In the second part of our look back at the transformative and impactful 1987 Nursing Home Reform Act, we explore some other major aspects of the legislation in addition to the core rights of residents and responsibilities of facilities to ensure those rights are respected. The 1987 Nursing Home Reform Act was a part of the broader Omnibus Budget Reconciliation Act of that year. In going beyond the initial 1965 legislation that created Medicare and Medicaid, the 1987 Act laid out a series of principles that re-defined what it meant to provide care to the elderly and infirmed at nursing homes and long-term care facilities. In addition to the minimum standards of care that would give rise to later legislation at the federal and state levels, and the modern notions of a residents’ bill of rights, the Act also laid out the foundation of an enforcement network that, while still improving today, has evolved and become more robust over time relative to its nascent stages two decades ago.
As we now know, the involvement of the Centers for Medicare and Medicaid Services (CMS) (under the umbrella of the U.S. Department of Health and Human Services), and relevant state health, aging and disability agencies together play a vital role in creating regulations under law and enforcing those regulations. The 1987 Act started this by requiring the surveying of nursing homes as well as the formal certification of those facilities to operate. A law is nothing without an enforcement mechanism, so the government began a process that would include multiple visits to nursing homes for surveys and inspections. These visits would occur at irregular times, and would also include unannounced visits, so inspectors would have a chance to see facilities in action on normal days, rather than having advanced notice to prepare and possibly portray a disingenuous image. As part of these visits, inspectors would not only observe the facilities in terms of cleanliness and staff levels, but would observe staff interactions with patients, and would even interview patients themselves. This process of course did not happen right away, as it took some years to create regulations governing this process – up until 1995 to be precise.
Understanding the Problem
Surveys also did not just occur as a matter of course, but would also occur in reaction to specific complaints at facilities. Surveyors would look into the matter and also make a general inspection to ensure other residents were safe. If a violation is found, the government would sanction the facility, which could include penalties, escalated monitoring, a mandatory plan of correction, training for staff, and withholding of Medicare or Medicaid reimbursements, which would hurt the bottom line for a nursing home that relied heavily on that funding. If homes followed plans of correction or did whatever they had to in order to correct a deficiency, the citation and any restrictions would likely be lifted.
None of this is new to those familiar with the nursing home industry and the regulation and enforcement of the law and regulations. The above measures still occur to this day, but have evolved as challenges in the industry have grown as well. It is important, though, to realize that the genesis of the modern regulatory and enforcement structure started with the vital passage of the Nursing Home Reform Act nearly thirty years ago.
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