The Basics of Promising Practices

The History and Key Provisions of OBRA '87

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Brief History of OBRA '87

In 1986, a blue ribbon panel, selected by the Institute of Medicine (IOM) completed a report titled Improving the Quality of Care in Nursing Homes.^[1] This report made it clear for the first time that quality of life carries equal weight to quality of care. Congress used the findings in this report to create The Omnibus Reconciliation Act of 1987 (OBRA '87),^[2] which changed the quality of care of nursing home residents across America, by mandating enforceable minimal quality of care standards for long term care facilities.

At the time of OBRA '87's landmark passage, nursing homes were viewed by the American public as institutions plagued with abuse and neglect, places without dignity and respect. The release of the IOM report substantiated the need to establish higher standards for nursing homes.

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OBRA '87 Key Provisions

At the heart of OBRA '87 is resident quality of life and quality of care. OBRA '87 established a series of uniform standards for Medicare and Medicaid-certified nursing homes designed to promote resident rights and maximize resident quality of care and functioning. The law mandated that the Centers for Medicare & Medicaid Services (CMS) (then the Health Care Financing Administration), develop and issue regulations to implement the law, which they did in 1990 at 42 CFR Part 483^[3].  The issuance of 42 CFR Part 483 compelled nursing homes to focus on the inherent right of each resident to "attain and maintain his/her highest practicable physical, mental, and psychosocial well-being." Some key provisions include the following:

• The right to freedom from abuse, mistreatment and neglect;
  
  
• The right to freedom from physical restraints;
  
  
• The right to choose a personal physician;
  
  
• The right to access medical records;
  
  
• The right to be treated with dignity and to exercise self-determination;
  
  
• The right to accommodation of medical, physical, psychological and social needs;
  
  
• The right to participate in resident and family groups;
  
  
• The right to communicate freely and voice grievances without discrimination or reprisal;
  
  
• The right to appropriate resident discharge and transfer;
  
  
• The development of a comprehensive resident assessment process;
  
  
• The development of preadmission and annual screening for residents with mental illnesses and other chronic conditions that might not be appropriately addressed in nursing homes
  
  

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[1] Improving the Quality of Care in Nursing Homes. Institute of Medicine. Committee on Nursing Home Regulation. National Academy Press: Washington, D.C.; 1986 Available at: http://books.nap.edu/catalog.php?record_id=646

[2] The Omnibus Reconciliation Act of 1987 Available at: http://www.socialsecurity.gov/OP_Home/ssact/title18/1819.htm

[3] Title 42 of Federal Regulations, Part 483, Requirements for States and Long Term Care Facilities
(42 CFR Part 483) Available at: http://www.access.gpo.gov/nara/cfr/waisidx_01/42cfr483_01.html



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