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Nursing Home Law Basics

Nursing homes are regulated by both federal and state laws. In 1987, Congress enacted amendments, known as the Nursing Home Reform Law, to the Social Security Act, the 1965 law that created Medicaid and Medicare. The Nursing Home Reform Law requires nursing homes and skilled nursing homes to provide certain services to their residents and to meet certain standards, in order to receive Medicaid or Medicare payments. Learn more about nursing home law and residents' rights below.

Background and History

In 1986, at the request of Congress, the Institute of Medicine issued a report on nursing homes in the U.S. The report concluded that many nursing homes were of low quality, that stronger federal regulation was necessary because many states failed to adequately regulate nursing homes, and that many residents were dissatisfied with the care they received. Congress enacted the Nursing Home Reform Law the following year. This law applies to nursing homes that receive Medicaid or Medicare payments. According to a government survey, roughly 80% of all nursing homes received such payments.

Nursing Home Requirements

Nursing homes subject to the Nursing Home Reform Law must:

  • Have sufficient staff
  • Assess each resident's particular needs
  • Develop comprehensive care plans for each resident, including proper hygiene, nutrition and diet, and medication
  • Ensure that residents are adequately supervised
  • Promote their residents' quality of life
  • Maintain their residents' dignity and respect
  • Keep accurate and complete medical records for each resident
  • Submit to unannounced inspections and allow resident interviews

If a nursing home fails to comply with any of these requirements, penalties can include fines, imposed staff training, increased monitoring, temporary outside management, and loss of Medicare and Medicaid certification.

Note that the Nursing Home Reform Law only applies to those nursing homes that receive Medicaid or Medicare payments. However, other federal laws, along with state laws, help to fill the gap. For example, the federal Elder Justice Act requires employees and staff at certain long-term care facilities to report crimes committed against elderly residents within specified time frames.

Residents' Rights

The Nursing Home Reform Law not only sets requirements for nursing homes but also provides residents with certain rights. These include the right to:

  • Be treated with respect and dignity
  • Be free of abuse, mistreatment, and neglect
  • Be free of physical restraints
  • Privacy
  • Participate in social or family groups
  • Communicate freely
  • Make decisions about the resident's care
  • Voice grievances without retaliation

For a more detailed list of residents' rights, read Findlaw's article on the legal rights of nursing home residents. You can also learn about state-specific laws on our nursing home legal answers page.

State Nursing Home Laws

States have enacted their own nursing home laws to complement federal law.

California, for example, regulates the number of nurses on a shift based on the number of resident beds. California also requires nursing homes to follow certain procedures when admitting new residents, to inform residents of the services that are provided by the facility's daily rate, and to provide residents with a copy of the state's Patient's Bill of Rights.

New York also has a Patient's Bill of Rights, and the state requires that residents have access to dental care and are provided with meals that are appropriate for their religious or dietary needs.

Finally, Texas law has safeguards for residents' money, provides residents with the right to choose their own physicians, and regulates residents' right to work or refuse to work at the nursing home.

For information on your state's nursing home laws, you can start here.

Getting Help

If you're looking for a suitable nursing home for yourself or for a loved one, visit the Medicare website to find a nursing home near you. It's important to speak with staff and residents and to consider factors such as cleanliness.

If you would like to know more about residents' rights or about nursing home laws in your state, contact an attorney who specializes in residential care law.

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Next Steps

Contact a qualified elder law attorney to help you and loved ones plan care and address problems.

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