The world of nursing home care changed in 1987 when Congress enacted the OBRA (Omnibus Budget Reconciliation Act) regulations.
OBRA is a comprehensive set of rules created by clinicians and designed to be a blueprint for quality nursing home care.
I’ve studied and worked with these regulations for over ten years, and I believe that there are four principal regulations that form the backbone of quality care.
The four are:
1. Quality of Life (42 USC 483.15)
2. Quality of Care (42 USC 483.25)
3. Nursing Services (42 USC 483.30)
4. Administration (42 USC 483.75)
1. Quality of Life
“The facility must care for its residents in a manner and in an environment that promotes maintenance or enhancement of each resident’s quality of life.” (42 USC 483.15)
What does “quality of life” in a nursing home mean?
It means that each resident is entitled to:
1. Dignity
2. Self-determination
3. Participation in resident and family groups
4. Accommodation of needs
5. Activities
6. Social Services
7. Safe, clean and comfortable physical environment
Dignity
Each resident must receive care in a manner and in an environment that promotes dignity and respect.
Self-determination
Each resident must be given the opportunity to make their own choices of activities and services.
Participation in resident and family groups
Each resident must be given the opportunity to organize with other residents to discuss issues of common interest and concern.
Families of residents must also be given the opportunity to meet with other families to discuss grievances.
Under both circumstances, the facility must be responsive to concerns and grievances that are raised by these groups.
Accommodation of Needs
Each resident is to receive services in a manner that recognizes any special resident needs such as food choices or accessability requirements.
Activities
Each resident must be offered a program of activities that meets the interests, physical, mental and social abilities. Residents must be afforded the opportunity to participate in social, religious, and community activities of their choice.
Social Services
Each resident must receive medically related social services.
Safe, Clean and Comfortable Physical Environment
Each resident must be provided with a clean, safe and well lighted and ventilated living space.
2. Quality of Care
“Each resident must receive the necessary care and services to attain or maintain the highest practicable physical, mental and psychosocial well-being based on each resident’s assessment and plan of care.” (42 USC 483.25)
This requirement is fashioned to ensure that the resident’s outcome, and not the facility’s capacity, is paramount.
Resident Assessment
Each resident must be comprehensively assessed and evaluated on abilities, needs and risks, among them are the following:
Activities of Daily Living
The resident’s ability to bathe, dress and groom himself; to transfer and ambulate; eat and toilet independently.
Mental and Psychosocial Functioning
The resident’s mental and psychosocial strengths and weaknesses.
Nutrition
The risk for malnutrition must be determined and addressed.
Pressure Sores
The risk of pressure sores must be determined and addressed.
Plan of Care
Every resident need, as well as how the facility will address them, must be outlined in a Plan of Care.
3. Nursing Services
“Each resident must receive the nursing and related services to attain their highest practicable physical, mental and psychosocial well-being.” (42 USC 483.30)
There are no minimum national staffing levels, however, the facility must have sufficient nursing staff to provide each resident with assessments, planning, evaluation, direct care needs and supervision.
4. Administration
“Facilities must be administered in a manner that enables them to use their resources effectively and efficiently to attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident.” (42 USC 483.75)
This is where the buck stops. The facility’s management must administer the facility so that it complies with all federal and state laws and regulations. The governing board sets policies and appoints the Administrator who is the general manager of the nursing home.
