In 1986, a study commissioned by Congress revealed that nursing home residents were often abused and neglected. As a result, sweeping nursing home reforms were included in the 1987 Omnibus Budget Reconciliation Act (OBRA). One reform required nursing home staff to conduct an assessment of each patient's condition upon arrival, as well as to an updated assessment at regular intervals. This assessment is known as the Minimum Data Set (MDS), and it provides a protocol for how each patient should be treated. In this way, nursing home residents get a highly individualized method of care. The patient's family can be a part of creating this standard of treatment.
OBRA strengthened patient care in other ways as well. The new laws limited the use of physical restraints and mood-altering medications as a way to control patients. In fact, because overmedication was such a problem in nursing homes, OBRA created a way to try to eliminate unnecessary medications. Regimens of more than nine medications must be justified in the MDS, and at each update of the assessment, doctors should consider whether certain medications are still needed.
OBRA also set forth a Resident's Bill of Rights in a nursing home, which in addition to requiring that patients be advised of their own medical plans, included mandates about a right to privacy and a right to dignity. Ideally, this means that patients are able to make their own decisions, but a 2008 Slate piece highlighted the ethical dilemmas that could arise from such a situation. In "An Affair to Remember," writer Melinda Henneberger recounts the tale of an 82-year-old woman and a 95-year-old man who fell in love in a nursing home, only to have the man's son break up the relationship when it became sexual. Despite wanting patients to live full lives, nursing homes still have to err on the side of caution in some issues, and there is the question of whether someone with dementia could provide informed consent. In other issues, such as smoking, however, nursing homes generally allow patients to do what they want.
Nursing homes must comply with OBRA regulations to receive Medicare and Medicaid funding. To ensure that the guidelines are being met, the homes are inspected regularly by state surveyors. What do these surveys find?