OBRA

In 1987 President Reagan signed that year’s Omnibus Budge Reconciliation Act (OBRA). That year the OBRA included the Federal Nursing Home Reform Act, which was designed to assure quality in nursing homes throughout the country. The Act applies to all skilled nursing facilities that are funded by Medicare or Medicaid. The Act specifies that certified nurses’ aids must have at least 75 hours of classroom instruction, plus practical experience under the supervision of the schools’ instructors and be evaluated by state boards of nursing before they are allowed to work in skilled nursing facilities. Most schools that offer certified nurses’ aid training courses are compliant with OBRA standards.

The Act states that skilled nursing facilities must provide quality of care so that each resident can “ attain and maintain her highest practicable physical, mental and psychosocial well-being.” The Act includes provisions designed to improve the residents’ quality of care:

• Each resident’s ability to perform activities of daily living, including walking and bathing, are to be maintained.
• Care plans must be in place.
• Residents have the right to remain in nursing homes as long as payments are made, residents are not dangerous, and no medical changes take place.
• Services for residents with mental retardation or mental illness are available.
• The resident has the right to maintain personal or bank funds, to return to the nursing home after a stay in an acute hospital or with family, to choose a physician or view medical records.
• The resident has the right to organize and participate in a residents’ group.
• The resident has the right not to be restrained unnecessarily by physical devices or drugs.
• There are uniform standards for skilled nursing facilities to become certified.
• Failing to meet uniform standards results in remedies.

In most states students must be at least 18 years of age with a high school diploma or General Educational Development (GED) certificate. Students spend between 75 and 150 hours in classrooms learning theory and about 24 hours in actual nursing homes or hospitals getting practical experience taking care of residents. At the end of the program students are required to demonstrate their knowledge and skills to the satisfaction of the State Board of Nursing. A written test consisting of 55 and 70 multiple-choice questions and a practical exam must be passed. The practical exam consists of demonstrating six skills on either patients or mannequins. An aid must pass both exams by four months after being hired by a hospital or skilled nursing facility. Once an aid passes the OBRA regulations he or she will be listed on an OBRA registry that employers can use to assure themselves that he or she is ready to work.

Several skills are taught in classrooms and clinical settings. To assess the patients’ health, prospective aids are taught to measure the vital signs, temperature, pulse, respirations and blood pressure. Making beds and giving bed baths are often taught in a classroom lab and then practiced on actual residents. Transferring residents between beds and chairs is another skill that is taught. Measuring fluid intake and output, helping with feeding, answering call lights, cleaning catheters and documenting information are other skills that go into the making of a certified nurses’ assistant.