Since Congress passed a law designed to improve the quality of nursing homes 20 years ago, nursing homes have improved, but there are still a lot of problems. This is the conclusion of a new report by the Kaiser Family Foundation that examines the progress nursing homes have made over the past 20 years since the Omnibus Budget Reconciliation Act of 1987 (also known as the Nursing Home Reform Act) became law.

The Nursing Home Reform Act changed federal law by instituting higher standards for patient care. The law increased staffing requirements and established a number of resident rights, including the right to be free from abuse, mistreatment, and neglect. It also established an enforcement system and merged Medicare and Medicaid standards and certification requirements.

According to the report, one of the biggest improvements since the passage of the Nursing Home Reform Act is the reduction in the use of physical restraints, which can decrease a resident's muscle tone and cause other health problems. In 2006, fewer than 6 percent of long-stay nursing home residents had been restrained during the last 7 days. In addition staffing levels and training have improved slightly.

Although there have been improvements, the report notes, there are still serious problems. The number of facilities cited for violations is still high. In 2006, nearly one-fifth of all certified facilities were cited for deficiencies that caused harm or immediate jeopardy to residents. Staffing levels have improved somewhat, but studies indicate that nursing homes are still significantly understaffed. In addition, while there were improvements in the system immediately after the law's passage, improvements seem to have plateaued.

The report examines some possible future strategies for improving care, including reforming Medicaid and Medicare reimbursement, changing organizational culture, and providing more information to consumers.

To read the full report, click here.

For more information on nursing homes, click here.