OBRA 87 – Flashcard

set of national minimum set of standards of care and rights for people living in certified nursing facilities.

OBRA through the legislative process

In one large

the Omnibus Bidget Recpmco;oatopm Act pf 1987 or OBRA 87. The separate Federal Nursing Home Reforem Act along with many other separate bills was "rolled into" one bill to insure final passage of all the elements.

Long Term Care Ombudsmen Program

One bill to insure final passage of all the elements

as a baseline that should be built upon to reach not only resident "well-bing" but also happiness and fulfilment.

through varitey of established protocols within nursing homes and regulatory agencies.

The federal Medicaid and Medicaid legislation included those distinct advocacy roles and subsequent regulations and other guidance has given LTCOPs additional tools to serve resident interests.

1) Emphasis on resident's quality of life as well as the quality of care 2) New expectations that each resident's ability to walk, bathe, and perform other activities of daily living will be maintained or improved absent medical reasons 3) A resident assessment process leading to development of *individualized care plan (translation: not cookie cutter care) 4) New opportunities for potential and current residents with mental retardatiom or mental illnesses for services inside and outside a nursing home (translation: PASSR is used for proper screening, otherwise a person can be improperly placed) 5) A right to safely maintain or bank personal fund with the nursing home (translation: residents do not have to participate) 6) Rights to return to the nursing home after a hospital stay or an overnight visit with family and friends (translation: This would be improper discharge of a resident. ocument why if you choose not to readmit patient 7) The right to choose a personal physician and to access medical records 8) The right to choose their own roommate 9) The right to organize and participate in a resident or family council 10) The right to be free of unnecessary and inappropriate physical and chemical restraints (RESTRAINT FREE) (translation: Not a restaint if patient is able to remove it upon command. Bed X 2 is considered a restraint) 11) Uniform certification standards for Medicare and Medicaid homes (translation - everyone judged the same way) 12) Prohibitions on turning to family members to pay for Medicare and Medicaid services 13) New remedies to be applied to certified nursing homes that fail to meet minimum federal standards (translation: penalites, denial of payment for new admissions) 14) IDT (interdisciplianary team) from all disciplines assess resident needs (the first step in determining a resident's potential is assessing the resident's needs (translation: IDT - Anyone who completes a section on the MDS) 15) Telephones accessible to bed-ridden patients and privacy while using the telephone. (translation: ex: cordless phone) 16) Requires facility to provide an adequate dining area, large enough to accommodate comfortably the maximum # of people who usually occupy that space. 17) 75 hours of training and testing of paraprofessional staff (CNA); CNAs are NOT licensed personnel 18) CNAs must be *certified & registered in every state in which they work 18) Rights to remain in the nursing home absent non-payment, dangerous resident behaviors, or significant changes in a resident's medical condition (translation: does not require a 30 day notice if there is non-payment and for behavior issues)

Yes

Inspectors no longer spend their time exclusively with staff or with facility records.

Conversations with residents and families.

Observing dining and medications administration.

It was due to growing public concern with the poor quality of care in too many nursing homes and the concerted advocacy of advocates, consumers, provider associations, and health care professiona.

Institute of Medicine

Institute of Medicine

1986

1) A stronger federal role in improving QUALITY 2) Revisions in perfomrance standards, te inspection process, and the remedies to improve nursing home services 3) Better training of nursing home staff 4) Improved assessment of resident needs 5) A dynamic and evolutionary regulatory process

OBRA

Yes

28 - 36%

40%

A system of rating the seriousness of deficiencies.

A regulatory requirement that a survey finds is not being met.

National

No. It is a system sued by all state survey agencies and ....

For each deficiency, the surveyor determines the 1) level of harm to the resident or resident(s) involved and 2) the scope of the problem within the nursing homes.

The surveyor then assigns an alphabetical scope and severity value of a through L to the deficiency.

A

L

Scope and severity matrix

B, C, D, E, G

No

Plan of Correction

Immediate Jeopardy

A technical regulatory term which means that one or more requirements under the federal regulations? 42CFR 483.13 (resident behavior and facility practices) 42CFR 483.15 (quality of life) 42CFR 483.25 (quality of care) - were not met, to a degree constituting - immediate jeopardy to resident health or safety, and - a scope of pattern or widespread acual harm, - or a widespread potential for more than minimal harm.

This indiciates that the nursing home was found to have had a significant deficiency (or deficiencies), which the home must address and correct quickly to protect the health and safety of residents.

No. Because this is not included in the definition of substandard care.

This is determined by the Division.