The Importance of Federal Law in Nursing Home Care

Many nursing home facilities in the United States receive funding from Medicaid and/or Medicare. Those facilities which do receive federal funds are regulated by federal law. These laws are the basis for all nursing home residents’ quality of care, rights, quality of life, etc.  Additional protections can be put in place by individual states, however, states cannot diminish the protections mandated by federal law.

The Nursing Home Reform Law, the primary federal law for nursing homes, passed in 1987 has never been substantially re-written, only modified. In September, 2016, the Centers for Medicare and Medicaid Services (CMS) issued the first major overhaul of federal nursing home regulations in 25 years. The new regulations will be implemented in three stages: Phase 1 on November 28, 2016, Phase 2 on November 28, 2017 and Phase 3 on November 28, 2019.

What provisions are included in the Nursing Home Reform Law?

Included in this overhaul are several provisions that can be classified as beneficial to the residents and their families. A few are outlined below:

• Additions to residents rights.
• Facilities are no longer able to take up to 14 days to develop a baseline plan of care. They now have up to 48 hours after admission to outline “instructions needed to provide effective and person-centered care that meets professional standards of quality care.”
• The resident’s care planning team must include a nurse aide and a member of the food and nutrition services staff to ensure that a resident receives appropriate care and is treated humanely.
• Added provisions to better address the needs of residents who have experienced trauma (ie. Holocaust survivors and veterans).
• The addition of a grievance officer and a written policy relating to grievances for filed complaints.
• Additional discharge protections including:
  • documentation of what the facility has done to meet the resident’s needs and how the new facility will be able to meet their needs;
  • written notice to the resident that explains the reason for the move;
  • notice be sent to a representative of the Office of the State Long-Term Care Ombudsman; and
  • When a resident is being sent to a hospital and cannot return to the facility, facilities must follow these transfer/discharge requirements.

There are also a few concerns that come along with these new provisions:

• CMS declined to provide a specific criteria for nurse staffing. Nursing homes are “required to have sufficient staffing to ensure that every resident receives the care and services needed to attain and maintain his or her highest physical and psycho-social well-being.”  However there is no specific number given of what “sufficient” means.
• How these new regulations will be implemented.
• Means of addressing and identifying problem areas, including whether or not the staff has been sufficiently trained to meet the needs of the residents. The new regulations will have the facilities self-evaluating these areas, which for obvious reasons, may not be the best way to determine areas that need improvement.

We are hopeful that these changes will help to improve nursing home standards, which in turn, will improve quality of care and life for nursing home residents.