Federal regulations and the care of patients with dementia in the nursing home.

More than half of the people residing in nursing homes in the United States have dementia. A long history of basic contradictions in the conceptualization of nursing home care in the United States has resulted in a serious mismatch between the needs of residents with dementia and the resources of nursing homes to care for these residents. Concern for this discrepancy, and the resultant inadequate and inappropriate care, provided a major impetus for nursing home reform. OBRA 87 was a broad public policy initiative intended to improve the quality of life of nursing home residents. The spirit of the legislation is embodied in federal regulations that explicitly recognize the importance of psychological and social domains of the lives of nursing home residents; restrict the use of psychotropic drugs and physical restraints; and advocate for activities and services to attain or maintain patients' highest practicable physical, mental, and psychosocial well-being. Although the impact of OBRA 87 on the quality of life of residents with dementia is unknown, the federal regulations constitute a major step in the movement for nursing home reform and toward improved quality of care.