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:
Abuse means the willful infliction of injury, unreasonable confinements, intimidation, or punishment with resulting physical harm, pain, or mental anguish.
Neglect means failure to provide goods and services necessary to avoid physical harm, mental anguish, or mental illness.
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