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Nursing Home Reform Act

Nursing homes began as a low-regulated industry. The public questioned the quality of care residents received. Despite the large investment of Medicare and Medicaid funds, problems persisted. Nursing home abuse and neglect continued at nursing home facilities. This affected the physical and psychosocial well-being of many full-time residents.

In the 1980s, public debate reached a turning point. The Institute of Medicine (IOM) publicized a report on these issues. Congressional probes revealed that nursing home residents were often neglected or abused. The federal government had to take action.

Congress finally created the Federal Nursing Home Reform Act of 1987 (NHRA). It passed as a part of the Omnibus Budget Reconciliation Act. The law enacted sweeping changes designed to protect nursing home residents. It also created uniform standards for long-term care facilities and established the Nursing Home Residents' Bill of Rights.

Nursing Home Reform Act Coverage

The NHRA is a federal law. Nursing homes that want to receive government money must follow the Act. Otherwise, they will not receive funding from Medicare or Medicaid. The law also protects nursing home residents who voice grievances. Nursing home facilities must take care to address legitimate complaints. To ensure the same, government social workers conduct assessments through unannounced surveys.

States are responsible for inspecting and certifying nursing facilities. They must ensure that facilities receiving government funding are compliant. An inspection can discover nursing home violations, such as:

  • Physical neglect in the form of residents suffering from bedsores
  • Physical abuse such as medical malpractice by nursing home doctors
  • Failure to render comprehensive care plans promised to residents

Some states have incorporated NHRA's requirements into their laws. In those states, all long-term care facilities must follow NHRA standards. This applies even if they don't receive government money.

Nursing Home Residents Bill of Rights

The Nursing Home Reform Act created a Nursing Home Resident Bill of Rights. In covered facilities, these rights include:

  • The right to dignity and respect
  • Freedom from abuse, mistreatment, and neglect
  • Freedom from physical restraints
  • The right of self-determination to manage one's own finances or to choose someone to do it
  • The right to privacy
  • The right to have personal belongings and property
  • The right to be informed of one's medical conditions and to consult a doctor of their choice
  • The right to refuse medications and medical care treatments
  • The right to choose a schedule and activities
  • The right to an environment that provides the greatest comfort and independence
  • Access to social services and dietary services

There are many more rights and special requirements relating to standards of care. Click here for a full list of nursing home residents' rights.

Standards of Care

The NHRA establishes standards of care intended to protect residents. Certification and accreditation ensure facilities meet standards to:

  • Maintain adequate staffing
  • Determine each resident's functional capacity
  • Develop care plans for all residents
  • Protect resident's ability to care for themselves
  • Provide services for hygiene and nutrition
  • Ensure access to proper medical treatment
  • Supervise medication and provide pharmaceutical services
  • Maintain accurate and complete clinical records

Failure to follow these and other standards of care can result in:

  • Fines and license probation/revocation,
  • Changes in facility management, and/or
  • The denial of Medicare and Medicaid funding.


  • Findlaw has extensive information on finding and reporting elder abuse.
  • Prospective residents and families can review their state's licensure and compliance inspection reports. The website Senior Living has gathered this information for every state.
  • Medicare's Nursing Home Finder compares a variety of quality metrics.

If Your Loved One Has Suffered Substandard Care, Talk to a Lawyer

Despite increased regulation, nursing home residents can still suffer from substandard care. This can threaten their health and even their lives. Family members should report suspected abuse or neglect to the appropriate government agencies. Consulting with the law offices of a nursing home abuse attorney is also a great step.

Nursing home abuse lawyers are personal injury lawyers specializing in the NHRA. They can provide case evaluations, sometimes through toll-free numbers. Talk to a local personal injury attorney today.

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