Nursing Home Reform Act

The federal Nursing Home Reform Act of 1987 established the quality standards for nursing home facilities in the United States. Nursing homes must meet these standards if they receive Medicaid or Medicare funding. The regulations outlined in the act help keep residents of long-term care facilities safe — but many residents still suffer from abuse each year. Find out what you can do if your loved one has been harmed.

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What Is the Federal Nursing Home Reform Act of 1987?Front of the Supreme Court building in Washington D.C.

The federal Nursing Home Reform Act of 1987 (NHRA) was passed as part of the Omnibus Budget Reconciliation Act (OBRA).

The act raised the standard of care across the U.S. and established financial penalties for non-compliant nursing homes and long-term care facilities.

The Nursing Home Reform Act also established a bill of rights to protect residents from all forms of nursing home abuse, mistreatment, and neglect.

The Omnibus Budget Reconciliation Act

OBRA is a federal law enacted by President Ronald Reagan. It was the first major revision of the federal standards for nursing home providers since the 1965 creation of Medicaid and Medicare.

OBRA changed the legal expectations of the care that nursing facilities provided. Facilities that want to receive funding for Medicaid or Medicare services must provide a level of care that meets OBRA’s standards.

Why Was the Nursing Home Reform Act Enacted?

The NHRA’s primary goal is to ensure that nursing and long-term care home residents receive quality care that allows them to achieve or maintain their “highest practicable” mental, physical, and social well-being.

While the Nursing Home Reform Act has helped protect vulnerable residents, many argue it is not enough. Nursing home abuse and neglect are still widespread across the country. Fortunately, you can take action and get justice if a loved one was harmed in a nursing home.

Download our FREE Nursing Home Abuse Workbook to learn more about how to keep your loved one safe.

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What Nursing Home Changes Were Set by the NHRA?

The federal Nursing Home Reform Act of 1987 brought about several pivotal changes aimed at improving the quality of care and life of nursing home residents.

Here are the top changes introduced by the Nursing Home Reform Act:

  1. Residents’ bill of rights: Residents are granted rights such as privacy, freedom from mistreatment, nursing home neglect, and abuse, the right to make complaints without fear of retaliation, and the right to participate in their care plans.
  2. Quality of care: Nursing homes must help residents reach and maintain their optimal physical, mental, and emotional well-being.
  3. Assessment and care planning: Each resident must receive a comprehensive assessment of their needs, and a care plan must be developed accordingly.
  4. Restrictions on antipsychotic drugs: Strict criteria were put forth for the use of antipsychotic drugs, emphasizing their use only when a specific diagnosis warrants them and pushing for periodic reviews to minimize unnecessary drug use and medication errors in nursing homes.
  5. Nurse aide training: The act introduced a mandated minimum of 75 hours of training for nursing aides, along with competency evaluations.
  6. Minimum staffing requirements: Facilities are required to have a registered nurse for at least 8 consecutive hours daily and licensed practical nurses on duty 24/7.
  7. Survey and certification: States are required to conduct unannounced surveys of nursing homes, investigate complaints, and to certify compliance with federal quality and safety standards.
  8. Sanctions: Facilities found to violate the NHRA’s requirements could face penalties ranging from monetary fines to the denial of Medicare and Medicaid payments.
  9. Protection from unnecessary services: Residents should not be given unnecessary services and should be free from unnecessary drugs or physical restraints.
  10. Dining and nutrition: The act emphasized the importance of dietary services to meet the needs and preferences of residents.

The Nursing Home Reform Act Residents’ Bill of Rights

The Nursing Home Reform Act includes a bill of rights for nursing home residents. It requires nursing homes to promote and protect these rights.

Under the bill, nursing home residents have the rights to:

  1. Privacy
  2. Necessary social, psychological, physical, and medical care
  3. Refuse or welcome visitors
  4. Remain in the facility until discharge or transfer
  5. Participate in family or resident groups
  6. Communicate freely
  7. Exercise self-determination (i.e., have the right to make their own choices)
  8. Voice grievances without fear of discrimination or retaliation
  9. Be fully informed in advance about changes in treatment, care, or status in the facility
  10. Be free from physical and chemical restraints
  11. Be free from mistreatment, abuse, and neglect
  12. Choose a physician
  13. Refuse treatments or medication

What the NHRA Means for Nursing Home Regulations

Overall, the Nursing Home Reform Act has changed the quality of care for the better. It has established the following regulations for nursing homes.

Survey Requirements

States must perform unannounced surveys of nursing homes at least once every 15 months and whenever residents and their family members make complaints. These surveys focus on residents’ quality of care, services provided to them, rights, and quality of life.

State Nursing Home Monitoring Requirements

States must also monitor nursing homes. Specifically, they must certify and survey nursing homes and enforce the NHRA. Monitoring ensures that nursing homes provide adequate care.

Government Penalties for Nursing Home Violations

Nursing homes deemed to violate the Nursing Home Reform Act are subject to government penalties and sanctions.

These penalties include:

  • Denial of Medicare or Medicaid funding
  • Monetary penalties
  • State monitoring
  • Temporary state management

Was the Nursing Home Reform Act Successful?

Since the Nursing Home Reform Act went into effect, the average number of deficiencies per facility had declined. As a result, the presence of bedsores (pressure ulcers) and use of urinary catheters, and chemical and physical restraints have all decreased.

Unfortunately, not enough has been done. According to the World Health Organization, about 66% of nursing home staff reported that they have committed abuse in the previous year.

Further, there is still chronic understaffing in nursing homes, which is one of the top causes of abuse and neglect.

Here are some changes that may make nursing homes more responsive to residents’ needs:

  • Change the staffing model and wages: Nursing home aides are often responsible for over 20 residents on a shift. Although the job is emotionally and physically demanding, the average wage is only $13 per hour. As a result, the turnover rate is very high, causing many nursing homes to be understaffed.
  • Improve infection control: Residents often have weak immune systems, making nursing home infections a serious problem. Nursing facilities should stock personal protective equipment, isolate sick residents, and implement proper hygiene to prevent outbreaks.
  • Reduce isolation: Social isolation results in a 50% higher risk of dementia, a 32% risk of stroke, and a 29% higher risk of coronary heart disease.
  • Require more registered nurses: Facilities with more registered nurses are more responsive to residents’ needs. Currently, federal laws only require nursing homes to employ a registered nurse for 8 consecutive hours per day. As a result, many residents receive substandard medical attention and suffer from abuse and neglect.

While the Nursing Home Reform Act was a step in the right direction in protecting residents, more needs to be done.

Nursing home abuse and neglect remains at crisis levels in the U.S. and many experts predict it will only increase as the population ages.

Nursing Home Abuse Justice is committed to keeping nursing home residents safe and free from harm. If you or a loved one has suffered nursing home abuse or neglect, connect with us 24/7.

Call (800) 896-7040 or fill out this case review form to get a free consultation.

Nursing Home Reform Act FAQs

What was the primary goal of the Nursing Home Reform Act of 1987?

The main goal of the federal Nursing Home Reform Act of 1987 was to protect older adults from physical and emotional abuse and neglect.

Although this act has changed how nursing facilities are run, further steps must be taken to reduce the epidemic of nursing home abuse and neglect.

What is OBRA and why is it important?

The Omnibus Budget Reconciliation Act (OBRA) was passed by the U.S. Congress in 1987. The federal Nursing Home Reform Act of 1987 was a part of it, and this changed the care that residents recieved for the better.

What does OBRA require every state to maintain?

OBRA requires every state to:

  • Establish minimum requirements for health care and nurse aide competency.
  • Establish state law-approved nurse aide training programs that meet federal government requirements pertaining to basic personal care, nursing, mental health, restorative skills, and social service.
  • Maintain an official database of people who have completed the nursing assistant training program.

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Nursing Home Abuse Justice Team

Nursing Home Abuse Justice was founded to shine a light on nursing home and elder abuse. Every day, thousands of people in nursing homes and assisted living facilities are abused. Our team helps educate seniors and their loved ones on the common causes, signs and preventions of nursing home abuse. We report on real-world studies and current events from respected news outlets to expose this national problem.

Last modified: August 24, 2023

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