Government Regulation of Nursing Homes
Nursing homes are regulated by the federal government under the Omnibus Reconciliation Act of 1987 (OBRA), 42 U.S.C. § 1395 – 1396 (1999). The primary goal of OBRA is to establish uniform standards for nursing homes and ensure the protection and safety of patients. OBRA does not allow nursing home residents to file a lawsuit in order to enforce OBRA regulations, that power is given to state and federal agencies. Under OBRA, state governments are responsible for licensing and certifying nursing homes in their states. Because states are responsible for licensing and certification of nursing homes, most states have adopted similar provisions found in OBRA.
In California, the state has adopted a “Patients Bill of Rights” that requires a nursing home to provide residents the right to a dignified existence, self-determination, and access to other persons and services inside and outside the facility. Residents also have a right to be free from coercion, discrimination, interference, and reprisal from the facility. If a nursing home fails to meet these rights, it may be penalized, or have their license revoked. A patient may also bring a civil action against the facility for up to five hundred dollars ($500), and for costs and attorney fees. Cal Health & Saf Code § 1430
It is important to note that most nursing home facilities receive the majority of their fees from Medicare and/or Medicaid. In order for nursing homes to receive Medicare or Medicaid, facilities must comply with OBRA provisions. The Center for Medicare & Medicaid Services (CMS) is part of the Department of Health and Human Services, and is the federal department in charge of overseeing the Medicare and Medicaid programs. CMS is also charged with the responsibility of working out the details of the law and how it will be implemented, which it does by writing regulations and manuals.
States have a contract with CMS to monitor and inspect nursing homes that want to be eligible to provide care to Medicare and Medicaid beneficiaries and make sure they meet the quality standard requirements established by Congress in the Social Security Act. Nursing homes are required to cooperate with the state departments in mandatory annual inspections under OBRA. In California, the Department of Health Services is responsible for protecting the health and safety of nursing care institutions. The department conducts inspections of each nursing home that participates in Medicare and/or Medicaid on average about once a year. There are over 150 regulatory standards that nursing homes must meet at all times. If the nursing home is performing poorly, the state inspectors may review the home more frequently, and when an inspection team finds that a home does not meet a specific regulation, it issues a deficiency citation. The regulations cover a wide range of aspects of resident life, from specifying standards for the safe storage and preparation of food to protecting residents from physical or mental abuse or inadequate care practices. After each inspection the Department of Health Services issues a quality rating based on the quality of service provided by the facility. The state also investigates complaints about nursing home care. Cal Health & Saf Code § 1421.
Depending on the nature of the problem, the law permits CMS to take a variety of actions; for example, CMS may fine the nursing home, deny payment to the nursing home, assign a temporary manager, or install a State monitor. CMS considers the extent of harm caused by the failure to meet requirements when it takes an enforcement action. If the nursing home does not correct its problems, CMS terminates its agreement with the nursing home. As a result, the nursing home is no longer certified to provide care to Medicare and Medicaid beneficiaries. Any beneficiaries residing in the home at the time of the termination are transferred to certified facilities.
Blackman Legal Group is committed to upholding the quality of care in our long-term care institutions by taking swift legal action to compensate nursing home residents and their families for injuries resulting from neglect or inadequate care. Only this way will the quality of care for all residents be assured. If you feel that you or a loved one has been victimized by medical malpractice while in the care of a senior citizen facility, call Blackman Legal Group now at 1-800-444-5602 or CLICK HERE TO SUBMIT YOUR QUESTIONNAIRE FOR A FREE CASE EVALUATION. The initial consultation is free of charge, and if we agree to accept your case, we will work on a contingent fee basis, which means we get paid for our services only if there is a monetary award or recovery of funds. Don’t delay! You may have a valid claim and be entitled to compensation for your injuries, but a lawsuit must be filed before the statute of limitations expires.