Nursing Home Reform Act

Nursing homes that receive federal funds must comply with federal legislation that calls for a high quality of care. Though all states must comply, at a minimum, with the federal regulations, some states have adopted tougher laws.

Congress enacted legislation in 1987 to require nursing homes participating in the Medicare and Medicaid programs to comply with certain requirements for quality of care. This law is included in the Omnibus Budget Reconciliation Act of 1987 (OBRA 1987), also known as the Nursing Home Reform Act. It specifies 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..."

To participate in the Medicare and Medicaid programs, nursing homes must be in compliance with the federal requirements for long term care facilities as prescribed in the U.S. Code of Federal Regulations (42 CFR Part 483).

Under the regulations, the nursing home must:

• Have sufficient nursing staff. (42 CFR §483.30)
• Conduct initially a comprehensive and accurate assessment of each resident's functional capacity. (42 CFR §483.20)
• Develop a comprehensive care plan for each resident. (42 CFR §483.20)
• Prevent the deterioration of a resident's ability to bathe, dress, groom, transfer and ambulate, toilet, eat, and to communicate. (42 CFR §483.25)
• Provide, if a resident is unable to carry out activities of daily living, the necessary services to maintain good nutrition, grooming, and personal oral hygiene. (42 CFR §483.25)
• Ensure that residents receive proper treatment and assistive devices to maintain vision and hearing abilities. (42 CFR §483.25)
• Ensure that residents do not develop 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 treatment and services to incontinent residents to restore as much normal bladder functioning as possible. (42 CFR §483.25)
• Ensure that the resident receives adequate supervision and assistive devices to prevent accidents. (42 CFR §483.25)
• Maintain acceptable parameters of nutritional status. (42 CFR §483.25)
• Provide each resident with sufficient fluid intake to maintain proper hydration and health. (42 CFR §483.25)
• Ensure that residents are free of any significant medication errors. (42 CFR §483.25)
• Promote each resident's quality of life. (42 CFR §483.15)
• Maintain dignity and respect of each resident. (42 CFR §483.15)
• Ensure that the resident has the right to choose activities, schedules, and health care. (42 CFR §483.40)
• Provide pharmaceutical services to meet the needs of each resident. (42 CFR §483.60)
• Be administered in a manner that enables it [the nursing home] to use its resources effectively and efficiently. (42 CFR §483.75)
• Maintain accurate, complete, and easily accessible clinical records on each resident . (42 CFR §483.75)