Characteristics of nursing home residents with mental retardation and developmental disabilities: Nursing implications of the OBRA '87 determination of need for a nursing facility

摘要

During the last twenty years, the use of nursing homes for people with mental retardation and developmental disabilities has been questioned. In 1987, federal legislation called the 1987 Omnibus Budget Reconciliation Act (OBRA '87) required states to conduct an "Annual Resident Review" of each nursing home resident with mental retardation and developmental disabilities to determine whether or not the nursing facility level of care was needed. This study examined the characteristics of 201 nursing home residents with developmental disabilities in relationship to their disposition of need for continued nursing facility care following the Annual Resident Review. The study also examined the clinical problems as identified by the OBRA '87 Minimum Data Set for Nursing Facility Resident Assessment for a subsample of 84.;Secondary data from the Nursing Home Transition Study (University of Illinois at Chicago) was analyzed on 201 nursing home residents with mental retardation and developmental disabilities, ages 30 to 88, from 17 nursing homes in a large metropolitan area in the Midwest to determine differences in characteristics by need for a nursing facility. Data from the MDS tool provided information about the clinical problems of residents.;Univariate analyses indicated that variables from functional status, physical health, health and therapeutic support and social and community participation accounted for Nursing Facility (NF) needed designation. Age was not a determining factor. Multivariate analyses supported the role of the number of nonroutine physician visits and the total number of physical conditions as predictors for need for NF. The most frequent MDS clinical problems with care plans for all residents were cognitive loss, ADL function and communication. MDS clinical problems with care plans which accounted for NF group differences were urinary incontinence, activity, tube-feeding and pressure ulcers. The clinical problem list with care plans provided the best prediction model for NF needed at an overall correct prediction rate of 98% using a logistic regression model. This study provides important information for nurses and others who may provide care for individuals with mental retardation and developmental disabilities as a result of the OBRA '87 Annual Resident Review of need for a nursing facility.