The twentieth anniversary of the Omnibus Budget Reconciliation Act of 1987's (OBRA) passage is an appropriate time to assess the progress made to ensure that America's oldest and most vulnerable citizens receive the highest quality nursing home care. After 20 years' experience with the federal nursing home standards and in view of the long-term care field's continuing evolution, it's also fair to ask whether there are parts of OBRA that no longer contribute to quality of care or are even counterproductive.

In addition to exploring where improvements are needed, we should also celebrate advancements in nursing home care since OBRA was enacted. OBRA enabled residents' rights came to the forefront of nursing home care, which led the charge for person-centered care and culture transformation nationwide. Restraint use is also dramatically reduced because of it. Nursing homes are also participating in numerous voluntary quality improvement initiatives, such as Quality First and the Advancing Excellence in America's Nursing Homes campaign, to achieve excellence and earn the public's trust.

AAHSA believes there should be two types of nursing homes: the excellent and the non-existent. Residents and their families don't want nursing homes to close, they want them to provide quality care. The goal should be to displace substandard owners and managers, not residents and dedicated staff members. Ideally, a well-performing nursing home would assume management or ownership of a troubled home. However, the current enforcement system requires providers that take over nursing homes to assume the liabilities incurred by previous management. These liabilities include fines, strict deadlines for correction of problems and other previously imposed penalties. The resources used to meet these liabilities would be better spent on improving quality of care.

To achieve these goals, AAHSA strongly urges Congress to pass legislation similar to H.R. 3437, the Nursing Facility Quality Improvement Act introduced in the last Congress. This legislation addressed the following issues: the counterproductive nurse aide training lock-out, the need for joint training of nursing home and surveyor staff, allowing states to demonstrate alternative quality assurance systems, facilitating new ownership for chronic problem homes and using civil monetary funds to improve nursing home quality. This legislation's passage will help providers ensure that quality in nursing home care is an automatic public expectation.

American Association of Homes and Services for the Aging