OBRA--its effect on the mentally ill in South Dakota nursing homes

Mental illness is quite prevalent in the nursing home population. The Omnibus Budget Reconciliation Act of 1987 (OBRA), as it relates to nursing homes, has many facets including preadmission screening, periodic assessment, formalized patient rights, and gives reviewers a broader list of sanctions for offending facilities. OBRA does away with the designation of skilled and intermediate levels of care. It provides for evaluation of special needs of the mentally retarded and developmentally disabled and expects relocation of residents in need of specialized treatments. Similarly, it requires evaluation of the mentally ill in nursing homes for appropriateness of placement and discourages admission of potential nursing home residents with mental illness. This last aspect of OBRA and its potential effect of the long term care system, the mental health system, and the budget of the state of South Dakota are the subject of this paper.