Nursing Home Design Guide
2006
Additionally, there were gradual
the Illuminating Engineering
Society of North America (IESNA),
changes in minimum space standards.
NHRA initiated an evolution of stronger
and adopted as an Approved
social, recreational, rehabilitative and
American National Standard (ANSI
meaningful activities programs such as:
RP-28-2001).
Personalization of rooms and the
2.1.4
OBRA 1987/NHRA
development of "homelike"
The Nursing Home Reform Act (NHRA)
residential environments,
Better food service programs,
of 1987 (PL 100-203) was an outgrowth
of the Omnibus Budget Reconciliation
Recreational activities and
wandering gardens,
Act of 1987. OBRA 1987 probably has
had more impact than any other single
Expansions of physical and
piece of legislation regarding Nursing
occupational therapies, activities of
Homes in the United States as well as
daily living and dementia programs,
the culture and philosophy of caregiving
The incorporation of engaging
within them.
environmental stimuli, and
The recruitment of volunteers,
NHRA guaranteed Nursing Home
families and other residents in
residents certain rights and protections,
stimulating daily experiences.
including, but not limited to:
2.1.5
HIPAA
Access to all of the nursing and
rehabilitation services offered by a
The Healthcare Insurance Portability
facility that may be needed to enable
and Accountability Act of 1996 (HIPAA)
a resident to attain his/her highest
has reinforced and extended NHRA
practical level of independence and
emphasis on privacy and dignity, to
physical, mental and psycho-social
include audible as well as visual privacy.
function
This is especially the case with respect
Development of an on-going
to protection of each individual's medical
program of care and activities
records, private information and
designed to meet the specific needs
communications. This law protects all
and interests of each individual
conversations between residents and
resident
admission interviewers, caregivers,
The right to participate and/or be
nurses, physicians and families.
represented in care planning, along
Serious breaches of those rights to
with certain rights of privacy and
privacy are subject to Federal litigation.
dignity
HIPAA is currently having an impact on
The right to be free from physical
the design of resident rooms in terms of
and chemical restraints.
audible privacy in standard two-person
room layouts where only a cubicle
The immediate effect of NHRA/OBRA
curtain separates resident beds.
'87 was the changes in state codes and
Resident unit layouts now consider the
regulations designed to incorporate the
juxtaposition of rooms and spaces,
NHRA requirements into state Medicare
which may limit sounds of private
and Medicaid reimbursement policies.
Office of Facilities Management
2-3
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