Thirty-Year Trends in Nursing Home Composition and Quality Since the Passage of the Omnibus Reconciliation Act.
Shekinah A Fashaw, Kali S Thomas, Ellen McCreedy and 1 others
PMID 31451383WHAT IT FOUND
Over 30 years, US nursing homes served more diverse, higher-need residents; dementia rose 39% to 45%, psychiatric diagnoses 11% to 31%, physical restraint 19% to 1%, pressure ulcers 8% to 6%.
Key findings
01Nursing home residents became more functionally dependent and more likely to have dementia or psychiatric diagnoses: average ADL dependency score increased from 15 to 17, dementia from 39% to 45%, and psychiatric diagnoses from 11% to 31%.
02Some nursing home quality measures improved: physical restraint fell from 19% to 1%, inappropriate antipsychotic use fell from 16% to 12%, and pressure ulcers fell from 8% to 6%.
03Nursing homes admitted more residents directly from hospital and became more racially and ethnically diverse: hospital admissions rose from 67% to 85%, and minority residents rose from 7.8% to 20.7%.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The data are averaged across facilities for each year, so they cannot show what happened to individual residents or distinguish long-stay from short-stay changes. Annual data were not available for 1986 to 1994, so some trends are not continuous. The paper used no inferential statistics, so the reported changes are descriptive and not tested for significance. Multiple policy, market, and demographic changes occurred over the same period, so the study cannot show that OBRA 1987 caused the observed trends. Different variables came from different national datasets and time periods, which limits direct comparison across all measures.
Declared interests
One author, VM, reports significant financial interests related to nursing home care: HCR Manor Care, Inc., NaviHealth, Inc., and PointRight, Inc., including chair, scientific advisory board, consultant, or former director roles, and holds less than 1% equity. The publication types list NIH and U.S. government research support, but no specific study funder is named in the text.
The easy way to misread this
Do not read the quality improvements as proof that OBRA 1987 caused them. The study is descriptive, uses facility-level averages, and includes no inferential statistics, so it shows co-occurring trends, not a causal effect.