Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI; Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI.
Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI; Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI; Center of Innovation in Long-Term Services and Supports, US Department of Veterans Affairs Medical Center, Providence, RI.
J Am Med Dir Assoc. 2020 Feb;21(2):233-239. doi: 10.1016/j.jamda.2019.07.004. Epub 2019 Aug 23.
In 1987, the Omnibus Reconciliation Act (OBRA) called for a dramatic overhaul of the nursing home (NH) quality assurance system. This study examines trends in facility, resident, and quality characteristics since passage of that legislation.
We conducted univariate analyses of national data on US NHs from 3 sources: (1) the 1985 National Nursing Home Survey (NNHS), (2) the 1992-2015 Online Survey Certification and Reporting (OSCAR) Data, and (3) LTCfocUS data for 2000-2015. We examined changes in NH characteristics, resident composition, and quality.
US NH facilities and residents between 1985 and 2015.
The proportion of NHs that are Medicare and Medicaid certified, members of chains, and operating not-for-profit has increased over the past 30 years. There have also been reductions in occupancy and increases in the share of residents who are racial or ethnic minorities, admitted for post-acute care, in need of physical assistance with daily activities, primarily supported by Medicare, and diagnosed with a psychiatric condition such as schizophrenia. With regard to NH quality, direct care staffing levels have increased. The proportion of residents physically restrained has decreased dramatically, coupled with changes in inappropriate antipsychotic (chemical restraint) use.
Together with changes in the long-term care market, the NHs of today look very different from NHs 30 years ago. The 30th anniversary of OBRA provides a unique opportunity to reflect, consider what we have learned, and think about the future of this and other sectors of long-term care.
1987 年，《综合预算协调法案》（OBRA）要求对疗养院（NH）质量保证体系进行重大改革。本研究考察了自该法规通过以来，设施、居民和质量特征的趋势。
我们对来自 3 个来源的美国 NH 全国数据进行了单变量分析：（1）1985 年全国疗养院调查（NNHS），（2）1992-2015 年在线调查认证和报告（OSCAR）数据，以及（3）2000-2015 年 LTCfocUS 数据。我们研究了 NH 特征、居民构成和质量的变化。
1985 年至 2015 年期间，美国 NH 设施和居民。
在过去 30 年中，医疗保险和医疗补助认证、连锁成员和非营利性经营的 NH 比例有所增加。入住率也有所下降，少数民族居民、急性后护理入院、日常生活需要身体帮助、主要由医疗保险支付、诊断为精神疾病（如精神分裂症）的居民比例有所增加。关于 NH 质量，直接护理人员配备水平有所提高。身体约束居民的比例大幅下降，同时不合理使用抗精神病药物（化学约束）的情况也发生了变化。
随着长期护理市场的变化，如今的 NH 与 30 年前的 NH 大不相同。OBRA 通过 30 周年提供了一个独特的机会，反思、思考我们所学到的东西，并思考这个和其他长期护理领域的未来。
