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The quality of services furnished as measured by indicators of medical, nursing, and rehabilitative care, dietary and nutritional services, activities and social participation, sanitation, infection control, and the physical environment.The Resident Care Requirements for Long Term Care Facilities experienced major revisions in 1989, 1991, and 1994
In addition to federal laws regulating the quality of care in nursing homes, most states have enacted laws prescribing licensure requirements for nursing facilities in their state. In many states, the state licensing body acts as the federal government’s agent in determining whether a facility has met the federal (and state) requirements for Medicare/Medicaid certification. For Medicare/Medicaid purposes, the state laws must be at least as stringent as the federal laws. Some states have adopted laws that are stricter than the federal laws. As an example, California nursing home care and services are regulated under Title 22 of the California Code of Regulations.
At this time, nursing facilities are not specifically mandated to provide routine or emergency vision and eye health services to their residents. Since vision and eye health care is not a required service in nursing facilities, the addition of an eye care program helps to improve the quality of care provided to the residents, and, as an added benefit, may positively impact the outcome of the nursing facility's annual survey. Nursing facilities are required to assist residents in obtaining eye care if they or their family makes a request for such services or in the case that services are triggered through the Minimum Data Set (MDS)/Resident Assessment Protocol (RAP) system.
During the 1980’s as the population of citizens residing in nursing facilities increased so did concerns over the quality of care being delivered. The Omnibus Budget Reconciliation Act of 1987 (OBRA 1987) mandated a national assessment system for evaluating all residents in nursing facilities in the United States. Each resident admitted to a facility is required to be evaluated using a Resident Assessment Inventory (RAI). The MDS and RAP and triggers are required by federal law to be components of the RAI. States may add other assessment tools or more in-depth data to be collected. Federal statutes also require facilities to screen for mental illness and mental retardation as a part of the initial evaluation at the time of admission. The Preadmission Screening and Routine Review (PASARR) of mental illness along with the MDS and RAP compose a common RAI battery.When mandating use of the RAI for nursing facilities, legislators recognized the need for uniformity among the data to be collected so that care practices could be monitored. The MDS was developed to meet this requirement.11 (See Appendix) The MDS, now in its second revision, is a multidimensional tool that evaluates a wide range of areas including medical, cognitive, and social-behavioral status. The MDS was designed to give structure and uniformity to the evaluation of long term care residents and has been used as the national assessment model since 1991.
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