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Nursing Home Reform Law (OBRA '87)

Federal Law and Regulations

Read a summary of OBRA '87, the full federal regulations, and the Medicaid and Medicare provisions.

Betty Hamburger, former Consumer Voice president, 
presides over Capitol event in 1986 kicking off 
national campaign for nursing home reform.

Learn about state-specific and federal regulations pertaining to nursing homes and regulation using "this searchable website [...] to examine and compare the content of state regulations related to nursing homes, the processes of regulation and exceptions to regulations within a state, recent state changes, innovative nursing-home designs and programs that were accomplished within existing regulations, and innovative state regulatory initiative."

Read An Advocate's Guide to OBRA - "Ombudsmen and Citizen Advocate Action: The Key to Change for Residents," by Sarah Greene Burger. This guide spells out the significant details of OBRA '87 and the history of how it was developed.

The Consumer Voice was instrumental in the development and passage of OBRA '87 through the Campaign for Quality Care, a coalition of advocates, providers, researchers, unions, professional organizations and others seeking reform. Read comments from consumers and advocates about the strengths and shortcomings of this important piece of legislation.

Consumer Voice Board and Staff
Consumer Voice Board and Staff Kick Off OBRA Campaign, 1987 (from left to right) 
Janet Wells, Cyma Heffter, Sarah Greene Burger, Susan Titus, Carleen Joyce, 
Nancy Lombardi, Elma Holder, Barbara Frank.

Actor Kirk Douglas
Actor Kirk Douglas helped kick off the Campaign for Quality Care to pass 
OBRA. He is shown with the late Senator John Heinz and Representative 
Claude Pepper, both champions of reform legislation.

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May 2, 2007, Oversight Hearing 

The Senate Special Committee on Aging, chaired by Senator Herb Kohl (D-WI), held an oversight hearing Wednesday, May 2, 2007, titled “The Nursing Home Reform Act Turns Twenty: What Has Been Accomplished, and What Challenges Remain?” Consumer Voice Executive Director Alice H. Hedt testified.

Watch a webcast of the hearing and read additional information.

Senator Herb Kohl (D-WI)

Statements of Committee Members

Witness Testimony

  • Kathryn Allen, Director of Health Care, U.S. Government Accountability Office, Washington, DC

  • James Randolph Farris, MD, Regional Administrator, Dallas Office, Centers for Medicare and Medicaid Services, Dallas, Texas

  • Charlene Harrington, Professor of Sociology and Nursing, University of California, San Francisco, California

  • Alice H. Hedt, Executive Director, National Citizens' Coalition for Nursing Home Reform, Washington, DC

  • Mary Ousley, President, Ousley & Associates, and former Chair of the American Health Care Association, Richmond, Kentucky

  • Orlene Christie, Director, Legislative and Statutory Compliance Office, Michigan Department of Community Health, Lansing, Michigan

Statements Submitted for the Hearing Record

  • Alice H. Hedt, Executive Director, National Citizens' Coalition for Nursing Home Reform, Washington, DC: Response to Question from Senator Gordon Smith about fire safety

  • Toby S. Edelman, Senior Policy Attorney, Center for Medicare Advocacy, Inc., Washington, D.C.

  • Gerald Kasunic, Director, Office of the D.C. Long-Term Care Ombudsman Program, Legal Council for the Elderly, Washington, D.C.

  • Rose B. McGarry, Ombudsman Program Director, Elder Services of Merrimack Valley, Massachusetts

  • Diane A. Menio, Executive Director, Center for Advocacy for the Rights and Interests of the Elderly (CARIE), Pennsylvania

  • Amy Paul, Executive Director, Friends and Relatives of Institutionalized Aged (FRIA), New York

  • Linda Sadden, State Long-Term Care Ombudsman, Louisiana

  • Cheryl Zuccola, Family Member of a Resident in a Skilled Nursing Facility in Massachusetts

Read the March 2007 GAO Report "Efforts to Strengthen Federal Enforcement Have Not Deterred Some Homes from Repeatedly Harming Residents."

Alice H. Hedt, Consumer Voice Executive Director, on C-SPAN's Washington Journal:

Washington Journal invited Alice to appear on May 3rd's program after reviewing her testimony on May 2, 2007, before the Senate Special Committee on Aging. The 30-minute interview covered a range of long-term care issues, and included questions and comments from consumers across the United States. Read notes on the consumers who called in during the segment.

 Ruth Morgan, Barren River District Long-Term Care Ombudsman, writes Bowling Green Daily News article "Column: Promise, unfulfilled potential in elderly care." Read the article, or visit http://bgdailynews.com/articles/2007/05/05/features/feat2.txt.

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December 7, 2007 Briefing

On December 7, 2007, the Alliance for Health Reform and the Kaiser Family Foundation sponsored a luncheon briefing.

The Nursing Home Reform Law, which was part of the Omnibus Reconciliation Act of 1987 (OBRA ’87), was considered to be landmark legislation for nursing home quality improvement and brought high hopes to consumers, advocates and legislators. But some recent reports and congressional hearings indicate there are still concerns about quality of care.

Twenty years later, what progress has been achieved? What’s left to do? Are legislative solutions the answer to improving quality? Can voluntary initiatives make a difference? Can the industry and policymakers find a cost-effective way to increase staffing and improve quality?

The briefing helped to address these and related questions, and discussants were: Ruth Katz, George Washington University, and former counsel to the House Subcommittee on Health and the Environment chaired by Rep. Henry Waxman; John Rother, AARP; Susan Weiss, American Association of Homes and Services for the Aging; Elma Holder, National Citizens’ Coalition for Nursing Home Reform; Janet Wells, National Citizens’ Coalition for Nursing Home Reform; Paul Willging, Johns Hopkins University and former head of the American Health Care Association (AHCA); Christine Williams, former health aide to then-Senate Majority Leader George Mitchell; Bruce Yarwood, AHCA; Mary Jane Koren, The Commonwealth Fund, and former director of New York’s Survey and Certification agency; Joshua Wiener, RTI International; and Jack MacDonald, Golden Horizons/Beverly Enterprises, Inc. Additionally, the event began with the short video, Nursing Home Reform: Then and Now, produced by the Kaiser Family Foundation. Ed Howard of the Alliance and Diane Rowland of Kaiser co-moderated.

All materials from the briefing packets are available on the Alliance for Health Reform's website. To download materials from the briefing, go to http://www.allhealth.org/index.asp. If you would like to receive a hard copy of the materials from the briefing or a copy of Kaiser Family Foundation's “Nursing Home Reform: Then and Now” on DVD, e-mail your name and address to info@allhealth.org.

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What Consumers Can Do 

  • Join Consumer Voice. Help the Consumer Voice define and achieve quality for long-term care consumers. As a member, you will strengthen the national consumer voice and receive regular updates on long-term care issues. Click on the link above to learn more about Consumer Voice member benefits.

  • Join a state Citizen Advocacy Group (CAG) working to improve long term care.

  • Volunteer with your local ombudsman program.

  • Encourage your own or your loved ones' facility to address consistent assignment and turnover through the Advancing Excellence Campaign.

  • Support the Elder Justice Act.

  • Learn about state and federal nursing homes and regulation by visiting http://www.hpm.umn.edu/nhregsPlus/.

  • Contact your Senators and Representatives to advocate for staffing and enforcement. There are three ways to do this:

  • Call the U.S. Congress switchboard at (202) 224-3121. They will put you through to the Representative's office, and you can give your message to the person who answers the phone.

  • Not sure who your current Representative is? Visit www.house.gov/writerep/ for a feature that will let you identify your representative by filling in your state and zip code, then send an e-mail message right from the House website.

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