The federal Omnibus Budget Reconciliation Act (OBRA) of 1987

The federal Omnibus Budget Reconciliation Act (OBRA) of 1987; established regulations for nursing homes receiving federal funding that includes reimbursements from Medicare or Medicaid programs. It was signed by President Ronald Reagan, and it was the first major revision to the federal standards for nursing home care since the creation of both Medicare and Medicaid in 1965. This legislation changed the legal expectations of nursing homes and their care. If nursing homes do not comply with these regulations they cannot receive federal reimbursement.

By the OBRA regulations nursing homes are not allowed to have working nurse aides for more than four months unless they are certified. In order to keep working longer than that aides need to go through a training and competency program. The nursing home will be responsible to verify that the aide is registered in their state. Under OBRA a nurse aide registry must consist of aides who have completed a nurse aide training and have successfully passed the competency evaluation program.

The registry must make available the full name of the person, the date his/her training were completed and all the information of any improper conduct. If the person has not practiced in two years he/she may be removed from the registry. OBRA requires that all nursing facilities keep all employees up to date in their trainings. Annual education requires a minimum of 12 hours of training that specially address any weaknesses or areas of concerns that the group may be having.

If the facility holds mentally ill patients the aid needs to be able to show that they have the proper skills to handle situations involving those mentally ill patients. The states can have their own training and competency program, for a program to be approves it must meet OBRA regulations. Such training must have a minimum of 75 hours of training of which 16 need to be supervise practical training hours. There are specific requirements under OBRA for a training curriculum.

Students need to learn proper communication skills and interpersonal skills, they need to learn how to control infections, the appropriate emergency procedures, appropriates safety procedures. They need to learn how to be able to help patients be independent and to respect the patient’s rights. Students need to learn the needed nursing skills, such as how to correctly take vital signs and how to identify abnormal changes in a patient. They need to be able to know the needs needed when working with patients with mental health problems, and how to give care to patients for cognitively mpaired patients. Some requirements under OBRA are: * To provide services that will help promote each resident’s quality of life to the fullest capacity * To maintain the dignity and respect each resident deserves * To develop a care plan for each resident * To conduct an accurate assessment of each resident upon admission to the center and at any required interval in regards to his overall health * To prevent any decline in regards to daily activities, that includes the ability to east, using the toilet, bathing and walking.

The staff of the facility must provide daily living activity care when necessary * To prevent any pressure sores from developing, and if a patient has a sore, to provide any necessary treatment and services to promote healing of such sores, prevent infection, and to prevent any new sores from developing. * To provide the right care for those residents that have urinary incontinence and if it’s possible to try and restore bladder function.

It includes also the use of urinary catheters when appropriate, according to the regulations to prevent any adverse consequences related to the use of them * To prevent any type of accidents, this includes any falls, accidental poisonings or any incident that may cause injuries to the residents * To maintain proper nutrition for residents and to prevent any unnecessary weight loss * To provide the residents with sufficient fluid intake as to prevent any dehydration * To ensure that the resident feel free from any medication errors * To make sure the center has enough nursing staff to take proper care of all the resident’s needs * To make sure that all the residents have the right to choose activities, schedules, and healthcare need and that everything is maintained as it should be * To provide all medication services that appropriately meet the physical and psychological needs for each and every resident * To maintain an accurate, complete, and easily accessible clinical record for every resident OBRA became a law because of all the public growing concern with the very poor quality of care in many nursing homes and due to all the concerted advocacy of advocates, consumers, provider associations, and health care professionals. OBRA changed the care and lives of nursing home residents all across America. Many improvements have improved the care planning of the residents in the nursing home system.


FEderal and MA Long term care laws and regulations. (2008). Retrieved July 1, 2013, from MANHR: State Operation Manual. (2011, January 7). Retrieved July 1, 2013, from Appendix PP: Hawes C, M. V. (1997, August). The OBRA-87 nursing home regulations and implementation. Retrieved July 1, 2013, from PUB

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