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Regulatory Support

The Omnibus Budget Reconciliation Act of 1987 (OBRA) introduced a new regulatory direction towards person-directed care with a focus on residents' rights, quality of life, resident assessment and quality of care. Karen Schoeneman, CMS senior policy analyst, presented the major themes of OBRA ’87 during the St. Louis Accord, which included the change from “patient” to “resident” to convey respect.

Other highlights of OBRA: The survey process is “resident-centered and outcome-oriented”; “good assessment is at the heart of providing good care”; “facilities are expected to maintain/improve well-being to the extent possible”; “Quality of life and rights are as important as quality of care”; and “physical restraints are dangerous.”

Click here for CMS Memo on Nursing Home Culture Change Regulatory Compliance Questions and Answers pdf

For Person Directed Care regulator questions, fill out this form.

F309 Quality of Care “Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care.”

F240 Quality of Life “A facility must care for its residents in a manner and in an environment that promotes maintenance or enhancement of each resident’s quality of life.”

F242 Self-Determination and Participation “The resident has the right to 1. Choose activities, schedules and health care consistent with his or her interests, assessments and plans of care; 2. Interact with members of the community both inside and outside the facility; and 3. Make choices about aspects of his or her life in the facility that are significant to the resident.”

MDS: Personal preferences should be communicated with the MDS coordinator and interdisciplinary team to ensure accurate MDS coding in sections such as Customary Routines in Section AC. The MDS assessment information should be available at all times as a resource for staff in all planning and revisions.