As people age, many times they need to move into long-term assisted living facilities. Different policies and procedures regulate these institutions for the safety and comfort of their patients. Though states oversee specific regulations, many of these are universal across the country thanks to federal guidelines.
In 1987, President Ronald Reagan signed into a law commonly known as "OBRA," The Federal Nursing Home Reform Act of the Omnibus Budget Reconciliation Act. It was the first revision of its kind since the inception of Medicare and Medicaid, which gave facilities a general guideline to follow in order to receive federal funding.
The more significant changes included the patients' rights to tend to and improve upon their own personal care as long as they were medically able to do so, which meant they could be free of physical or chemical restraints. This was to ensure the patient's quality of life and not just the quality of care, as this act addressed both.
Quality of Care
Long-term care facilities are required to concentrate on the needs of the patient as a whole; this includes psychological, mental and physical concerns. The federal government enacted Medicaid policies to provide services that covered anything from pharmaceutical services to dietary services to routine dental services.
Specific guidelines ensure that a physician or suitable substitute is readily available to the nursing home to supervise regular or emergency care. Medicare also requires that a skilled nursing facility provide 24-hour licensed nursing care sufficient to cover the patients' needs. At least one registered nurse needs to be on duty eight hours a day, seven days a week. The facility must post data daily on the nursing staff responsible for care in the facility.
Quality of Life
Other policies maintain the patient's dignity as an individual. For instance, the staff must knock before entering the room, they must call the patient by name and allow patients such choices like what they want to eat or activities they want to join, even if confined to their room.
Patients may participate in social, religious or community activities, provided it does not infringe on the rights of the other residents. Policies also protect all patients in airing their grievances with the institution without fear of discrimination or reprisal.
For facilities with more than 120 beds, it is required at least one social worker be employed full time to make sure these rights are protected.
On the Medicare website is a checklist for all these expectations, policies and regulations required of long-term care facilities. Among these are facility cleanliness and comfort, as well as staff qualifications and cohesiveness, and providing preventive care (like flu shots). It also covers basic mandates for maintaining the patient's dignity.
For many elderly patients, dementia or Alzheimer's disease can add complications to long-term care and, especially, to the stress of the patient. Patients perceived a better quality of life in those facilities that provided a more specialised approach, had better-trained staff in dementia-related illnesses and that encouraged activity participation.
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- Alliance for Health Reform: Federal Nursing Home Reform Act From the Omnibus Budget Reconciliation Act of 1987 or Simply OBRA '87 Summary
- Cornell University Law School: U.S. Code Title 47, Chapter 7, Subchapter 19, § 1396r. Requirements for Nursing Facilities
- Cornell University Law School: U.S. Code Title 47, Chapter 7, Subchapter 18, Part A, § 1395i--3. Requirements For, and Assuring Quality of Care In, Skilled Nursing Facilities
- Medicare: Nursing Home Checklist
- Oxford Journals: The Gerontologist: Dementia Care and Quality of Life in Assisted Living and Nursing Homes