Posted: October 27th, 2022

week -5 aging

  Mrs. J is repeatedly asking for a nurse; other patients are complaining, and you simply cannot be available to Mrs. J for long periods.  Considering the setting and the OBRA guidelines, what would you do to manage the situation?
 

The Omnibus Budget Reconciliation Act (OBRA), also known as the Nursing Home Reform Act of 1987, has dramatically improved the quality of care in the nursing home over the last twenty years by setting forth federal standards of how care should be provided to residents. 

This Act is interpreted with the U.S. Code of Federal Regulations (42 CFR Part 483). Such improvements include less use of antipsychotic drugs, a reduction in chemical and physical restraint use, and a reduction in inappropriate use of indwelling urinary catheters.

Mandates

The quality of care mandates contained within OBRA, and the regulations, require that a nursing home must provide services and activities to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident in accordance with a written plan of care. 

In order to participate in Medicare and Medicaid programs, nursing homes must be in compliance with the federal requirements for nursing homes.

The mandates of OBRA are regarded in the nursing home setting to represent minimum accepted standards of care. The failure of a nursing home to comply with the OBRA quality of care mandates in caring for a resident represents a failure to exercise the degree of reasonable care and skill that should be expected.

Penalties

The Indiana State Department of Health is responsible for ensuring that nursing homes follow these mandates through the state survey process. The Department of Health and Human Services (DHHS) and the states may apply penalties against nursing homes for failure to meet the minimum standard of care as defined in the OBRA regulations. 

Such penalties may include fines, appointment of administrative consultants to run the nursing home while deficiencies are remedied, and even closure of a nursing home.

· Residents must be assessed to identify their medical problems and their abilities to perform basic self-care activities. The DHHS established a uniform data set, referred to as the minimum data set (MDS), to document this assessment.

· The nursing home is responsible for the safety of each resident. This includes being responsible for orders written by the resident’s primary physician or other medical provider. If the physician writes an order that does not comply with the federal regulations, the nursing home is responsible for making sure the physician changes such order. The mere presence of a physician’s inappropriately written order does not absolve the nursing home of responsibility in providing safe care.

· Provide services that will enhance each resident’s quality of life to its fullest (42 CFR §483.15).

· Maintain the dignity and respect of each resident (42 CFR §483.15).

· Develop a comprehensive care plan for each resident (42 CFR §483.20).

· Conduct a comprehensive and accurate assessment of each resident’s overall health upon admission and at each required interval (42 CFR §483.20).

· Prevent a decline in activity of daily living (ADL) activities, including the ability to eat, toilet, bathe and walk. Staff must provide for ADL care when necessary (42 CFR §483.25).

· Prevent the development of pressure sores, and if a resident has pressure sores, provide the necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing (42 CFR §483.25).

· Provide appropriate care to those who have urinary incontinence and restore bladder function if possible. This also includes only using urinary catheters when appropriate as outlined in the regulations to prevent adverse consequences related to such use (42 CFR §483.25).

· Prevent accidents, including falls, accidental poisonings and other incidents that could cause injuries (42 CFR §483.25).

· Maintain adequate nutrition to prevent unnecessary weight loss (42 CFR §483.25).

· Provide each resident with sufficient fluid intake to prevent dehydration (42 CFR §483.25).

· Ensure that residents are free from significant medication errors (42 CFR §483.25).

· Have sufficient nursing staff (42 CFR §483.30).

· Ensure that each resident’s rights to choose activities, schedules, and health care are maintained (42 CFR §483.40).

· Provide pharmaceutical (medication) services to appropriately meet the physical and psychological needs of each resident (42 CFR §483.60).

· Maintain accurate, complete, and easily accessible clinical records for each resident (42 CFR §483.75).

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WEEK # 5

OBRA

OBRA

The Omnibus Budget Reconciliation Act (OBRA), also known as the Nursing Home Reform Act of 1987, has dramatically improved the quality of care in the nursing home over the last twenty years by setting forth federal standards of how care should be provided to residents. 

This Act is interpreted with the U.S. Code of Federal Regulations (42 CFR Part 483). Such improvements include less use of antipsychotic drugs, a reduction in chemical and physical restraint use, and a reduction in inappropriate use of indwelling urinary catheters.

Mandates

The quality of care mandates contained within OBRA, and the regulations, require that a nursing home must provide services and activities to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident in accordance with a written plan of care. 

In order to participate in Medicare and Medicaid programs, nursing homes must be in compliance with the federal requirements for nursing homes.

The mandates of OBRA are regarded in the nursing home setting to represent minimum accepted standards of care. The failure of a nursing home to comply with the OBRA quality of care mandates in caring for a resident represents a failure to exercise the degree of reasonable care and skill that should be expected.

Penalties

The Indiana State Department of Health is responsible for ensuring that nursing homes follow these mandates through the state survey process. The Department of Health and Human Services (DHHS) and the states may apply penalties against nursing homes for failure to meet the minimum standard of care as defined in the OBRA regulations. 

Such penalties may include fines, appointment of administrative consultants to run the nursing home while deficiencies are remedied, and even closure of a nursing home.

• Residents must be assessed to identify their medical problems and their abilities to perform basic self-care activities. The DHHS established a uniform data set, referred to as the minimum data set (MDS), to document this assessment.
• The nursing home is responsible for the safety of each resident. This includes being responsible for orders written by the resident’s primary physician or other medical provider. If the physician writes an order that does not comply with the federal regulations, the nursing home is responsible for making sure the physician changes such order. The mere presence of a physician’s inappropriately written order does not absolve the nursing home of responsibility in providing safe care.

• Provide services that will enhance each resident’s quality of life to its fullest (42 CFR §483.15).
• Maintain the dignity and respect of each resident (42 CFR §483.15).
• Develop a comprehensive care plan for each resident (42 CFR §483.20).
• Conduct a comprehensive and accurate assessment of each resident’s overall health upon admission and at each required interval (42 CFR §483.20).
• Prevent a decline in activity of daily living (ADL) activities, including the ability to eat, toilet, bathe and walk. Staff must provide for ADL care when necessary (42 CFR §483.25).
• Prevent the development of pressure sores, and if a resident has pressure sores, provide the necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing (42 CFR §483.25).
• Provide appropriate care to those who have urinary incontinence and restore bladder function if possible. This also includes only using urinary catheters when appropriate as outlined in the regulations to prevent adverse consequences related to such use (42 CFR §483.25).
• Prevent accidents, including falls, accidental poisonings and other incidents that could cause injuries (42 CFR §483.25).
• Maintain adequate nutrition to prevent unnecessary weight loss (42 CFR §483.25).
• Provide each resident with sufficient fluid intake to prevent dehydration (42 CFR §483.25).
• Ensure that residents are free from significant medication errors (42 CFR §483.25).
• Have sufficient nursing staff (42 CFR §483.30).
• Ensure that each resident’s rights to choose activities, schedules, and health care are maintained (42 CFR §483.40).
• Provide pharmaceutical (medication) services to appropriately meet the physical and psychological needs of each resident (42 CFR §483.60).
• Maintain accurate, complete, and easily accessible clinical records for each resident (42 CFR §483.75).

CASE STUDY: Mrs. J is repeatedly asking for a nurse; other patients are complaining, and you simply cannot be available to Mrs. J for long periods.  Considering the setting and the OBRA guidelines, what would you do to manage the situation?

 

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◄ Quiz 1_Spring2021

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Evolve Resources for Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition
Sherpath for Gerontologic Nursing (Touhy GNHA Version), 5th Edition
Chapter 1 Introduction to Healthy Aging
Chapter 2 Cross-Cultural Caring and Aging
ANA Gerontological Nursing
QSEN competencies
The Nursing Process ANA
Chapter 3 Biological Theories of Aging and Age-Related Physical Changes
Chapter 4 Psychosocial, Spiritual, and Cognitive Aspects of Aging
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Myths
Chapter 5 Gerontological Nursing and Promotion of Healthy Aging
Chapter 6 Gerontological Nursing Across the Continuum of Care
Careplan/Plan of Care
Concepts of Aging Case Study: Concepts of Aging
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Chapter 7 Economic and Legal Issues
Chapter 8 Assessment and Documentation for Optimal Care
Quiz 1_Spring2021
Chapter 9 Safe Medication Use
Chapter 10 Nutrition
Chapter 14 Promoting Healthy Skin
Case Study # 2 : OBRA
Chapter 11 Hydration and Oral Care
Chapter 12 Elimination
Research Article # 2 Drop Off
Chapter 13 Rest, Sleep, and Activity
Chapter 14 Promoting Healthy Skin
QUIZ 2
Chapter 15 Falls and Fall Reduction
Chapter 16 Promoting Safety
CARE PLAN # 2
Chapter 17 Living with chronic illness
Chapter 18 Pain and comfort
Care of the Aging Population on Global Health/Research Paper
MIDTERM
Chapter 19 Diseases affecting vision and hearing
Chapter 20 Metabolic disorders
Chapter 21 Bone and joint problems
Chapter 22 Cardiovascular and respiratory disorders
Chapter 23 Neurologic disorders
Chapter 24 Mental Health
Chapter 25 Care of individuals with neurocognitive disorders
QUIZ 3
Interdisciplinary Paper
Chapter 26 Relationship, roles and transitions
SHERPATH DUE 04/07/2021
Chapter 27 Caregiving
Chapter 28 Loss, death and palliative care
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