How is the MDS used in the staffing measure calculations? The number of assessments submitted dictates the hours required from Registered Nurse assessment coordinators. Case-mix adjustment is derived from case-mix indices achieved on the submitted MDS assessments and the census for hours per resident day is calculated from entry records and OBRA discharge assessments. The MDS is not used in the staffing measure calculations. The average number of MDS assessments submitted across a full quarter determines hours per resident day