Regulations Applicable to Nursing Home Operators

Grasping the laws around nursing homes will challenge you. They’ve evolved over decades. They’ve gone back and forth. Governments have changed them many times. Crises have spurred action. Mistakes have triggered change. Ciphering where the rules stand now might dupe even the best of lawyers.

Yet, it’s important that you get it right. You must keep your nursing home compliant under every state, federal law. Failure to do so can risk your whole operation. You can be fined, cited, or even shut down. Any worker can jeopardize the whole company. If they abuse, mistreat, or neglect a resident, that victim can sue you. If you don’t follow agencies’ demands, they can prosecute you. Sound difficult? It is. But we’ve laid out information below to help you understand nursing home regulations. To learn more about how these rules apply to your nursing home, contact us today.

• History of Nursing Home Regulations
• Current State of Nursing Home Regulations
• How can I Keep My Nursing Home in Compliance with Regulations?
• What are the Penalties for Violating Nursing Home Regulations?
• Nursing Home Regulation Resources

The government jumped into elder care and nursing homes during the Great Depression. It got authority to do so from the Social Security Act of 1935. That law set up a plan named the Old Age Assistance program. It arose out of concerns over the living conditions of the elderly. To be frank, they weren’t great. At the same time, Congress didn’t want to house the elderly with everyone else. They wanted to erect a system of care for the aging population.

Over time, both state and federal governments played a part in nursing home administration. They each balanced the competing concerns of availability and quality of care. Also, they differentiated between residents needing long, short, or intermediate forms of care. Key laws addressing these topics include the Social Security Act (1935),Hill-Burton Act (1954), Kerr-Mills Act (1960), and Medicare/Medicaid (1965).

In the last decades of the twentieth century, republican and democrat administrations fought over nursing home regulation. State and federal governments sparred too. General issues revolved around lack of funding, overcrowded homes, and complicated medical issues. Regulatory bodies focused on quality concerns. Reformers attempted to fix the issue on patient care and experience. The debate over rules and laws has circled around some important themes like these.

• Enforcement that deters insufficient care without closing facilities and abandoning residents.
• Equipping states and agencies with sufficient tools to combat bad nursing homes.
• Erecting a sound system of nursing home licensure.
• Enabling regulatory bodies to inspect for comprehensive care concerns instead of just quality control.

As mentioned above, states and the federal government jumped into the nursing home fray many years ago. By the 1980s, Congress wanted to take further action on the subject. The country was witnessing a crisis across the industry. Facilities were suffering a number of failures. Patient care was falling. Accidents were rising. Homes were not acting responsibly. In response to this, it passed the Nursing Home Reform Act in 1987. This federal law required a list of things from homes like the following.

• Proper staffing (kind and amount). 42 CFR §483.30.
• Initial and comprehensive patient assessments. 42 CFR §483.20.
• Plan of care for each resident. 42 CFR §483.20.
• Work to maintain a resident’s daily functions. 42 CFR §483.25.
• Ensure residents’ can continue daily functions even if incapable of doing so by themselves. 42 CFR §483.25.
• Develop a proper diet regimen for each resident. 42 CFR §483.15.
• Protect the respect and dignity of every resident. 42 CFR §483.15.
• Prevent or treat bed sores. 42 CFR §483.25.
• Prevent or treat resident bladder/incontinence issues. 42 CFR §483.25.
• Prevent or treat residents for issues related to malnutrition and hydration. 42 CFR §483.25).
• Provide all residents with proper supervision. 42 CFR §483.25.

As you know, states can add on additional burdens to nursing homes. They can’t let homes skirt or fall below federal mandates though. To find out what you must do, consult with experienced counsel.

How can I keep my nursing home compliant? This is an expensive question. Any misstep can cost you tens of thousands of dollars, maybe millions. Expanding regulatory schemes make it harder to figure out what’s going on too. Therefore, it’s crucial to sit down with nursing home professionals. Seek counsel that can answer what agencies you report too. Then, identify what each demands of your nursing home. Both state and federal authorities will have things to say about your nursing home business. You need to listen and follow all of their scriptures. To help your nursing home stay in compliance, follow these directions.

• Draft policies that aim to address every federal, state, and local rule.
• Craft procedures that tie your policies to daily workplace practices.
• Enable a surveillance system that can overview your practices and report any deviations from procedures and policies.

This will be a good start to maintaining a culture of compliance in your nursing home. To ensure your home stays on the right foot, work with experienced professionals to identify your responsibilities and marry those to corporate actions.

Nursing home liability is virtually unlimited. Many facility operators think of lawsuits first. But there are other forms of penalty that homes can run into. We want to review them right now. First, they can be cited by regulatory agencies for bad behavior. This hurts their reputations and marketing appeal. Second, they can be fined for repeated offenses. Clearly, this hurts their bottom line. Third, staff can be stripped of their credentials. This reduces their manpower and possibly threatens their licensing. Fourth, the home could lose its license too. This would put the facility completely out of business. Finally, it could get sued. This might trigger huge financial losses and possibly bankruptcy.

The kind of trouble you run into depends on your mistakes. However, as we outline above, you can take steps to avoid them. With adequate counsel, policies, and procedures, you can minimize your risk. This will ensure your nursing home operates smoothly and productively.

Here are some resources on nursing home regulations.

• Great compilation of the development of nursing home laws.
• Great breakdown of nursing home regulations by state.
• Information from the Centers for Medicare and Medicaid Services on the regulation of nursing homes.
• Information from the Illinois Department of Public Health on the regulation of nursing homes.

Learn more about how to better operate your nursing home! Read these pages.

• Nursing Home Financing Guide
• Nursing Home Employee Safety Guide
• Nursing Home Staffing Guide
• Nursing Home Insurance Guide
• Nursing Home Marketing Guide

Back to the Top

Nursing Home Abuse & Neglect Resources