The United States Department of Health and Human Services through its Health Care Finance Administration enforces nursing home regulations.  Both in 1980 and 1987, the standards to be met by nursing facilities were updated with the regulations imposed under the Omnibus Budget Reconciliation Act of 1987.

OBRA 87:  The Omnibus Budget Reconciliation Act of 1987 or OBRA 87 requires that the facility provide each patient with care that will enable the patient “to attain or maintain the highest practicable physical, mental and psychosocial well-being”. The main purpose behind enacting this legislation is to maintain the quality of life of nursing home residents and makes it the duty of the state to ensure that state licensing and federal standards are maintained. States are also required to maintain investigatory units and Ombudsman units, and to fund and staff them adequately.  Subsequently, OBRA 87 has been updated with OBRA 90.

Inside OBRA