Menno Haven Rehabilitation Center. RDG Planning & Design
The “common ground” identified as the foundation for SAGE was the resident-centered philosophy behind the federal Nursing Home Reform Act of 1987, known as OBRA '87 since it passed Congress as part of the Omnibus Budget Reconciliation Act of 1987. OBRA was a fundamental paradigm shift for the nursing home industry and the state regulatory units that evaluate nursing homes. The basis for evaluation changed from staff inputs to resident outcomes. Nursing home surveys now focused on the quality of life of individual residents and the quality of care each received in response to their needs.
The objective was to maintain or improve the well-being of each resident. For each nursing home resident to have a sense of well-being, the environment must meet his or her social, psychological, and spiritual needs as well as physical needs.
Since the physical setting is a key element of the environment, the OBRA philosophy applies to the built environment as well as to operations.While OBRA wasn't written to address the built environment, its holistic focus on the individual resident with unique interests, abilities, and needs provided the philosophical foundation needed to provide common ground between providers, regulators and designers. The providers had to comply with the OBRA regulations and the regulators were required to enforce them. The building designers had to understand the OBRA philosophy, since if the built environment is not in alignment with operations it will create a major barrier to achieving the desired outcomes. On the other hand, if all aspects of the environment are in alignment with the resident-centered OBRA philosophy, the objectives of OBRA will be a natural outcome.