should trigger a new MDS and an updated care plan. If it hasn't, ask why.
For relatives with mental illness or developmental disability, follow the PASRR thread. Confirm a Level II evaluation was done, learn what specialized services it recommended, and hold the facility to delivering them.
The takeaway
PASRR and the MDS are invisible to most families, but they are the machinery that decides what care a resident is deemed to need and actually receives. You don't need to master the clinical detail. You need to know these assessments exist, that you have the right to participate in the care planning they drive, and that asking whether they accurately reflect your relative is one of the most effective forms of advocacy available — because you are checking the document everything else depends on.
Want a clear shortlist before you start calling?
If you don't know which nursing homes to contact first, Curalune Care Help can prepare an ordered shortlist of 3 to 5 suitable options — with contacts, useful links and a ready-to-send message you can put to all of them at once.
The service helps you organise the search. $89, one-off. If you don't receive at least 3 homes matching the area and criteria you gave us, we refund you in full. It does not replace the home's own assessment and does not guarantee admission, price or bed availability.
Important limit
Curalune offers practical help with the search and orientation. Admission, pricing, bed availability and the final assessment always rest with the nursing homes and the competent authorities (your state Medicaid agency, the state survey agency and Medicare).