Nursing Home Regulations
In 1965 Medicare and Medicaid came into existence
and with it came federal nursing home regulations. Nursing homes
that qualify and voluntarily elect Medicare and Medicaid to their
facility must follow these nursing home regulations put forth by
federal standards. The Health Care Finance Administration that is
part of the United States Department of Health and Human Services
enforces these nursing home regulations. Congress authorized the
first set of standards that were to be met by nursing facilities
in 1967 and created classifications for the Skilled Nursing Facilities
and Intermediate Care Facilities. In 1980 and again in 1987 these
nursing home regulations were updated with the most current standards
imposed under the Omnibus Budget Reconciliation Act of 1987.
OBRA 87: Omnibus Budget Reconciliation Act of
1987 (OBRA 87)
OBRA 87 requires that the facility provide each patient with care
that will enable the patient "to attain or maintain the highest
practicable physical, mental and psychosocial well-being."
-Quality of life for patients is the goal. The
facility must allow patient choice in activities, schedules and
health care decisions.
-OBRA 87 requires that SNFs and ICFs provide 24-hour
licensed practical nurse care seven days a week, and have at least
one RN on duty at least 8 hours per day, seven days a week. Nurses
aides are required to undergo special training.
-OBRA 87 makes it the State's responsibility to
establish, monitor and enforce state licensing and federal standards.
States are required to maintain investigatory units and Ombudsman
units, and to fund and staff them adequately.
OBRA 90: Omnibus Budget Reconciliation Act of
1990 (OBRA 90)
The Patient Self Determination Act covers all long-term care facilities
that participate in Medicare or Medicaid. At the time of admission
to a hospital or nursing home, at the time of enrollment with an
HMO, Hospice, or Home Health Care Agency, the following must happen:
-The facility must provide the patient written
information concerning the patient's rights under state law to participate
in decisions concerning medical care, including the right to accept
or refuse medical or surgical treatment, the right to formulate
-The facility must provide a written statement of its policy regarding
implementation of these rights.
-The facility must document in its records whether the patient has
executed an advance directive. Note: the facility is not required
to provide advance directives to patients.
-The facility is forbidden to discriminate in the provision of medical
care on the basis of whether a patient has or has not executed an
-The facility is required to comply with all state laws regarding
-The facility must provide for staff and community education on
issues related to advance directives.
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