The impact of federal regulations on urethral catheterization in Virginia nursing homes

The 1990 Omnibus Budget and Reconciliation Act (OBRA) nursing home regulations limit the use of indwelling urinary catheterization to certain appropriate cases. This study examines the impact of OBRA on catheterization among 3149 pre-OBRA and 5073 post-OBRA Virginia residents. The two cohorts were similar in activities of daily living function and medical status, but the post-OBRA cohort was more incontinent. A higher percentage of residents were catheterized pre-OBRA than post-OBRA. Post-OBRA, catheterized residents were more likely to meet OBRA conditions for appropriate catheterization than noncatheterized residents, and less than 1% of long-term catheterized residents were catheterized inappropriately. Long-term catheterized residents had more urinary tract infections than short-term catheterized residents, however. Also, some nursing homes may substitute ostomies for catheters. Catheter use may no longer be a reliable indicator of quality of care at the nursing home level, if homes are minimizing catheterization in response to OBRA.