Federal Nursing Home Laws and Regulations

Since the 1960s, federal regulations have been in place to protect the welfare of nursing home residents. These facilities are required to adhere to specific standards. If they fail to do so, they can be subjected to fines, penalties, and removal from certain federally funded programs.

These national or federal nursing home laws ensure that all long-term care facilities across the United States adhere to a uniform standard of quality.

Despite these regulations and laws, there are still instances of nursing home abuse across the country. Let’s take a closer look at the federal rules and regulations concerning nursing homes.

Nursing Home Reform Act

The Omnibus Budget Reconciliation Act (OBRA), also known as the Nursing Home Reform Act of 1987, significantly changed how nursing homes were regulated throughout the United States. These effects can still be felt even today.

The OBRA has helped improve nursing homes’ quality of care by setting standards that all facilities must follow. Along with that, the Act also grants the following rights to residents:

• The right to be treated with dignity
• The right to be free from discrimination and to receive equal care
• The right to proper protocols being followed during discharge
• The right to express their rights without fear of retaliation
• The right to be free from any form of abuse, be it physical, emotional, financial, or sexual
• The right to manage their own property
• The right to personal privacy

Regulations for Medicare and Medicaid Programs

The Centers for Medicare & Medicaid Services (CMS) has established a set of requirements that must be met by Long-Term Care (LTC) facilities, such as nursing homes, that participate in Medicare and Medicaid programs.

These requirements make sure that the facilities provide high-quality care and services to their residents while maintaining compliance with all federal regulations and guidelines.

The requirements cover a wide range of areas, including:

• Freedom from Abuse, Neglect, and Exploitation ( 483.12) ensures that the resident has the “right to be free from abuse, neglect, misappropriation of resident property, and exploitation.”
• Resident Assessment (§ 483.20) and Comprehensive Person-Centered Care Planning (§ 483.21) require the facility to conduct a comprehensive, accurate, standardized, reproducible assessment of each resident’s functional capacity, which is used to develop, review, and revise the resident’s care plan.
• Quality of Life (§ 483.24) and Quality of Care (§ 483.25) sections outline the care and services needed to attain or maintain the highest level of physical, mental, and psychosocial well-being of every resident.
• Nursing Services (§ 483.35) states that the facility has sufficient nursing staff with the knowledge and skill sets to care for the residents.
• Food and Nutrition Services (§ 483.60) requires the facility to provide each resident with “a nourishing, palatable, well-balanced diet that meets each resident’s daily nutritional and special dietary needs.”

Also, under provision § 59.140, specific requirements exist for the residents’ rooms. They include:

• The room must be designed to house no more than four residents, each with a separate bed.
• The room must provide direct access to an exit corridor and have at least one window facing the outdoors.
• The room must either be equipped with toilet and bathing facilities or be located close to these facilities.
• The room’s design must ensure complete visual privacy for each resident.
• Each resident must be provided with a clean, comfortable mattress and bedding suitable for the weather and climate conditions.
• The room must have functional furniture and individual closet space for each resident.

Facilities that fail to meet these requirements may be subject to sanctions or other penalties.

Inspections of Nursing Home Facilities

CMS surveyors use these guidelines to determine compliance with federal regulations when visiting a nursing home. Their evaluation process includes:

• Conducting a thorough review of the nursing home’s policies and procedures
• Observing the care provided to residents
• Interviewing both the staff and residents to gather firsthand information
• Reviewing relevant documentation to ensure compliance

In cases where a nursing home fails to meet these requirements, CMS and state agencies have the authority to take enforcement actions. These actions can include:

• Imposing civil financial penalties
• Denying federal payment for new admissions
• Terminating the nursing home’s participation in Medicare and Medicaid

These measures hold facilities accountable for providing quality care.

The Long-Term Care Ombudsman Program

Another program that protects the health and safety of nursing home residents is the Long-Term Care Ombudsman Program. Under the Older Americans Act of 1978, this program has advocated for residents in these facilities. Today, it operates in all 50 states, Puerto Rico, the District of Columbia, and Guam.

The Ombudsman has a very specific role: to address complaints, ensure quality care, advocate for residents’ rights, and resolve issues concerning welfare and safety. These professionals can help to hold both nursing facilities and care providers accountable when abuse occurs.

The Long-Term Care Ombudsman Program is available for all patients, regardless of whether they are in a Medicare/Medicaid-approved facility. In 2022, the Ombudsman program investigated over 198,502 nursing home abuse complaints.

The Elder Justice Act

Another piece of federal legislation is the Elder Justice Act, which addresses the issues of neglect and elder abuse in nursing homes. This Act officially came into effect in 2010.

One of the most important parts of the Act is the requirement for nursing home staff to report instances of suspected abuse and neglect. Some provisions also protect residents in the face of nursing home closures. Now, facilities must notify both the state and the Secretary of Health and Human Services about how they plan to move residents into a new location.

There are also regulations for an employee check system. All nursing homes must conduct a thorough background check on potential employees. With that, it can prevent those potential abusers from working in the facility.

State Laws and Regulations

For more information on state-specific laws and regulations, please refer to our guides for the following states:

• Kentucky
• Illinois
• Missouri
• Ohio

New Legislation for Nursing Home Standards

In addition to the above federal regulations and laws, a few other pieces of legislation are looking to prevent abuse in nursing homes further.

The CMS is in the process of proposing a rule that would establish a federal minimum for staffing levels in nursing homes. If this proposal is approved, every facility must always have a Registered Nurse on staff.

Additionally, it would mandate a specific minimum number of registered nurses and nurse aides to make sure routine care is provided to every resident.

There are also new measures to heighten accountability within the nursing home industry.

This includes the implementation of stricter enforcement actions against the worst-performing nursing homes.

Also, the Special Focus Facilities (SFF) Program would be reformed to better monitor the performance of the lowest-ranking nursing homes in the country.

Federal regulations and laws set the framework for nursing home facilities to operate safely and responsibly. However, despite these rules, nursing home abuse is still a concern for many vulnerable residents.

While these regulations are in place, that does not mean an elimination of physical, emotional, financial, sexual, or neglect in nursing homes. In these cases, if you suspect this type of abuse, you have legal options to hold those neglected parties accountable for their actions.