Food-Service-Manual-for-Health-Care-Institutions

will grow 86 percent, reaching $267 billion, and Medicare spending will grow nearly 110 percent,
reaching $216 billion. Medicare budgets will increase more than 44 percent. Medicaid is the largest
and fastest growing part of the state budgets, comprising 20 percent of all state expenditures. The
number is expected to grow as the population ages, the need for long-term care increases, and older
people enter nursing homes. Medicaid is the largest purchaser of nursing home services and maternity
care in the nation. Much of the anticipated increase in spending will go to purchasing prescription
drugs.
Omnibus Budget Reconciliation Act of 1987
Food service departments that serve hospital extended-care units and long-term care facilities also
must comply with the Medicare and Medicaid Requirements for Long-Term Care Facilities. These
requirements, finalized in September 1992, implement the nursing home reform amendments
enacted by the Omnibus Budget Reconciliation Act (OBRA) of 1987, as published by the Health
Care Financing Administration. It is estimated that nearly 50 percent of the OBRA regulations
relate directly or indirectly to nutrition and food service departments. The OBRA standards pertain
to dignity and independence in dining, initial and annual nutrition assessments, nutrition care
plans, and participation of a dietitian in family conferences. Discussions of how to maintain compliance
with these regulations are covered in chapters 9 and 20.
Joint Commission on Accreditation of Healthcare Organizations
Medicare and Medicaid regulations are government imposed, but some facilities choose to further
their compliance efforts by following standards set by independent organizations. The
JCAHO (http://www.jcaho.org) is one such organization. Standards set by the JCAHO are similar
to those set by Medicare; however, JCAHO surveys tend to place more emphasis on the systems,
processes, and procedures that influence quality of patient care and outcomes. More
recently, publications by the JCAHO report that future emphasis will be on the education and
training of patients and their families; orientation, training, and education of staff; leadership
roles of directors; and approaches and methods of quality improvement. They also have
announced increased standards for safety, infection control, pain management, and emergency
readiness. They will no longer announce the date or time of the surveys. Because JCAHO guidelines
are updated and published annually, they must be reviewed annually to ensure compliance.
Americans with Disabilities Act
In addition to significantly influencing operations, legislation continues to dictate employment
practices. As the labor force shrinks and alternative labor sources are explored, Americans with
disabilities are one solution to some of the problems associated with inadequate staffing.
Furthermore, ensuring equal employment opportunities for this segment of the population is
mandated by federal law. In 1990, President George H. W. Bush signed the Americans with
Disabilities Act, which prohibits employment discrimination against the disabled. The act
mandated that employers with 25 or more employees are prohibited from discriminating
against qualified individuals with disabilities with regard to applications, hiring, discharge,
compensation, advancement, training, or other terms, conditions, or privileges of employment.
The act affects both the selection of employees and the service of meals to consumers.
Reasonable accommodations have to be made for both groups. Further explanation of the
Americans with Disabilities Act is found in chapters 8 and 20.
Health Care Affordability
Given the alarming rate of increase in health care costs and in an aging population, alternative
health care options will be necessary. It is estimated that by 2011 the total national health expenditures
will be $2,815,813 and will account for 17 percent of the gross domestic product. By 2009
the percentage of uninsured workers will be between 22 and 30 percent or about 60 million workers
by 2011. The American Hospital Association (AHA) has called for hospital leaders to become
Food Service Industry: An Overview
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