When it comes to nursing homes, ensuring that residents receive quality care is a fundamental priority. Federal laws have been enacted to ensure that nursing homes adhere to a specific standard of care, particularly those facilities that accept Medicare and Medicaid funding. One such critical piece of legislation is the Federal Nursing Home Reform Act, passed as part of the Omnibus Budget Reconciliation Act of 1987, commonly known as OBRA ’87. This law forever changed how nursing homes operate, creating a set of minimum care standards and resident rights that must be followed across the country.

What Is OBRA ’87?

In 1987, President Ronald Reagan signed OBRA ‘87 into law, marking the first major reform of federal nursing home care standards since the creation of Medicare and Medicaid in 1965. The law introduced sweeping changes to ensure that residents in certified nursing facilities receive care that allows them to “attain and maintain their highest practicable physical, mental, and psycho-social well-being.”

This legislation applies to nursing homes that receive Medicare or Medicaid funding and sets national minimum standards for care. It also enshrines a comprehensive set of rights for nursing home residents. Importantly, OBRA ‘87 focuses not just on the quality of care but also on the quality of life for nursing home residents. This emphasis on holistic well-being was revolutionary at the time.

Key Provisions of OBRA ‘87

OBRA ’87 brought several significant changes to the nursing home industry. Some of the most critical provisions include:

• Quality of Life and Care: Nursing homes are required to focus on improving or maintaining each resident’s ability to perform activities of daily living, such as walking, bathing, and dressing, unless medical reasons prevent such improvement.

• Individualized Care Plans: Every resident must undergo an assessment that leads to a personalized care plan tailored to their unique needs.

• Training for Staff: OBRA mandates at least 75 hours of training and testing for paraprofessional staff to ensure they are adequately prepared to care for residents.

• Resident Rights: Residents have the right to remain in a nursing home except in cases of non-payment, dangerous behavior, or significant changes in medical condition. Additionally, residents have rights to choose their personal physicians, access their medical records, and participate in family or resident councils.

• Restraints: The law prohibits the unnecessary use of physical or chemical restraints on residents.

• Financial Protections: Nursing homes cannot require residents’ families to pay for Medicaid or Medicare services, protecting families from financial exploitation.

Impact of OBRA ’87

OBRA ‘87 fundamentally changed how nursing homes are regulated. Inspections, which used to focus primarily on staff and facility records, now involve talking to residents and observing daily routines such as dining and medication administration. This shift ensures that inspectors get a better sense of the actual care residents receive.

In addition, the use of antipsychotic drugs and physical restraints has dropped significantly due to OBRA’s emphasis on resident rights and individualized care. The law has led to more personalized care planning, better staff training, and a reduction in the overuse of medication and restraints, resulting in improved overall care for residents.

Advocacy and the Creation of OBRA ‘87

OBRA ’87 didn’t happen overnight. Its passage was the result of growing public concern over the poor quality of care in many nursing homes. The U.S. Congress commissioned the Institute of Medicine (IoM) to study how to improve the regulation of nursing homes. The IoM’s 1986 report, Improving the Quality of Care in Nursing Homes, recommended stronger federal oversight, better staff training, and a more dynamic inspection process. These recommendations laid the foundation for the reform act.

Advocacy groups like the National Citizens’ Coalition for Nursing Home Reform played a vital role in pushing for these changes, organizing a national “Campaign for Quality Care” to support federal reforms. The collaboration between consumer groups, healthcare professionals, and nursing home associations helped create the consensus needed for this landmark law.

OBRA’s Legacy

Since its implementation, OBRA ’87 has had a lasting impact on nursing home care in the United States. Some states, like Washington and Michigan, have gone even further by incorporating parts of OBRA into state law or expanding its provisions to other long-term care facilities.

The law set a new standard for care that has improved the lives of nursing home residents nationwide, emphasizing not just their physical health but also their dignity, rights, and overall well-being.

OBRA ’87 remains a cornerstone of nursing home regulation, ensuring that the care provided in these facilities meets a basic standard of quality. Its effects continue to ripple across the nation, reminding us of the importance of compassion and high standards in caring for some of the most vulnerable members of our society.

Know Your Rights and Seek Help When Needed

OBRA ’87 is proof that laws can bring about meaningful change in healthcare, setting minimum standards that nursing homes must follow while also promoting a focus on individual care and resident rights. For families with loved ones in nursing homes, understanding these legal protections is crucial in ensuring that their loved ones receive the best possible care.

If you have a loved one who has been injured or neglected in a nursing home, it is essential to take action. The legal team at Olsman MacKenzie Peacock specializes in advocating for victims of nursing home abuse and neglect. We are here to help you seek justice and ensure your loved one receives the care they deserve. Call us today at 800-366-8653 to discuss your case and learn how we can assist you.