The implementation of the requirements of OBRA 87 has resulted in many changes for HHAs and home healthcare nurses. These include the patient bill of rights, training and competency evaluation of home healthcare aides, and the revised certification/recertification process. It is important that sound structural and process criteria be in place in an HHA. These will provide the foundation for successful site visits during which patient-focused outcomes can be identified. Increased knowledge should also decrease the nurses' apprehension about the revised process.