Question

What was the significance of the passage of the Omnibus Budget Reconciliation Act (OBRA) of 1987?

Answer 1

The Omnibus Reconciliation Act of 1987 set forth new provisions for Medicare and Medicaid sections related to new standards for care in the nursing home setting. One major provision was for nurse aide training.

The Omnibus Reconciliation Act of 1987 set forth new provisions for Medicare and Medicaid sections related to new standards for care in the nursing home setting. One major provision was for nurse aide training. Within that provision there are four specified requirements: (1) nurse aide training for 75 hours, (2) competency evaluation of newly trained nurse aides, (3) competency evaluation of nurse aides already providing care, and (4) a registry for nurse aides. The primary implications of the these requirements center on the responsibility of the individual nurse or nurse community in ensuring appropriate implementation of the new requirement. Without appropriate implementation, some of the provisions increase the liability of the nurse and the risk to the public. The reality of OBRA 1987 and its intent of bringing a measure of quality assurance to the nursing home industry should only serve as an impetus for the nursing community to better translate the nurse role and its contribution in the nursing home setting to policy makers at local, state, and federal levels.

On December 22, 1987, President Ronald Reagan signed the Omnibus Budget Reconciliation Act of 1987 (OBRA-87) also known as the Federal Nursing Home Reform Act. This was enacted to protect the rights of patients in long-term care facilities such as nursing homes, skilled nursing facilities, and assisted living homes. This act gave the Centers of Medicare and Medicaid Services(CMS) the authority to enact key measures to reduce unnecessary costs while improving the quality of patient care in these facilities.

Prior to the passage of this act there were many patient treatment practices that are considered unethical by today's standards; including

• routine orders for all patients to receive antidepressants without diagnosis of an appropriate condition,
• lack of routine monitoring of medication therapy, and
• frequent use of patient restraints (physical and chemical) at medically unnecessary times.

Some of the most important resident provisions in OBRA-87 include:

• Emphasis on a resident’s quality of life as well as the quality of care;
• New expectations that each resident’s ability to walk, bathe, and perform other activities of daily living will be maintained or improved absent medical reasons;
• A resident assessment process leading to development of an individualized care plan 75 hours of training and testing of paraprofessional staff;
• Rights to remain in the nursing home absent non-payment, dangerous resident behaviors, or significant changes in a resident’s medical condition;
• New opportunities for potential and current residents with mental retardation or mental illnesses for services inside and outside a nursing home;
• A right to safely maintain or bank personal funds with the nursing home; Rights to return to the nursing home after a hospital stay or an overnight visit with family and friends The right to choose a personal physician and to access medical records;
• The right to organize and participate in a resident or family council;
• The right to be free of unnecessary and inappropriate physical and chemical restraints;
• Uniform certification standards for Medicare and Medicaid homes;
• Prohibitions on turning to family members to pay for Medicare and Medicaid services; and
• New remedies to be applied to certified nursing homes that fail to meet minimum federal standards.