Abstract
Looking back on the last 25 years of nursing home care and the advent of the medical director, it is hard to imagine what the field might look like when today's newly minted doctors are asked to make some mid-career observations. Certainly this has been a time of change and opportunity for physicians in long-term care settings. Since the Institute of Medicine (IOM) 1986 report, “Improving the Quality of Care in Nursing Homes,” a lot has happened. The report was immediately followed by the Omnibus Budget Reconciliation Act of 1987 (OBRA-87), which was designed to improve care provided in institutions through changes in the medical assessment and treatment of nursing home residents. 1 Hawes C Mor V Phillips CD et al. The OBRA-87 nursing home regulations and implementation of the resident assessment instrument: Effects on process quality. J Am Geriatr Soc. 1997; 45: 977-985 Crossref PubMed Scopus (204) Google Scholar Some recommendations brought about dramatic change (restraints) while other suggestions have been slow and uneven in implementation (enforcement). The impact was profound and not to be felt again so strongly until the advent of the prospective payment system. But more on that later.
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