Nursing Home Reform Act

Nursing Home Reform The Nursing Home Reform Act (NHRA) was established to ensure that nursing home residents receive the “highest practicable” mental, physical, and psychosocial wellbeing. The Nursing Home Reform Act enforces quality care and the provision of certain services to nursing home residents. Additionally, it establishes a Bill of Rights for residents.

The Nursing Home Reform Act is in place as a guideline for facilities that wish to receive state funding for Medicare and Medicaid services. Facilities receiving funding are required to meet the criteria set forth by the Nursing Home Reform Act. The state is responsible for certifying nursing home facilities that substantially comply with these criteria.

Nursing Home Reform Act Background

Congress asked the Institute of Medicine to conduct a study to evaluate the quality of care in U.S. Medicare and Medicaid nursing homes. The results of this 1986 study revealed that nursing home residents were often neglected, abused, and cared for inadequately. As a solution to these issues, the Institute of Medicine proposed a series of sweeping reforms. In 1987, many of these reforms became law, including the Nursing Home Reform Act. The Act was part of the 1987 Omnibus Budget Reconciliation Act.

Residents’ Bill of Rights

Under the Nursing Home Reform Act, nursing home residents are entitled to a basic set of rights. These rights are in place to protect each resident’s privacy, individuality, dignity, and medical needs. The Nursing Home Reform Act’s Bill of Rights ensures that each resident receives a standard of care that is free from abuse, isolation, and improper medical treatment.

The Residents’ Bill of Rights provides residents with the right to:

  • Privacy
  • Accommodation of physical, mental, and psychosocial needs
  • Communicate freely
  • Be treated with dignity
  • Be free from mistreatment, abuse, and neglect
  • Exercise self-determination
  • Voice grievances without facing reprisal or discrimination
  • Be free from physical restraints
  • Participate in family and resident groups
  • Participate in their own care plan, including advance notice of changes in treatment, care, or facility status

Required Services for Residents

Under the Nursing Home Reform Act, nursing homes are required to provide residents with certain services. Additionally, the Act establishes a set of standards for these services.

Required resident services under the Nursing Home Reform Act include:

  • Access to nursing, social, and rehabilitation services
  • Access to dietary and pharmaceutical services
  • Periodic assessment of each resident
  • A comprehensive care plan developed specially for each resident
  • Access to a full-time social worker if the facility has more than 120 beds


Nursing Home Regulations

The Nursing Home Reform Act also has strict guidelines for facility certification and regulation while receiving funding. States must conduct unannounced surveys that include resident interviews. These surveys must be conducted at irregular intervals that occur no farther than 15 months apart. Required surveys have a general focus on evaluating quality of care, residents’ rights, quality of life, and the services that the facility provides to residents. When complains are filed, surveyors must conduct targeted surveys to investigate the complaints.

The Nursing Home Reform Act features an enforcement process that begins when a survey reveals non-compliance of a nursing home. The nature of the deficiency, or violation, determines the action taken by the state. In some cases, the nursing home may be provided with the opportunity for violation correction before action is taken against it.

The state evaluates several violation criteria, including:

  • Whether or not the deficiency immediately jeopardizes a resident
  • Whether or not the deficiency is an isolated occurrence, part of an ongoing pattern, or widespread in the facility

If nursing home facilities violate any of the guidelines set forth by the Nursing Home Reform Act, the state may impose remedies such as monitoring, temporary management, Medicare or Medicaid payment denial, civil monetary penalties, and termination of the agreement.



“Nursing Home Reform Act (OBRA ‘87): 20 Years of History.” United States Senate Special Committee on Aging. United States Senate. Web. 28 May 2013.

Turnham, Hollis. “Federal Nursing Home Reform Act from the Omnibus Budget Reconciliation Act of 1987.”All Health. National Long Term Care Ombudsman Resource Center. Web. 28 May 2013.

Xiang, Zhang, and David C. Grabowski. “Nursing home staffing and quality under the nursing home reform act.” Gerontologist. 44.1 (2004): 13-23. Web. 28 May. 2013.