Code Work: RAI-MDS, Measurement, Quality, and Work Organization in Long-Term Care Facilities in Ontario

Albert Einstein’s notion of the role of subjectivity in measurement is high-lighted by the Neils Bohr character in Michael Frayn’s play Copenhagen:Measurement is not an impersonal event that occurs with impartial univer-sality. It’s a human act, carried out from a specific point of view in time and space, from a particular viewpoint of a possible observer. (Frayn 1998, 71)Reflecting on the notion of measurement as a human act, informed by the observer’s viewpoint – in terms of what is measured, by whom, and to what ends – raises important questions for health, health services, health outcomes, and care work organization. What conditions and care are measured, what health care data are collected, by whom, in what way and for what ends affects who gets care with public funds, the quantity and quality of that care, the way care work is organized, and the quality of working conditions for those providing care.In response to growing quality concerns, the Ontario government requires long-term care facilities (LTCFs) to collect clinical assessment data about residents’ health conditions and behaviours, using the Resident Assessment Instrument-Minimum Data Set (RAI-MDS) Version 2.0 (Canadian Institute for Health Information 2002). This standardized assessment tool, originally created in the United States and now developed by the non-profit corporation interRAI, tabulates residents’ clinical needs and calculates resource allocations. The Ontario govern-ment relies mainly on this tool to track quality indicators, to impose care accountability requirements, and to assess funding levels based on acuity measures, which are then pegged to resource utilization groups for resource allocation. The data are collected and collated by nurses and dietary, recreation, and RAI coordinator staff (who are mostly nurses and social workers by training).

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