Decision‐making incapacity among nursing home residents: Results from the 1987 NMES survey

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Abstract
Recent legislative and regulatory developments have focused attention on older adults' capacity for involvement in health care decision‐making. The Omnibus Budget Reconciliation Act of 1987 (OBRA 87) focused attention on the rights of nursing home residents to be involved in health care decision‐making to the fullest extent possible. This article uses data from the 1987 National Medical Expenditure Survey (NMES) to examine rates of incapacity for health care decision making among nursing home residents. Elements of the Oklahoma statute were used to operationalize decision making incapacity: disability or disorder, difficulty in decision‐making or communicating decisions, and functional disability. Fifty‐three percent of nursing home residents had a combination of either physical or mental impairment and an impairment in either self‐care or money management. The discussion focuses on the policy and practice implications of significant rates of incapacity among nursing home residents.