REPLY
OBRA Regulations for Nursing Homes—Enhancing Paperwork or Patient Care?
Joseph G. Ouslander, MD, and
Dan Osterweil, MD
1 November 1994 | Volume 121 Issue 9 | Pages 724-725
IN RESPONSE:
Both Drs. Portnoi and Jameson view OBRA 1987 as an unnecessary and counterproductive bureaucratic intrusion into the practice of geriatric care in nursing homes. Although promoting OBRA was not a primary objective of our review, we do believe that when viewed in proper context, these regulations will foster improved care for nursing home residents. We recognize that many caring physicians like Drs. Portnoi and Jameson struggle to provide high-quality, cost-effective care to nursing home residents in the face of seemingly endless paperwork, needless regulations enforced by often overzealous and sometimes adversarial inspectors, and limited resources.
The OBRA legislation was not intended to regulate physician practice or to create unnecessary paperwork. In responding to the 1986 Institute of Medicine's report on improving the quality of care in nursing homes, the new regulations focused on residents' rights, quality of care, and the achievement among residents of the highest practicable level of functioning.
We agree with Dr. Portnoi that unnecessary hospitalizations among nursing home residents should be prevented. This is a complicated issue [1]. Establishing a medical unit within a nursing home is conceptually attractive but may be financially difficult given current incentives, may detract from the care of chronically ill residents, and may require substantial training and resources for facilities that Dr. Portnoi states are "poorly prepared" to care for subacutely ill patients. We strongly agree with Dr. Portnoi's recommendations for integrated multilevel systems of geriatric care with multidisciplinary approaches to care.
We also believe that basic clinical and health services research in the nursing home [2] on ways to translate research findings into practice in nursing homes [3] is critical to improving care. Only through the cooperative efforts of all geriatricians in creating models of practice, carrying out productive research, summarizing the "state of the art," and engaging in constructive discourse will we meet the challenge of providing optimal medical care to our aging population.
1. Ouslander JG. Reducing the hospitalization of nursing home patients (Editorial). J Am Geriatr Soc. 1988; 36:171-3.
2. Ouslander JG, Schnelle JF. Research in nursing homes: practical aspects. J Am Geriatr Soc. 1993; 41:182-7.
3. Schnelle JF, Ouslander JG, Osterweil D, Blumenthal S. Total quality management: administrative and clinical application in nursing homes. J Am Geriatr Soc. 1993; 41:1259-66.
About Letters
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Top
References
Article
