More than 15,000 nursing homes across the country care for millions of residents. These facilities are governed by federal regulations designed to maintain a quality standard of care and protect residents.
If you or a family member lives in a nursing home, knowing these laws can help you understand your rights and what can happen if federal regulations are violated.
Over the past several decades, concerns over the quality of care in nursing homes have risen.
In response, the federal government has enacted a number of different laws to protect elderly residents and hold these facilities accountable. Some of the major laws to know are:
In 1986, the Institute of Medicine (IOM), now called the National Academy of Medicine, published a report that would lay the groundwork for legislation that still applies to nursing homes today.
The IOM report found significant evidence of poor quality of care, neglect, and abuse in nursing homes. As a result, the Nursing Home Reform Act (NHRA) was passed in 1987.
The NHRA outlines a minimum standard of care all nursing homes across the US must meet. Nursing home services mandated by the NHRA include:
The nursing home must also be adequately staffed and keep accurate medical records for all residents.
Additionally, the NHRA includes a bill of rights for all nursing home residents, which guarantees the right to:
The EJA was specifically written to combat elder abuse, neglect, and exploitation and protects people aged 60 or older. It aims to do this by improving the prevention and detection of elder abuse through the coordination of reporting of such crimes.
Any nursing homes that receive $10,000 or more in federal funds are subject to EJA reporting requirements. The facility’s owners, managers, employees, and contractors are held responsible to the reporting requirements.
Under EJA rules the following must be formally reported:
The EJA also created the Elder Justice Coordinating Council and advisory board and an employee database.
The Elder Justice Coordinating Council is a federal entity that helps coordinate the federal government’s response to elder abuse, neglect, and exploitation.
The Secretary of HHS and the Attorney General are members of the council. The Advisory Board on Elder Abuse, Neglect, and Exploitation, also created under the EJA, provides support to the council.
Legislation like the NHRA and EJA were enacted at the federal level, but they are enforced in a few different ways.
Federal oversight outlines mandatory measures that all nursing homes must meet, but state agencies are largely responsible for regulatory enforcement. These agencies include:
Nearly all nursing homes are certified by Medicare and Medicaid.
Only 4% are not certified by Medicare or Medicaid; the rest are certified by one or both.
The Centers for Medicare and Medicaid (CMS) work with the state agencies responsible for licensing to ensure nursing homes meet federal requirements.
CMS provides a State Operations Manual (SOM), which helps state surveyors complete their reviews of nursing homes. Nursing homes need to achieve CMS certification to receive reimbursement from Medicare and/or Medicaid. The state agency responsible conducts surveys of nursing homes at least once a year.
The National Nursing Home Initiative is the federal government’s latest effort to enforce quality care in nursing homes.
In 2020, the Department of Justice launched the program to investigate the worst facilities in the country. As of March 2020, the initiative was investigating 30 different facilities across nine states.
Investigation through the initiative is being coordinated with the Elder Justice Initiative and the U.S. Attorney’s Office.
If a nursing home is found to be in violation of federal regulations, it faces a number of potential consequences, including:
Failure to comply with regulations like the EJA and NHRA can also result in loss of Medicare and Medicaid certification, which means the facility in question cannot receive reimbursement from CMS.
Federal regulation exists to protect nursing home residents, but families still need to be vigilant. Only one in 23 cases of abuse is reported as mandated. If you suspect your family member is the victim of abuse in a nursing home, you do not have to wait for the facility to act.
Understanding the basics of the regulations that guarantee nursing home residents can help you advocate for your loved ones. But, it can be confusing when a facility violates these regulations.
Federal regulations mandate nursing homes report any instances of abuse, neglect, or exploitation, but this does not always happen.
If you suspect your rights or the rights of your loved one guaranteed by federal law are being violated, you can file a complaint with the facility’s administration and the Arizona Department of Health. That state agency is required to investigate the complaint.
Violating federal regulations opens a nursing home up to the possibility of civil and criminal action. If a nursing home is found to be non-compliant with any federal regulations designed to protect its residents, you and your family may be able to pursue a civil case.
A civil case can help you or your loved one receive a settlement as compensation for any abuse or neglect suffered.
Enforcement of federal regulations is meant to push facilities to reach compliance. As such nursing homes still operating today may have violated regulations in the past. If you are deciding on a nursing home or researching your loved one’s current facility, you can find out which facilities have faced regulatory action.
AZ Care Check is Arizona’s database. You can search a nursing home and find if the Arizona Department of Health Services has ever found it deficient. You can also use the federal government’s Nursing Home Compare tool to compare the quality of any nursing home certified by Medicare or Medicaid.
The Trump administration has proposed measures that could roll back some federal regulations overseeing nursing homes.
The “Medicare & Medicaid Programs; Requirements for Long-Term Care Facilities: Regulatory Provisions to Promote Efficiency and Transparency” rule proposed by CMS would reduce standards for facility assessments and infection control, among other changes.
The changes are being made in an effort to reduce burden on long-term care facilities. Organizations, like the Center for Medicare Advocacy, argue that this type of deregulation is dangerous for the residents of nursing homes.
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