The U.S. National Nursing Home Resident Assessment Instrument (V 1.0 and 2.0) is implemented.The instrument was implemented in 1991 by Brant Fries and collaborators in every nursing home in the U.S. to improve care planning. Computerization was mandated in 1998 and, since then, 13 million assessments have been performed every year in the U.S. In addition, 13 assessment systems for frail, elderly, and disabled persons in other sectors that have been implemented around the world, ranging from palliative care assessment instruments adopted across Ontario to home care assessments used in 20 U.S. states as well as Iceland, Belgium, and Finland, and acute care assessment systems used throughout Australia and Belgium. Algorithms based on these assessment systems are being used for determining eligibility for nursing home care under Medicaid in Michigan, Arkansas, Louisiana, and New Jersey. Fries and collaborators also developed the Resource Utilization Groups (RUGs), Version III and Version IV: A case-mix system, based on the national nursing home Resident Assessment Instrument, used to categorize residents based on intensity of resource use. The system is used to pay all U.S. nursing homes under Medicare’s Prospective Payment System ($33 billion/year), acknowledging differences in the cost of caring for their patients. RUG-III was implemented nationwide in 1998, RUG-IV in 2010. These systems are also used in three other nations to adjust payment to nursing homes. Nine independent validations have shown it to predict the cost of care in other nations as well.