Nursing Home Reform Act

Nursing homes began as a largely unregulated industry. While regulations grew over time, concerns continued to be raised about the quality of care residents received. Despite the large investment of Medicare and Medicaid funds, too many nursing homes were missing the mark.

In the 1980s, congressional probes revealed that nursing home residents were often neglected or abused. The Nursing Home Reform Act (NHRA) of 1987 enacted sweeping changes designed to protect nursing home residents. It created uniform standards for long-term care facilities and established the Nursing Home Resident Bill of Rights.

Nursing Home Reform Act Coverage

The NHRA is a federal law. Compliance with the Act is mandatory for nursing homes that want to receive funding from Medicare or Medicaid. States are responsible for inspecting and certifying that the facilities receiving Medicare and Medicaid funding are substantially compliant with the Act's standards.

Some states have included NHRA's requirements into their state laws regulating long-term care facilities. In those states, all nursing homes must comply with NHRA standards, not just those seeking Medicare or Medicaid funds.

Nursing Home Residents Bill of Rights

The Nursing Home Reform Act created a Nursing Home Resident Bill of Rights for those living in covered facilities. These rights include:

• The right to be treated with dignity and respect
• Freedom from abuse, mistreatment, and neglect
• Freedom from physical restraints
• The right to manage one's own finances or designate someone of their choice to do so
• 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 treatments
• The right to a choice as to schedule and activities
• The right to an environment that provides maximum comfort and independence

There are many more rights. See this document from the Centers for Medicare and Medicaid Services for an in-depth explanation of a nursing home resident's rights.

How these rights are protected is found in the Act's requirements relating to standards of care.

Standards of Care

The NHRA established standards of care intended to protect residents. Certification and accreditation ensured facilities have met a minimal standard of care. Other NHRA requirements required that nursing homes:

• 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
• Monitor medication and provide pharmaceutical services
• Maintain accurate and complete clinical records

Failure to comply with these and other standards of care can result in fines, changes in facility management, and ultimately the denial of Medicare and Medicaid funding.

The Future of Nursing Home Safety

As noted in an article in AARP: "The extent to which the Nursing Home Reform Act succeeds in actually improving nursing homes, however, depends on the effectiveness of its enforcement."

Prospective residents and families can review their state's licensure and compliance inspection reports. The website Active Living has gathered this information for every state.

Families also have a resource to help them assess quality care: the Nursing Home Compare website. Provided by The Center for Medicare and Medicaid Services, this site allows users to compare nursing homes on a variety of quality metrics.

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

Despite increased regulation, nursing homes residents can still suffer from substandard care that threatens their health and even their lives. Family members should report suspected abuse or neglect to the appropriate state agency. A personal injury lawsuit is also an option. If you believe your loved one has been injured or died from inadequate medical care, talk to a local personal injury attorney today.