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Care of the Aging Population

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  8. OBRA

OBRA

The Omnibus Budget Reconciliation Act (OBRA), also known as the Nursing Home Reform Act of 1987, has dramatically improved the quality of care in the nursing home over the last twenty years by setting forth federal standards of how care should be provided to residents. 

This Act is interpreted with the U.S. Code of Federal Regulations (42 CFR Part 483). Such improvements include less use of antipsychotic drugs, a reduction in chemical and physical restraint use, and a reduction in inappropriate use of indwelling urinary catheters.

Mandates

The quality of care mandates contained within OBRA, and the regulations, require that a nursing home must provide services and activities to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident in accordance with a written plan of care. 

In order to participate in Medicare and Medicaid programs, nursing homes must be in compliance with the federal requirements for nursing homes.

The mandates of OBRA are regarded in the nursing home setting to represent minimum accepted standards of care. The failure of a nursing home to comply with the OBRA quality of care mandates in caring for a resident represents a failure to exercise the degree of reasonable care and skill that should be expected.

Penalties

The Indiana State Department of Health is responsible for ensuring that nursing homes follow these mandates through the state survey process. The Department of Health and Human Services (DHHS) and the states may apply penalties against nursing homes for failure to meet the minimum standard of care as defined in the OBRA regulations. 

Such penalties may include fines, appointment of administrative consultants to run the nursing home while deficiencies are remedied, and even closure of a nursing home.

  • Residents must be assessed to identify their medical problems and their abilities to perform basic self-care activities. The DHHS established a uniform data set, referred to as the minimum data set (MDS), to document this assessment.
  • The nursing home is responsible for the safety of each resident. This includes being responsible for orders written by the resident’s primary physician or other medical provider. If the physician writes an order that does not comply with the federal regulations, the nursing home is responsible for making sure the physician changes such order. The mere presence of a physician’s inappropriately written order does not absolve the nursing home of responsibility in providing safe care.
  • Provide services that will enhance each resident's quality of life to its fullest (42 CFR §483.15).
  • Maintain the dignity and respect of each resident (42 CFR §483.15).
  • Develop a comprehensive care plan for each resident (42 CFR §483.20).
  • Conduct a comprehensive and accurate assessment of each resident's overall health upon admission and at each required interval (42 CFR §483.20).
  • Prevent a decline in activity of daily living (ADL) activities, including the ability to eat, toilet, bathe and walk. Staff must provide for ADL care when necessary (42 CFR §483.25).
  • Prevent the development of pressure sores, and if a resident has pressure sores, provide the necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing (42 CFR §483.25).
  • Provide appropriate care to those who have urinary incontinence and restore bladder function if possible. This also includes only using urinary catheters when appropriate as outlined in the regulations to prevent adverse consequences related to such use (42 CFR §483.25).
  • Prevent accidents, including falls, accidental poisonings and other incidents that could cause injuries (42 CFR §483.25).
  • Maintain adequate nutrition to prevent unnecessary weight loss (42 CFR §483.25).
  • Provide each resident with sufficient fluid intake to prevent dehydration (42 CFR §483.25).
  • Ensure that residents are free from significant medication errors (42 CFR §483.25).
  • Have sufficient nursing staff (42 CFR §483.30).
  • Ensure that each resident’s rights to choose activities, schedules, and health care are maintained (42 CFR §483.40).
  • Provide pharmaceutical (medication) services to appropriately meet the physical and psychological needs of each resident (42 CFR §483.60).
  • Maintain accurate, complete, and easily accessible clinical records for each resident (42 CFR §483.75).
CASE STUDY: Mrs. J is repeatedly asking for a nurse; other patients are complaining, and you simply cannot be available to Mrs. J for long periods.  Considering the setting and the OBRA guidelines, what would you do to manage the situation?

 

Click OBRA87summary.pdf link to view the file. ◄ Quiz 1_Spring2021 Jump to... Jump to... Announcements Office hours Syllabus_NUR3400_F_BSN_Spring2021 Syllabus Acknowledge Evolve Resources for Ebersole and Hess' Gerontological Nursing & Healthy Aging, 5th Edition Sherpath for Gerontologic Nursing (Touhy GNHA Version), 5th Edition Chapter 1 Introduction to Healthy Aging Chapter 2 Cross-Cultural Caring and Aging ANA Gerontological Nursing QSEN competencies The Nursing Process ANA Chapter 3 Biological Theories of Aging and Age-Related Physical Changes Chapter 4 Psychosocial, Spiritual, and Cognitive Aspects of Aging Research Article Upload Myths Chapter 5 Gerontological Nursing and Promotion of Healthy Aging Chapter 6 Gerontological Nursing Across the Continuum of Care Careplan/Plan of Care Concepts of Aging Case Study: Concepts of Aging Case Study Drop off Chapter 7 Economic and Legal Issues Chapter 8 Assessment and Documentation for Optimal Care Quiz 1_Spring2021 Chapter 9 Safe Medication Use Chapter 10 Nutrition Chapter 14 Promoting Healthy Skin Case Study # 2 : OBRA Chapter 11 Hydration and Oral Care Chapter 12 Elimination Research Article # 2 Drop Off Chapter 13 Rest, Sleep, and Activity Chapter 14 Promoting Healthy Skin QUIZ 2 Chapter 15 Falls and Fall Reduction Chapter 16 Promoting Safety CARE PLAN # 2 Chapter 17 Living with chronic illness Chapter 18 Pain and comfort Care of the Aging Population on Global Health/Research Paper MIDTERM Chapter 19 Diseases affecting vision and hearing Chapter 20 Metabolic disorders Chapter 21 Bone and joint problems Chapter 22 Cardiovascular and respiratory disorders Chapter 23 Neurologic disorders Chapter 24 Mental Health Chapter 25 Care of individuals with neurocognitive disorders QUIZ 3 Interdisciplinary Paper Chapter 26 Relationship, roles and transitions SHERPATH DUE 04/07/2021 Chapter 27 Caregiving Chapter 28 Loss, death and palliative care FINAL EXAM AGREEMENT FINAL EXAM Chapter 9 Safe Medication Use ► You are logged in as Yoslaine Guevara (Log out) MAIN_NUR3400_E-F-BS4_2021-UG1

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