The Omnibus Budget Reconciliation Act (OBRA), also known as the Nursing Home Reform Act of 1987, has
dramatically improved the quality of care in the nursing home over the last twenty years by setting forth federal
standards of how care should be provided to residents.
This Act is interpreted with the U.S. Code of Federal Regulations (42 CFR Part 483). Such improvements
include less use of antipsychotic drugs, a reduction in chemical and physical restraint use, and a reduction in
inappropriate use of indwelling urinary catheters.
Mandates
The quality of care mandates contained within OBRA, and the regulations, require that a nursing home must
provide services and activities to attain or maintain the highest practicable physical, mental, and psychosocial
well-being of each resident in accordance with a written plan of care.
In order to participate in Medicare and Medicaid programs, nursing homes must be in compliance with the
federal requirements for nursing homes.

The mandates of OBRA are regarded in the nursing home setting to represent minimum accepted standards of
care. The failure of a nursing home to comply with the OBRA quality of care mandates in caring for a resident
represents a failure to exercise the degree of reasonable care and skill that should be expected.
Penalties
The Indiana State Department of Health is responsible for ensuring that nursing homes follow these mandates
through the state survey process. The Department of Health and Human Services (DHHS) and the states may
apply penalties against nursing homes for failure to meet the minimum standard of care as defined in the
OBRA regulations.
Such penalties may include fines, appointment of administrative consultants to run the nursing home while
deficiencies are remedied, and even closure of a nursing home.
Residents must be assessed to identify their medical problems and their abilities to perform basic self-care
activities. The DHHS established a uniform data set, referred to as the minimum data set (MDS), to document
this assessment.
The nursing home is responsible for the safety of each resident. This includes being responsible for orders
written by the resident’s primary physician or other medical provider. If the physician writes an order that does
not comply with the federal regulations, the nursing home is responsible for making sure the physician changes
such order. The mere presence of a physician’s inappropriately written order does not absolve the nursing
home of responsibility in providing safe care.
Provide services that will enhance each resident’s quality of life to its fullest (42 CFR §483.15).
Maintain the dignity and respect of each resident (42 CFR §483.15).
Develop a comprehensive care plan for each resident (42 CFR §483.20).
Conduct a comprehensive and accurate assessment of each resident’s overall health upon admission and at
each required interval (42 CFR §483.20).
Prevent a decline in activity of daily living (ADL) activities, including the ability to eat, toilet, bathe and walk.
Staff must provide for ADL care when necessary (42 CFR §483.25).
Prevent the development of pressure sores, and if a resident has pressure sores, provide the necessary
treatment and services to promote healing, prevent infection, and prevent new sores from developing (42 CFR
§483.25).
Provide appropriate care to those who have urinary incontinence and restore bladder function if possible. This
also includes only using urinary catheters when appropriate as outlined in the regulations to prevent adverse
consequences related to such use (42 CFR §483.25).
Prevent accidents, including falls, accidental poisonings and other incidents that could cause injuries (42 CFR
§483.25).
Maintain adequate nutrition to prevent unnecessary weight loss (42 CFR §483.25).
Provide each resident with sufficient fluid intake to prevent dehydration (42 CFR §483.25).
Ensure that residents are free from significant medication errors (42 CFR §483.

Sample Solution

60

SHARES

Share on Facebook

Tweet

Follow us

Share

Share

Share

Share

Share