Nursing Home Regulations Updated in U.S.

It’s been a quarter of a century since nursing home regulations have been updated. Finally, last fall the Centers for Medicare and Medicaid Services issued the 2016/2017 Nursing Home Action Plan, a hefty document broadly outlining federal revisions to nursing home regulations. Some of these regulations took effect in November, 2017, and the rest are scheduled to be phased in between 2017 and 2019. 

Uncertainty surrounds how these regulations will be implemented, and what will happen to nursing homes that don’t comply. In fact, Medicare isn’t planning to release information on compliance until this summer.

Nursing Home Regulations Updated for First Time Since 1991

“These are the first comprehensive updates to long-term care requirements since 1991,” Dr. Kate Goodrich, the Centers for Medicare and Medicaid Services’ chief medical officer told The New York Times‘ Paula Span, and the regulations will impact a large proportion of Americans. According to the Nursing Home Action Plan, 3 million Americans rely on services provided by nursing homes at some point during the year, and 1.4 million Americans reside in approximately 15,654 nursing homes on any given day. Nursing home staff will also be affected, as will families of nursing home residents. In fact, there are few people that these regulations won’t touch in some way.

No doubt that these changes are long overdue, but although they’re now law, uncertainty remains. “We’re wondering and worrying whether these new regulations will be repealed by the Republican Congress,” Robyn Grant, public policy director at the National Consumer Voice for Quality Long-Term Care told Span. Although some of the recent Republican changes could impact recent home care regulations, nothing definitive has been said about nursing home regulations.

Further complicating the uncertainty of the new regulations, The American Health Care Association (which represents a number of for-profit nursing homes) has filed a lawsuit to stop a major regulation change: A ban on binding arbitration agreements that nursing homes often ask residents to sign before they are admitted (and before a dispute arises). The outcome of this lawsuit has not yet been determined.

Nursing Home Change is Good

Despite the uncertainty, a number of the new regulations are urgently needed. Some of the positive changes include:

Focus on Person-Centered Care

Many changes in the Nursing Home Action Plan attempt to increase residents’ control over their daily lives. Examples include:

• No more visiting hours — Residents can now receive any visitor (not just relatives) at any time of the day, as long as they aren’t disruptive to the community
• Roommates — Friends, siblings and same-sex couples can choose to live in the same room
• No predetermined mealtimes — Nursing homes are now required to make meals and snacks available when residents want to eat (not just at predetermined times)

Focus on Protection

The Nursing Home Action Plan has focused on increasing protection of residents’  health, security, safety and rights. Nursing homes are now:

• No longer able to require residents to sign waivers saying the nursing home is not responsible for loss or theft of belongings. “They must take reasonable care of residents’ personal belongings,” Span reports
• Not able to bounce residents from one nursing home to another or unjustly evict residents. This change addresses the issue of residents loosing their space when they are admitted to hospital. In fact, a number of grievance and appeal procedures have been changed to help protect residents
• Required to have a designated infection-control officer
• Required to establish a system to monitor the use of antibiotics
• Required to expand staff training on senior abuse protection
• Required to expand staff training on dementia care

What Rules and Regulations Are Missing?

According to Span, “the regulations disappointed nursing associations and many advocates by declining to set minimum staffing standards.” The Nursing Home Action Plan requires nursing homes to develop resource and needs assessments, and hire accordingly, but they don’t require specific staff ratios, minimum hours of care or a registered nurse to be onsite 24/7. Although these were highly sought after changes, “federal regulators feared that some homes, particularly in rural areas, might find higher staff requirements unnecessary and impossible to reach, and close down rather than face violations and fines,” Span says.

Advocates, however, are worried that without staffing standards, nursing homes can “cut staff, keep their wages low and pocket the profits,” Charlene Harrington, a nursing home researcher at the University of California told the New York Times. Without standards, “it’s completely left to the nursing homes, and they’re not going to change because there’s no incentive to,” she says.

Looking for more information? A complete overview of the new nursing regulations is available here, and the entire 2016/2017 Nursing Home Action Plan is available here.