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 New Study Examines Significant Changes in Nursing Centers Over the Decades

A new study in JAMDA takes a look at how skilled nursing facilities have changed over the past decades since passage of the Omnibus Budget Reconciliation Act of 1987 (OBRA ’87), with the most marked differences being the greater diversity and higher acuity in today's centers as well as the new ways in which care for residents has evolved over time.

In 1987, the OBRA Act called for a major overhaul of the nursing care quality assurance system.

In “Thirty-Year Trends in Nursing Home Composition and Quality Since the Passage of the Omnibus Reconciliation Act,” the authors of the study analyzed data from the National Nursing Home Survey, Online Survey Certification and Reporting Data/Certification and Survey Provider Enhanced Reporting, and data from 

Researchers found that in the past 30 years, the nursing care industry has decreased in size from 19,068 facilities to 15,686 , with an increase in the number of nonprofit (25 percent to 31 percent), dually certified (33 percent to 97 percent), and chain facilities (51 percent to 57 percent), as well as those with an Alzheimer’s special care unit (11 percent to 15 percent).

The nursing center population has changed as well, the report said. 

“There are more racial and ethnic minorities in this setting. While the number of long-stay residents has remained stable, the percentage of residents admitted from the hospital has increased by over 15 percent, with more people coming into nursing homes for rehabilitative/post-acute care,” the study said. “The number of residents with Medicaid as a primary payer has decreased, while the percentage of those mostly supported by Medicare has risen," the study said. 

Notably, acuity has increased, and more residents have physical and/or cognitive issues and need assistance with various activities of daily living such as bathing and eating. “The number of residents with dementia, as well as those with psychiatric diagnoses, has risen considerably. At the same time, fewer residents are bed-bound,” the report said.

See the full report at

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