What was the primary goal of the Nursing Home Reform Act of 1987?

Oct 20, 2025 4 min read •

senior care long-term care Healthcare Policy

In 1986, a groundbreaking study by the Institute of Medicine revealed widespread neglect and abuse in U.S. nursing homes, prompting federal intervention. The federal response was the Omnibus Budget Reconciliation Act (OBRA) of 1987, which sought to address these systemic failures by establishing minimum standards for quality of care. This landmark legislation directly answers the question: What was the primary goal of the Nursing Home Reform Act of 1987?

Quick Summary

The primary goal was to ensure residents receive quality care that promotes their highest practicable physical, mental, and psychosocial well-being, along with establishing comprehensive resident rights and strengthening enforcement standards for facilities receiving Medicare and Medicaid funding.

Key Points

Highest Practicable Well-being: The Act's core goal was ensuring residents achieve their highest potential physical, mental, and psychosocial well-being.
Enhanced Resident Rights: It established a Resident's Bill of Rights, protecting residents from abuse and promoting their dignity and self-determination.
Improved Care Standards: The Act mandated comprehensive resident assessments and individualized care plans based on a uniform data set (MDS).
Stronger Enforcement: It created a robust system of graduated sanctions and regular, unannounced surveys to ensure facility compliance with federal standards.
Mandatory Staffing and Training: It established minimum staffing levels, including RN coverage, and required special training for nurse's aides.
Shifted Regulatory Focus: The law moved the emphasis from simple procedural compliance to focusing on the quality of resident outcomes and life.

The Catalyst for Change: Addressing Widespread Neglect

Prior to 1987, the U.S. nursing home industry was largely unregulated, leading to significant deficiencies in resident care. The 1986 Institute of Medicine study presented Congress with irrefutable evidence of poor conditions, abuse, and neglect across the country. This report served as the primary catalyst for legislative action, leading to the Nursing Home Reform Act, a cornerstone of the Omnibus Budget Reconciliation Act of 1987 (OBRA '87). The legislation was designed to shift the regulatory focus from merely ensuring structural compliance to actively monitoring the quality of care and, most importantly, the quality of life for residents.

Elevating Resident Well-being as a Core Mandate

The central principle of the Nursing Home Reform Act is that nursing home residents should receive care that helps them "attain or maintain the highest practicable physical, mental, and psychosocial well-being". This marked a profound shift from viewing nursing homes simply as medical facilities to recognizing them as residents' homes, where personal dignity and self-determination must be upheld. This foundational goal permeates every provision of the Act, driving requirements for individualized care and a resident-focused approach.

The Residents' Bill of Rights

A key component of the act was the establishment of a Residents' Bill of Rights, which provides a framework for protecting the dignity and independence of nursing home residents. These rights are not merely suggestions but are enforceable federal mandates. The rights include:

Freedom from Abuse and Neglect: This includes physical, sexual, mental, and verbal abuse, as well as neglect.
Freedom from Restraints: Prohibits the use of physical and chemical restraints for punishment or convenience, emphasizing residents' right to freedom of movement.
Right to Participation in Care: Residents have the right to participate in developing their care plan, be fully informed of changes, and refuse medication or treatment.
Right to Privacy: Ensures privacy concerning medical treatment, personal care, and communications.
Right to Independent Choices: Grants residents the right to make personal decisions, such as choosing their schedule and activities.

Enhancing Clinical and Operational Standards

To ensure the primary goal of promoting resident well-being, the Act introduced several new and robust operational standards for facilities. These include:

Comprehensive Assessments and Care Plans: Facilities are required to conduct an initial comprehensive assessment of each resident's functional capacity and create a personalized care plan. This plan must be updated regularly to reflect changes in the resident's condition.
Minimum Data Set (MDS): The act mandated the use of a uniform resident assessment instrument, the MDS, which provides a standardized way to collect information on residents' needs. This data is used to inform care planning and monitor facility performance.
Staffing Requirements: OBRA '87 mandated minimum staffing levels, including a registered nurse on duty for at least 8 hours a day, and 24-hour licensed practical nurse coverage. It also required special training for nurse's aides.

Strengthening Enforcement and Oversight

Before the Act, enforcement was inconsistent and often ineffective. The new law dramatically overhauled the enforcement system by creating a range of graduated sanctions for non-compliant facilities. Penalties can range from civil monetary fines to denial of Medicare and Medicaid payments, and in severe cases, termination of the facility from federal programs. State survey agencies were empowered to conduct unannounced inspections at least every 15 months to ensure compliance.

Comparison of Pre- and Post-NHRA Nursing Home Regulations


Feature	Before the Act (Pre-1987)	After the Act (Post-1987)
Regulatory Focus	Focused on structural compliance and paper records.	Focused on resident outcomes, quality of care, and quality of life.
Resident Rights	Lacking comprehensive, enforceable rights.	Established a Residents' Bill of Rights, including freedom from abuse and restraints.
Care Planning	Assessments were often incomplete and not standardized.	Mandated comprehensive, uniform assessments (MDS) and individualized care plans.
Enforcement	Inconsistent with few meaningful sanctions for non-compliance.	Created a range of graduated sanctions and regular, unannounced state surveys.
Staffing	Minimal or no federal staffing requirements.	Mandated minimum staffing levels and special training for nurse's aides.

The Lasting Legacy of the Nursing Home Reform Act

The Act's impact on nursing home care in the U.S. has been profound. Studies have shown a significant decrease in the use of physical restraints and a reduction in the inappropriate use of psychotropic drugs. Resident involvement in their care plans has increased, and physical functioning has improved. Although challenges remain, and the fight for better senior care is ongoing, the Nursing Home Reform Act of 1987 established a critical legal and ethical baseline for the treatment of nursing home residents. For a deeper understanding of the regulatory landscape for long-term care, consult official government resources like the CMS website on nursing homes. The principles of dignity, quality, and resident rights enshrined in the act continue to guide policy and advocacy efforts today.

Conclusion

In summary, the primary goal of the Nursing Home Reform Act of 1987 was to transform the landscape of institutional long-term care by mandating federal standards that prioritized the health, safety, dignity, and quality of life of nursing home residents. By introducing comprehensive residents' rights, establishing robust assessment and care planning processes, and strengthening enforcement mechanisms, the Act sought to correct the systemic failings exposed by earlier investigations and create a more humane and resident-centered care environment. Its legacy continues to shape the standards and expectations for senior care across the nation.

Frequently Asked Questions

The Act was necessary due to a 1986 study by the Institute of Medicine that documented widespread abuse, neglect, and substandard care in U.S. nursing homes, revealing that the existing regulations were inadequate.

The Act aimed to improve residents' overall quality of life and care by ensuring their highest practicable well-being, protecting their rights, and guaranteeing certain services like proper nutrition and rehabilitation.

The Residents' Bill of Rights grants nursing home residents specific rights, including freedom from abuse and restraints, the right to dignity and privacy, and the right to participate in their own care decisions.

The Act required minimum staffing levels, including a registered nurse for at least 8 hours a day and licensed practical nurse coverage 24/7. It also mandated special training for nurse's aides.

Compliance is ensured through a system of state-conducted, unannounced surveys at least every 15 months. Non-compliant facilities face sanctions, including fines and potential loss of Medicare/Medicaid funding.

The MDS is a uniform resident assessment tool mandated by the Act. It provides a standardized way to assess each resident's functional capacity and needs, which informs their individualized care plan.

The Act's requirements apply specifically to nursing homes that participate in the Medicare or Medicaid programs. This covers the vast majority of certified facilities.

References

Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider regarding personal health decisions.