Nursing homes are admitting more patients from hospitals 30 years after the passage of the Omnibus Budget of Reconciliation Act of 1987 (OBRA ’87), according to new research. 

Also during that time, the industry has contracted, nursing home quality has improved and the resident population has become more diverse, the study revealed.

The number of residents being admitted from hospitals has increased by 15% since 1985, with more patients needing rehabilitative and post-acute care, according to a new study that evaluated nursing home composition and quality since OBRA. Conducting the study were researchers at the Center for Gerontology and Healthcare Research and Department of Health Services, Policy, and Practice at the School of Public Health, Brown University; and the Center of Innovation in Long-Term Services and Supports, U.S. Department of Veteran Affairs Medical Center, Providence, RI.

“There is still a long way to go, but what was accomplished following OBRA gives good insight on how we should move forward, especially with home- and community-based services in mind,” lead researcher Shekinah Fashaw, MSPH, told McKnight’s Long-Term Care News

Shekinah A. Fashaw, MSPH

Investigators also found that the nursing home industry has decreased in size by nearly 400 facilities, while the number of nonprofit, dually certified and chain facilities has increased in the last three decades. And nursing homes have seen more diversity among residents. 

OBRA’87 was aimed at improving care quality and standards in nursing homes. 

It “focused on residents’ quality of life and care; expectations for improved or maintained resident health; as well as residents’ rights to banking, organized family councils, and freedom from unnecessary physical and chemical restraints,” a press release about the report said. “It also standardized certification standards and enforcement strategies.”

Nursing home quality has improved over the last 30 years, the report found. The number of residents receiving antipsychotics has dropped, while the use of physical restraint also dropped significantly. 

Fashaw described the changes around serious mental illnesses and psychotropic medications as “enlightening.” She said the findings have inspired new lines of research for herself and close colleagues. 

Fashaw added that long-term care providers should continue to think about alternatives to psychotropic medications for residents with dementia and serious mental illnesses “as these medications tend to have dangerous side effects for the nursing home population,” she said.

Direct care staffing levels have also increased. 

“Although the quality gains may not seem large by some standards, considering an older and sicker nursing home population, the observed quality improvements are commendable,” Fashaw said.  

She added that the biggest challenge for providers will continue to be issues around disparities and behavioral health. 

“The nursing home population is continuously shifting to become one that is older, sicker and more diverse, and almost one-third of the population has a psychiatric diagnosis,” Fashaw said. “The introduction and integration of home- and community-based services will become increasingly important for long-term care providers in both positive and challenging ways.”

Full findings were published in the February issue of the Journal of Post-Acute and Long-Term Care Medicine.