OBRA87 and quality in nursing homes

Purpose. To examine whether the Nursing Home Reform Act, 1987 Omnibus Budget Reconciliation Act (OBRA87), improved nursing home staffing and quality. Design and methods. Data from 5,092 nursing homes were linked across the 1987 Medicare/Medicaid Automated Certification System and the 1993 Online Survey, Certification and Reporting system. Dummy-year models were used to examine the effects of the OBRA87 on staffing and measures of quality, including the presence of pressure ulcers, and the use of physical restraints and urinary catheters. A first-difference approach to fixed-effects regression analysis was employed to estimate the effects of time-varying staffing on the quality of care. Results. Overall, there was a significant increase in nursing home staffing levels and a decrease in the proportion of residents with physical restraints and urinary catheters following the implementation of the OBRA87. Interestingly, however, the increase in staffing was not directly related to the improvement in quality over the period of this study. Implications. Although some quality improvements were found in nursing homes nationwide, the findings suggest that quality improvements under the OBRA87 have not necessarily been related to the staffing standards established under the legislation.