Learn the System

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Under the Biden-Harris Administration several new initiatives have been created to help improve the quality of long-term care facilities in the United States. For the White House statement on these planned initiatives, please follow the link: Fact Sheet on Steps to Improve Nursing Homes

 

  1. The US Department of Heath and Human Services put forth a proposal in September 2023 for improving staffing requirement minimums in long-term care facilities. Staffing has been an ongoing issue in the long-term care system and studies show it significantly contributes to quality of care. To learn more about this proposal, please follow the link below

2. The Center for Medicaid and Medicare revised surveyor guidelines for long-term care facilities became effective in October 2022. This revision attempts to address deficiencies in staffing and training, infection prevention, infection control, visitation, cultural consideration of residents, arbitration agreements, resident rights, transfers, discharges and additional survey provisions. A brief overview can be found in the link below.

 

In September 2023, KFF released a review of new proposed staffing standards, discussing how many facilities meet these new requirements. Please refer to the below link in regard to this.

 

 

Accurate long-term care facility ratings can be difficult to find. A 2021 investigation conducted by The New York Times found that over 2,700 dangerous incidents were not factored into the CMS Rating System. CMS has been working to attempt improvements to this rating system and has current plans of another update in April 2024.

 

When possible, it is best to visit a facility prior to transfer or admission. If you or the individual are in the hospital, ask hospital staff like nurses for their opinions. Nurses and physicians often see many residents from care facilities and may have insight from their experiences. If you visit facilities, try to ask any visitors you see about the facility.

 

Make observations of what is occurring at the facility when you visit, in addition to the state of residents you see. 

ProPublica

ProPublica offers a nursing home inspect tool to search are review nursing home inspections and penalties to help individuals evaluate facilities and compare options.

 

Freedom of Information Service Center

The Freedom of Information Act (FOIA) enables you to file a CMS FOIA and FOIA/Privacy Act request. Members of the public can request in-depth records of Medicare beneficiary claims and CMS agency reports of facilities. These reports provide more detailed reviews of facility quality reports and any complaints that have been filed.

For more information on this process, including contacts and forms, click the link: FOIA Service Center

 

CMS Rating System

Care Compare is the CMS Five-Star Quality Rating System they provide, so the public can compare nursing homes. 

 

 

 

While there are state-specific regulations for facilities, there are also federal regulations and the national Nursing Home Reform Action of 1987. 

 

 

Code of Federal Regulations for Long-term Care Facilities

The following are links to the requirements for states and long-term care facilities with a clickable index. Navigating through the index allows for effortless access to specific sections for detailed information.

 

The Federal Nursing Home Reform Act (NHRA)

The NHRA (also referred to as OBRA ’87), is a reform act that enforces standards of provided care and resident rights. This reform states that facilities should promote residents’ quality of life;  resident health and quality of life should not decline due to care provided by the facility. 

 

Below are noteworthy excerpts of nursing home requirements put in place by the NHRA. (This is not a complete list):

  1. “Provide services and activities to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident in accordance with a written plan of care which–

(A) describes the medical, nursing, and psychosocial needs of the resident and how such needs will be met; is initially prepared with the participation to the extent practicable of the resident or the resident’s family or legal representative

(B) is initially prepared, with the participation to the extent practicable of the resident or the resident’s family or legal representative, by a team which includes the resident’s attending physician and a registered professional nurse with responsibility for the resident; and

(C) is periodically reviewed and revised by such team after each assessment under paragraph (3)”

 

2. “A nursing facility must conduct a comprehensive, accurate, standardized, reproducible assessment of each resident’s functional capacity, which assessment—

(i) describes the resident’s capability to perform daily life functions and significant impairments in functional capacity;

(ii) is based on a uniform minimum data set specified by the Secretary under subsection (f)(6)(A);

(iii) uses an instrument which is specified by the State under subsection (e)(5); and

(iv) includes the identification of medical problems.”

 

3. “Such an assessment must be conducted—

(I) promptly upon (but no later than not later than 14 days after the date of) admission for each individual admitted on or after October 1, 1990, and by not later than October 1, 1991, for each resident of the facility on that date;

(II) promptly after a significant change in the resident’s physical or mental condition; and

(III) in no case less often than once every 12 months.

(ii) Resident review.—The nursing facility must examine each resident no less frequently than once every 3 months and, as appropriate, revise the resident’s assessment to assure the continuing accuracy of the assessment.

(D) Use.—The results of such an assessment shall be used in developing, reviewing, and revising the resident’s plan of care under paragraph (2).”

 

Here are a few facility requirements included in the NHRA (This is not a complete list):

 

    1. Maintain staffing
    2. Maintain clinical records
    3. Provide proper treatment
    4. Develop care plans for each resident
    5. Provide sufficient nutrition and hygiene 
    6. Provide sufficient quality care

 

 

Residents of long-term care facilities have rights defined both by the state and the federal government.

 

 

Resident Rights

The following are brief excerpts from the Code of Federal Regulations concerning long-term care Resident Rights:

 

Residents have the right…

      1. To freedom from abuse, neglect, and misappropriation of resident property
      2. To be free of physical restraints
      3. To refuse medication or other treatments (with exceptions)
      4. To be self-determined and free to make their own choices
      5. To a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility
      6. To exercise his or her rights as a resident of the facility and as a citizen or resident of the United States
      7. To be informed of, and participate in, his or her treatment/care
      8. To choose his or her attending physician
      9. To be treated with respect and dignity
      10. To organize and participate in resident groups in the facility
      11. To participate in family groups
      12. To have family member(s) or other resident representative(s) meet in the facility with the families or resident representative(s) of other residents in the facility
      13. To participate in other activities, including social, religious, and community activities that do not interfere with the rights of other residents in the facility
      14. To choose to or refuse to perform services for the facility and the facility must not require a resident to perform services for the facility
      15. To manage his or her financial affairs. This includes the right to know, in advance, what charges a facility may impose against a resident’s personal fund
      16. That the facility must not impose a charge against the personal funds of a resident for any item or service for which payment is made under Medicaid or Medicare (except for applicable deductible and coinsurance amounts)
      17. To information and communication, to be informed of his or her rights and of all rules and regulations governing resident conduct and responsibilities during his or her stay in the facility
      18. To access personal and medical records pertaining to him or herself
      19. To personal privacy and confidentiality of his or her personal and medical records
      20. To a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely
      21. To voice grievances to the facility or other agency or entity that hears grievances without discrimination or reprisal and without fear of discrimination or reprisal
      22. To communicate with federal, state, or local officials, including, but not limited to, federal and state surveyors, other federal or state health department employees, including representatives of the Office of the State Long-Term Care Ombudsman, and any representative of the agency responsible for the protection and advocacy system for individuals with mental disorder (established under the Protection and Advocacy for Mentally Ill Individuals Act of 2000 (42 U.S.C. 10801 et seq.), regarding any matter, whether or not subject to arbitration or any other type of judicial or regulatory action

 

For the complete list and details of long-term care facility Resident Rights, please follow this link and utilize the clickable index.

 

 

For additional shortened factsheets on Resident rights, please refer to the following.

 

The Federal Nursing Home Reform Act (NHRA)

The NHRA (also referred to as OBRA ’87), is a reform act that enforces standards of provided care and resident rights. This reform states that facilities should promote residents’ quality of life; resident health and quality of life should not decline due to care provided by the facility. These rights are briefly reviewed above and are further reviewed in the following links.

 

Discharges, Transfers, and Room Changes

1. Room/roommate changes

 

Facilities are required by law to provide residents written notice before changing their room or roommate. In some states this is a 10-30 day notice requirement.

 

2. Transfers/discharges

 

Facilities must provide a 30-day written notice of any plans to discharge or transfer residents and the written notice must include why they are transferring/discharging, the date of anticipated action, the right of the resident to appeal this action, information on how the resident can file an appeal, the location of discharge/transfer and ombudsman contact information. Residents also have the right to appeal any transfer or discharge. During the time of their pending appeal, residents are not legally allowed to be discharged or transferred.  For more information on how to appeal a transfer or a discharge, please follow the link below. 

 

 

3. Hospital Discharge Appeal

 

You have the right to appeal your discharge from the hospital. Talk with physicians and care staff at the hospital about your concerns and then file an appeal. Individuals cannot be discharged during the appeals process.

 

 

4. Bed Holds at Facilities for Out-of-Facility Hospital Stays

 

State bed hold periods vary. This can also be referred to as “therapeutic leave” and Medicare/Medicaid will cover the facility bed hold costs during a specified time period.

 

 

This website serves solely as a supplementary and educational resource. It does not offer direct advice or recommendations for individual situations. Additional research should be conducted, and official and professional guidance sought. Federal, state, and local services should always be consulted for appropriate assistance and guidance. Additionally, professional health, legal, and government services should always be consulted, as this website does not serve as a substitute for them. While efforts are made to provide accurate and up-to-date information, this website cannot guarantee the accuracy or currency of the content. It is encouraged that users verify information with relevant authorities or professionals. Please note that if you or someone you know is in imminent danger, call 911.