Highlights of the Nursing Home Reform Act
August 15th, 2016 by Attorney John Colvin
In 1986, at the request of the U.S. Congress, the Institute of Medicine conducted a study about the health and safety of nursing homes. After researchers found that abuse, neglect, and a low standard of care were common in nursing homes, they suggested to Congress that new laws be enacted to help protect nursing home residents. Lawmakers acted on those recommendations by including in the Omnibus Budget Reconciliation Act of 1987 a Nursing Home Reform Act, which mandated several new rights and responsibilities.
The new laws did make nursing homes safer, although some officials say that more needs to be done.
The Nursing Home Reform Act defined a comprehensive list of rights for all nursing home residents, which include:
- The right to information, such as the availability of services and their rates, advance notice of rooming or roommate changes, facility rules and policies, and contact information for the state ombudsman
- The right to complain without fear of retaliation to or about internal staff; to file a complaint with the state ombudsman; to file a complaint with a state or certifying agency
- The right to allow or disallow personal visitors, including doctors, family, friends, and social services workers
- The right to privacy in personal communication and health-related matters
- The right to be treated with dignity and respect
- The right to be free from abuse, involuntary isolation, physical punishment, restraint, and from the administration of drugs as a form of restraint
- The right to make one’s own choices, including the ability to refuse medical procedures and medication; to participate in community activities; to review one’s own medical records and to be involved in planning one’s own medical treatment.
The provisions of the Nursing Home Reform Act went into effect on Oct. 1, 1990, with enforcement of those regulations beginning in the spring of the following year. In 1997, a team at the Research Triangle Institute conducted a study, comparing nursing home conditions before 1990 to nursing home records from 1993, to determine the impact of the Nursing Home Reform Act. Researchers found that some particularly worrisome behaviors – like physically restraining residents – decreased by 1993. Records also showed an increase in quality care initiatives, such as end-of-life planning and providing residents with community activities. Some aspects of care had neither worsened nor improved in the timeframe studied.
A Call for Further Action
The U.S. Government Accountability Office reviewed nursing home records from 2005 through 2014 and found that, in that time, the average number of serious deficiencies – those that pose an immediate risk to the health and safety of residents – declined by 41 percent. But at the same time, resident complaints about quality increased by 21 percent.
The Centers for Medicaid & Medicare Services has oversight of nursing homes, and in recent years, it has modified and/or reduced some of its oversight activities. The GAO says the CMS has not measured how those changes may impact its ability to accurately assess quality in nursing homes. So while inspection reports show a decrease in serious deficiencies, that could be because fewer homes are undergoing rigorous inspection. The GAO recommended that the CMS develop a plan for auditing self-reported data and monitoring the effects of changes in nursing home oversight.