Federal Regulations for U.S. Nursing Homes

When a nursing facility would like to receive federal funds, such as those from Medicare, it must meet federal standards in addition to state and local requirements. A facility may meet Oregon state requirements and accept private insurance or payment. However, if it does not meet these federal standards, it is ineligible to accept Medicare payment for services.

These standards function, in part, to reduce instances of abuse or neglect by including requirements surrounding psychosocial well-being. If you have concerns that your loved one is not being cared for to these standards and is being neglected or abused, you may want to speak with a nursing home abuse attorney in Portland to discuss legal recourse. Seeking legal representation may help you recover damages for the abuse as well as hold the guilty parties accountable.

Federal Regulations for U.S. Nursing Homes

Federal Regulations for Nursing Homes

The regulations for US nursing homes provide a comprehensive guideline for the requirements of Medicare-enrolled nursing facilities. The Centers for Medicare and Medicaid Services (CMS) reports that they have paid more than $33 billion to skilled nursing facilities (SNF). According to the code of federal regulations 483.1, some of the general requirements that a nursing home are as follows:

If facilities fail to meet the guidelines provided, they may be required to pay back funds received for inadequate services or may lose their ability to accept Medicare payments and patients altogether. The high volume of payouts motivates the desire to ensure that federal money is going to facilities that provide a fundamental level of care to residents.

Patient Rights and Person-Centered Care

The federal regulations are clear: all patients have the right to be free from abuse, neglect, and exploitation. Section 483.12 further emphasizes this by requiring facilities to provide training on the topic and to have policies in place to report and investigate such behavior. This commitment to resident rights is a cornerstone of the nursing home system.

Upon admission to the Skilled Nursing Facility, the patient and their representative must be made aware of the patient’s rights. This also pertains to the admission, discharge, or transfer from the facility requirements as they pertain to 483.15. If the facility must keep a resident in their facility with few exceptions. These exceptions are typically due to the health and safety of the patient or inability or unwillingness to pay.

Federal regulations require that residents enter nursing facilities and receive a comprehensive evaluation to assess their physical and emotional needs and mental capacity. Completing this evaluation allows for a level of care tailored to the individual and ensures that their specific needs are met. This assessment should result in a person-centered plan of care that will be adhered to and re-evaluated as needed.

Quality of Life Requirements

Nursing facilities are meant to provide an environment that is as close to ‘normal’ as possible. This goal is reflected in the 483.24 Quality of Life regulations, which require that the resident receive services that support the highest practicable level of physical, mental, and psychosocial well-being that is consistent with their resident assessment and plan of care. These requirements include:

In addition to daily life activities, the facility must also provide an ongoing program of options for daily activities. These options must align with the resident’s plan of care and facilitate psychosocial connections. This statute also lays out the requirements for those who direct the activities program.

Quality of Care

Quality of care is a concept that relates to quality of life. Per 483.25, this regulation provides guidelines on what the quality of care should be, including ensuring that vision and auditory appointments are made and kept and that any other accommodations for quality of life are provided. These may include prostheses, preventing bed sores, providing mobility devices, or providing bed rails to prevent unnecessary falls.

Physical Care

The federal guidelines for physical and medical care are the most robust. In 483.30 the regulations provide guidelines for physician visits and services, indicating that each resident’s care must be overseen by a physician. Each resident must be seen every 60 days after the first 90 days, during which time the patient must be seen every 30 days. Additionally, a physician assistant or nurse practitioner may provide daily immediate care.

Nursing requirements for a federally approved facility have some degree of flexibility, as the number of nursing staff may adjust to the patient’s needs. According to 483.35, this number is equal to 3.48 nursing hours per resident per day. These numbers may vary depending on the level of licensure and support staff.

In some instances, the facility may be able to get a hardship exemption for the required hours worked based on certain criteria, including good faith efforts to hire and appropriate financial commitment. Additionally, the facility is required to post the exemption status.

Medication Guidelines

Federal standards place guidelines on how medications can be stored, labeled, and supplied. Under 483.45, the facility is expected to keep a medication error rate of under 5%. Additionally, any medication prescription errors providers make should not be significant.

Training and Educational Requirements

Skilled Nursing facilities must create, implement, and maintain training programs to meet the needs of the specific staff in the facility based on assessments indicated in 483.71. There are a number of topics that can be discussed, including criteria for federal compliance such as:

By providing this training for staff, the facility may be able to decrease adverse events and increase confidence in crucial decision-making. Training and education are what make the difference in a well-equipped facility that provides appropriate, individualized, and compassionate care. If you have concerns that your loved one is not receiving adequate care or is suffering from abuse or neglect, you may benefit from speaking with a nursing home abuse lawyer with Paulson Coletti Trial Attorneys.