Quality of care suffers without involvement of patients, clinicians, and agencies. Patients must have confidence in the clinician's knowledge and skill or they can be reluctant to disclose correct information. To establish that confidence, clinicians must be skilled in conducting an integrated assessment that combines sophisticated observation and interview. Agencies must provide clear guidance for assessment and provide, encourage, and support ongoing orientation and training. Such training must address OASIS data collection and processing and clinical assessment skills.