Abstract
Resident Assessment Protocol (RAP) triggers summarized the care problems after the primary assessment for the long-term care facility (LTCF) residents, and the related care plans would be triggered while each individual RAP trigger was generated. Aside from the triggers for care plan, RAP triggers are also effective indicators to evaluate the complexity of care and have been shown to predict one-year mortality of LTCF residents independent from multimorbidity. Besides, the increase of RAP triggers was also predictive for physical functional decline of LTCF resident, as well as decline in cognitive function. A complex interrelationship between cognitive decline, mood conditions, malnutrition and decline of physical function was noted, and RAP triggers were significant indicators for these phenomena. Further intervention study should be conducted to evaluate whether current care plans successfully reduce the over care complexity and prevent functional declines.