Ask the care expert: Where can I learn more about OBRA 87?
Sherrie Dornberger, RNC, CDONA, FACDONA, executive director, NADONA
A: Having been a director of nursing before, during and after OBRA, I can tell you, “We have come a long way, baby.” The best document I have found is from the Henry J. Kaiser Family Foundation. It's an entire booklet titled “Nursing Home Quality Care Twenty Years After the Omnibus Reconciliation Act of 1987,” printed in 2007, prepared by Joshua Wiener, Ph.D. It's available at www.kff.org.
At the booklet's conclusion, Wiener writes, “In the 20 years since the passage of OBRA 87, real progress has been made in providing improved quality care to nursing home residents, yet significant problems remain ...
“The 20th anniversary of the nursing home reform amendments provides an important opportunity to consider lessons learned, assess options for the future, and strategies for caring for an aging population in a variety of long-term care settings.”
The Kaiser booklet puts “everything OBRA” into one concise booklet. It goes over the rules, the changes in regulations and inspections, and how regulations were initiated. It reviews the reimbursement and prospective versus retrospective payment.
OBRA changed long-term care as it forced us to look at the needs of the “individual” resident. For instance, we would produce a policy, say, on whirlpool baths and everyone was forced to have their bath on our time schedule, when the CNA or charge nurse would create the WP schedule, with no consideration to the fact that the resident might be in pain and an evening bath may be less painful for him or her.
Before OBRA, we felt as though we allowed those residents to live in OUR facilities. Facilities today are much more homelike and friendlier places.