Resolutions

Background

The Nursing Home Reform Amendments passed as part of the Omnibus Budge Reconciliation Act of 1987 (OBRA ’87) represent an attempt by the Congress to improve the quality of nursing home care through improved regulation.  Fashioned after the 1986 Institute of Medicine Report, Improving the Quality of Care in Nursing Homes (1), the Nursing Home Reform Amendments of OBRA ’87 focus on several areas including:

  1. Resident Rights (including the right to be free from unnecessary physical or chemical restraints)
  2. Resident assessment and care planning
  3. Nursing assistant training and certification, and
  4. Quality of care.

OBRA ’87 represents an attempt to move away from a regulatory process focused on structural criteria into a more process and outcome oriented approach to regulatory surveillance of nursing homes.

Positions

  1. PALTmed supports the intent of OBRA ’87 to improve and standardize the regulation of nursing homes.
  2. PALTmed believes that improved regulation is a necessary component, but in and of itself, insufficient for improving the quality of care delivered within nursing homes.
  3. PALTmed maintains that physician participation in the life of the nursing home is an essential component for successful implementation of OBRA ’87 and that leadership of nursing home medical directors should be a key factor in facilitating interaction and understanding between physicians and nursing homes.
  4. With respect to the Drug Therapy Guidelines outlined in the interpretive guidelines for surveyors that are used as a tool for implementing OBRA ’87, PALTmed:
    1. Agrees that neuroleptic medication has been over prescribed and inadequately monitored within nursing homes,
    2. Agrees that documentation of an appropriate diagnosis, attempted does reductions, and careful monitoring for efficacy and side effects are generally consistent with a model of good medical practice,
    3. Maintains that it is the physician who has the education, training, legal authority, responsibility, and liability for prescribing medication for patients and that a cookbook approach should not supersede sound clinical judgment,
    4. Maintains that although the interpretive guidelines can be useful to surveyors as screening criteria, only physicians (through peer review methodology) should be the final judge of physician practice within the nursing home,
    5. Maintains that the medical director should play a key role in the education of medical and nursing staff, monitoring physician practice, and developing a mechanism to assure that the quality of physician practice within the nursing home is in keeping with the community standard of quality care.

 

Note: Effective August 13, 2024, AMDA - The Society for Post-Acute and Long-Term Care Medicine is now Post-Acute and Long-Term Care Medical Association (PALTmed).