glect in nursing homes. The nursing home reforms contained in the Omnibus Budget Reconciliation Act of 1987 (OBRA 1987. Pub L. No. 100-203) specified that nursing home residents had the “right to be free from verbal, sexual, physical, and mental abuse, corporal punishment, and involuntary seclusion” (42 CFR Ch. IV (10-1-98 Edition) §483.13 (b)). HCFA issued regulations and guidelines implementing these provisions of the OBRA 1987 legislation. These regulations specified the following definitions:

The federal regulations implementing OBRA 1987 also specified long-term care facilities’ responsibility to “develop and implement written policies and procedures that prohibit mistreatment, neglect, and abuse of residents and misappropriation of resident property” (42 CFR Ch. IV (10-1-98 Edition) §483.13 (c)). Furthermore, the law required that the facility “must not employ individuals who have been found guilty of abusing, neglecting, or mistreating residents by a court of law or have had a finding entered into the state nurse aide registry concerning abuse, neglect, mistreatment of residents, or misappropriation of their property” (42 CFR Ch. IV (10-1-98 Edition) §483.13 (c)(1) (ii) (A) (B)).³

For decades, nursing homes have been plagued with reports suggesting widespread and serious maltreatment of residents, including abuse, neglect, and theft of personal property (Douglass et al., 1980; Fontana, 1978; Institute of Medicine, 1986; Mendelson, 1974; Moss and Halamandaris, 1977; New York State Moreland Act Commission, 1975, 1976; Ohio General Assembly Nursing Home Commission, 1978; Stannard, 1973; U.S. Senate, 1970; U.S. Senate, 1971; U.S. Senate Special Committee on Aging, 1974– 1975; Vladeck, 1980). In addition, a number of case studies, participant-observation studies, interviews with nursing home staff, and interviews with residents and ombudsmen provided evidence of abuse (Doty and