First phase of transformative nursing home regulations now in effect

It may come as a surprise for people to learn that much of the cost of nursing home care in the U.S. is covered by the federal Medicaid and Medicare programs. Consider that the price tag for this care reached an astounding $75 billion in 2014 alone.

While this steady stream of reliable income is naturally a great boon to U.S. nursing homes, as with most situations in life, there is no such thing as a free lunch. Indeed, in exchange for federal funding, nursing homes must agree to abide by rules established by the U.S. Department of Health and Human Services.

As it turns out, HHS Secretary Sylvia Matthews proposed a groundbreaking set of rules, slated to be rolled out in three separate phases, just last year. In fact, the first of these phases officially took effect in late November, marking the first time in 25 years that the federal rules for nursing homes have undergone any substantial changes.

These changes, hailed as transformative by some advocacy groups, are designed to shift nursing homes toward offering more “patient-centered care.”

To that end, the first set of regulations, which affect roughly 1.4 million people, call for the following:

• Protection from abuse: In addition to expanding the definition of abuse to cover financial exploitation, nursing homes are now prohibited from hiring any licensed professionals who have been previously disciplined for mistreatment, abuse, neglect or financial exploitation of residents.
• Staffing: While the regulations stop short of setting minimum staffing levels, they do mandate that nursing homes maintain enough competent and skilled staffers to meet the needs of residents. Specialized training covering care for those with dementia and preventing elder abuse is also mandated going forward.
• Quality of life: The regulations grant residents the right to more variety and flexibility concerning snacks and meals, the right to select their roommates, and the right to receive visitors whenever they would like (provided it doesn’t infringe on the rights on another).
• Discharges: When it comes to discharges, the regulations dictate that residents cannot be evicted for nonpayment if they’ve applied for Medicaid or insurance, are appealing a claim denial, or awaiting a payment decision. Furthermore, residents are granted the right to appeal any refusals to readmit following a hospital stay and the right to return to their same room (if available).

Here’s hoping these regulations do indeed prove transformative and that this marks a fundamental shift in nursing home care as we know it.

Consider speaking with an experienced legal professional to learn more about your options if you believe that nursing home neglect or abuse is to blame for the serious injuries suffered by a loved one.