Understanding the Nursing Home Reform Act

Nursing home abuse is a widespread problem affecting many seniors and their families in the United States. Unfortunately, addressing abuse cases in these facilities continues to be challenging for various reasons. Some seniors may be unwilling to report the abuse or neglect because they fear angering nursing home staff. Others may be unable to file complaints due to physical or mental limitations.

If you or your elderly loved one is experiencing elder abuse or neglect in a nursing home, understanding the fundamentals of the Nursing Home Reform Act and other California elder abuse laws can empower you to protect their rights – and their health and well-being.

What Is the Nursing Home Reform Act (NHRA)?

The Nursing Home Reform Act is a federal law enacted in 1987 to establish the fundamental rights of seniors residing in nursing homes, protect them from abuse and neglect, and ensure they receive quality care.

The law covers nursing homes receiving funding from Medicare or Medicaid payments and requires them to meet specific minimum care standards. Each state is tasked with inspecting and certifying that the nursing homes in their area comply with the Act’s standards. Facilities that fail to meet the requirements may face fines, penalties, management changes, and, ultimately, the denial of federal funding.

History of the NHRA

Initially, nursing homes were largely unregulated. Policies emerged over time, but substandard care continued to affect and harm residents.

In 1986, Congress ordered the Institute of Medicine (now the National Academy of Medicine) to look into the issue and evaluate the quality of care provided by nursing homes in the country. These probes gathered evidence showing that inadequate care was widespread and nursing home residents commonly experienced abuse or neglect.

The reforms proposed by the Institute of Medicine to address these issues became part of the Nursing Home Reform Act. The NHRA was added to the Omnibus Budget Reconciliation Act and was passed in 1987.

Standards Set by the NHRA

The NHRA enumerated several requirements to protect seniors’ health, safety, and well-being in nursing homes. The legislation requires nursing homes to provide the following:

• Proper nutrition for their residents
• Proper preparation and administration of their prescribed medications
• Comprehensive and personalized care plans for each resident
• Assessments for all residents with continual updates
• Pharmaceutical services
• Nursing services
• Rehabilitation services
• Social services
• Sufficient staffing based on the ideal ratio of staff to residents
• A full-time social worker for nursing homes with over 120 beds

Nursing Home Residents’ Bill of Rights

Most importantly, the NHRA established a Bill of Rights to promote the rights of all nursing home residents. Some fundamental rights included in the legislation are:

The Right To Be Treated With Respect

Nursing home residents need to be treated with dignity and respect. They have the right to make their own choices, like deciding when to go to bed and when to wake up and choosing the activities they would like to participate in.

The Right to Proper Living Arrangements

Staying in nursing homes does not mean seniors lose their rights to privacy and proper living arrangements. The NHRA’s Bill of Rights states that they have the right to the following:

• • To keep their personal belongings (as long as they do not interfere with other residents’ health, safety, or rights)
  • To be notified before their room or roommate is changed
  • To have their preferences considered when changing their room or roommate
• To have the facility protect their property from theft.

The Right To Be Free From Abuse, Mistreatment, and Neglect

One of the most significant things the NHRA has done is to protect elderly residents from any kind of elder abuse: physical, emotional, financial, and sexual. This also covers neglect and abandonment, which can lead to serious problems such as bedsores, sepsis, and even death.

The Right To Be Free From Restraints

With the Nursing Home Reform Act’s Bill of Rights in place, nursing homes are prohibited from using physical and chemical restraints to discipline residents or for the convenience of the staff. Medications may only be used to ensure the safety of a senior resident and other individuals.

The Right To Participate in Activities

Nursing home residents must be able to participate in programs meant to meet their needs.

The Right To Form or Participate in Groups

Seniors living in a nursing home facility have the right to join or form resident groups where they can raise grievances about the institution’s policies and operations. The nursing home must provide these groups with a meeting space. More importantly, the nursing home must listen to and act upon the concerns brought to its attention.

The Right To Make Complaints Without Retaliation or Discrimination

The NHRA gives residents the right to voice their complaints to the staff or nursing home without fear of retaliation or discrimination. The nursing home should also aim to address the concern promptly.

The Right to Proper Medical Care

Besides the right to information regarding their health status, medical condition, medications, vitamins, and supplements, nursing home residents also have the right to:

• Be involved in choosing their doctor
• Be involved in making decisions concerning their care
• Access their clinical records promptly
• Refuse to participate in experimental treatment.

The Right to Social Services

Nursing homes are also obligated to provide any social services that a resident may need, including counseling and discharge planning. They must also help seniors address issues with other residents, or get in touch with legal and financial professionals when the need arises.

The Right to Information on Services and Fees

Residents have the right to receive written information from nursing homes about their services and fees before they move into the facility. They must also be made aware of any changes promptly.

The Right To Welcome, Spend Time With, or Refuse Visitors

Seniors must not be restricted from:

• Spending private time with their visitors
• Receiving visitors at any time (given that they want to see them and that the visit does not interfere with other residents’ care and privacy)
• Meeting any individual that can assist them with their health, social, financial, legal, or other services at any time, including their doctor, a health department representative, or their Long-Term Care Ombudsman, among others
• Refusing visitors

The Right To Leave the Nursing Home

Living in a nursing home is a resident’s choice, so they must also be free to leave for visits. If they are cleared by their doctor, they can take a “leave of absence” to see their family or friends during the day or go on an overnight trip. However, they must notify the nursing home staff in advance to give them time to prepare their medications.

Ultimately, residents also have the right to move out and choose another facility. However, some facilities require residents to provide advance notice of their plans to leave; otherwise, the resident may have to pay an additional fee.

The Right Against Unfair Discharge or Transfer

It is against the guidelines set by the NHRA for residents to be sent to another nursing home or made to leave the facility, except in these circumstances:

• Nursing home care is no longer necessary as the resident’s health has improved.
• The discharge or transfer is necessary for the health, safety, and welfare of the resident or others living in the facility.
• The nursing home did not receive payment for the services the resident received.
• The nursing home is closing.

Residents have the right to receive a 30-day written notice of the nursing home’s plan and reason for the relocation, except in emergencies. Most importantly, they must be provided with a safe and orderly discharge or transfer.

The Right To Have Family and Friends Involved

Nursing home residents may also involve their family and friends to ensure they receive good quality care. As such, families and friends should visit the facility, get to know the staff and the nursing home’s rules, and help develop a care plan for the senior resident with their permission.

Ultimately, if a senior has appointed a family member or friend as their legal guardian, they now have the right to access the resident’s medical records and make important decisions on their behalf.

Aside from enumerating the basic rights that nursing home residents are entitled to, the NHRA also established that facilities that violate these rights might be subject to legal action.

How the NHRA is Being Enforced

Most of nursing home care funding comes from Medicare and Medicaid payments. To enforce the Nursing Home Reform Act, Congress tied federal funding with a facility’s adherence to the rules and regulations set by the legislation.

The states are responsible for monitoring and evaluating their nursing homes. They are mandated to perform random, unannounced surveys of nursing home facilities at least once every 15 months, looking into their quality of care and services and their residents’ welfare and quality of life. When complaints are made, the state government is also tasked with conducting investigations.

Nursing homes found violating the NHRA may face sanctions from the government, including penalties, state monitoring, temporary state management, and denial of Medicare or Medicaid funds.

Take the First Step Toward Protecting Your Elderly Loved One Today

While the Nursing Home Reform Act of 1987 provided much-needed surveillance of nursing homes receiving federal funding, abuse and medical malpractice still occur. Unfortunately, most of these cases go unreported for a number of reasons. Some seniors fear retaliation from staff. Others may be unable to pursue legal action due to cognitive problems or because they don’t have family or friends to advocate on their behalf.

The good news is that there are various steps you can take if you suspect that you or your elderly loved one has suffered from nursing home abuse or neglect. To begin with, reporting the abuse to authorities like your local police, your county’s Adult Protective Services, or the California Department of Public Health can help keep a victim safe.

Another option is to take legal action against the abusive staff or facility and seek the compensation you or your elderly loved one deserves. Get a free case evaluation today to understand your legal options, and take steps toward fighting for your or your loved one’s right to quality care.