title: Decision-making incapacity among nursing home residents: results from the 1987 NMES survey. National Medical Expenditure Survey.
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.
authors.affiliation: Department of Human Development and Family Studies, Pennsylvania State University, University Park 16802, USA.
authors.forename: P E
authors.initials: PE
authors.lastname: Goodwin
authors.forename: M A
authors.initials: MA
authors.lastname: Smyer
authors.forename: T I
authors.initials: TI
authors.lastname: Lair
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D003430:Cross-Sectional Studies; D006801:Humans; D016743:Mental Competency / Q000331:legislation & jurisprudence; D009735:Nursing Homes / Q000331:legislation & jurisprudence*; D009825:Oklahoma; D010344:Patient Advocacy / Q000331:legislation & jurisprudence*; D010358:Patient Participation / Q000331:legislation & jurisprudence*; D011569:Psychiatric Status Rating Scales; D014481:United States