If you or your loved one needs nursing home care, you may be concerned about the quality of the care that you or your loved one might receive when living in a nursing home. In the U.S., nursing homes are regulated under both state and federal laws. These laws help to make certain that the quality of care in nursing homes meets certain minimum standards and that the residents’ rights are protected. The Nursing Home Reform Law was enacted by Congress in 1987 as an amendment to the Social Security Act, which is the 1965 law that created Medicare and Medicaid. Under the Nursing Home Reform Law, skilled nursing facilities and nursing homes must provide certain services to all of their residents and to adhere to specific standards if they want to receive payments from Medicaid or Medicare. At Elder Care Direction, we can explain these standards and the rights that nursing home residents have.
History and background
Congress requested that the Institute of Medicine to release a report about nursing homes in the nation in 1986. The report contained multiple conclusions that prompted Congress to act, including that many nursing homes and facilities were of poor quality and that stronger federal oversight was needed because many states failed to police their own nursing homes. Finally, the report found that many residents were unhappy with the quality of care that they received. The following year, Congress passed the Nursing Home Reform Law and it was signed into law by President Ronald Reagan. This federal law covers nursing homes that receive payments from Medicare or Medicaid. According to data from the government, this means that an estimated 80% of all nursing homes in the U.S. receive these types of payments.
What are the requirements for nursing homes?
Under the Nursing Home Reform Law, covered nursing homes must meet a number of criteria in order to continue receiving payments from Medicare or Medicaid. Nursing homes must meet all of the following requirements:
- Have enough staff to meet the needs of their residents
- Complete assessments of each resident’s individual needs
- Develop comprehensive individual care plans for every resident, including nutrition and diet, proper hygiene, and medication
- Ensure that all of the residents have adequate supervision
- Promote a good quality of life for every resident
- Maintain the dignity and respect of every resident
- Keep complete and accurate medical records for every resident
- Submit to surprise inspections and allow the residents to be interviewed
Nursing homes that do not comply with these requirements may face a number of different penalties. They may have to pay fines, conduct required staff training, submit to increased monitoring, be temporarily subjected to outside management, and the loss of their Medicaid and Medicare certification.
While the Nursing Home Reform Law only covers nursing homes and skilled nursing facilities that receive Medicare or Medicaid payments, other federal and state laws help by covering homes that do not receive these types of governmental payments. For example, employees and staff at some long-term care facilities are required to report crimes against the elderly residents within a specific period of time under the federal Elder Justice Act. There are also other federal and state laws that apply to nursing homes that do not receive benefits payments from the federal government.
What rights do nursing home residents have?
Under the Nursing Home Reform Law, nursing home residents are also provided a number of legal rights. These rights include the following:
- The right to be treated with dignity and respect
- The right to not be mistreated, neglected or abused
- The right to not be physically restrained
- The right to privacy in their areas and in their communications with family members and visitors
- The right to participate in family or social groups
- The right to freely communicate
- The right to be involved in the decision-making process about the resident’s care
- The right to file grievances without fear of retaliation
State nursing home laws
Many states have passed their own nursing home laws as complements to the federal laws.
For example, California has regulations concerning the ratio of nurses who are on shift to the number of resident beds. The state also requires that nursing homes follow certain procedures when they admit new residents. It requires nursing homes to inform the residents of the services that they provide by the home’s daily rate and to give residents a copy of the patient’s bill of rights.
Like California, New York has a patient’s bill of rights. New York requires that nursing homes provide access to their residents to dental care and that the nursing homes provide residents with meals that meet their religious or dietary needs.
Texas has a law in place that protects the money of the residents. The residents retain the right to choose their own doctors, and they have the right to work or to refuse to do so at the nursing homes where they reside.
Get help from Elder Care Direction
If you are trying to find a good nursing home for your loved one or for yourself, it is a good idea to start by checking the Medicare website to find the homes that are near to you. When you visit potential nursing homes, make certain that you talk to both staff and residents. Take note of the cleanliness of the facility and other factors that are important to you. Elder Care Direction is also available to provide you with guidance about the nursing homes in your area and the types of questions that you should ask when you tour them. We can also help you to understand your rights and refer you to an Elder Law attorney if you need legal assistance. Contact us today to schedule a consultation so that you can learn more about nursing home requirements and your rights.