Current nursing homes laws and regulations on the federal level as well as the state level owe their genesis to the immensely important foundational laws that preceded them. The current laws and regulations continue to evolve and improve over time thanks to advocacy by watchdog and public interest groups, as well as other interested parties that fight for nursing home residents every day in legislatures, court rooms, and media. One tremendous law at the root of decades of efforts was passed by the United States Congress and signed into law by President Ronald Reagan in 1987.
It was called the federal Nursing Home Reform Act, which was part of the broader Omnibus Budget Reconciliation Act of 1987. The 1987 Act brought with it many vital reforms steeped in the overall principle that nursing home residents are entitled to their own bill of rights that requires them to receive a certain level of dignified and quality care such that they can enjoy a quality of life at the home. This also marked a significant moment in that the federal government took on a substantially greater role in governing nursing home care for the first time since Medicare and Medicaid were created by federal law in 1965, more than twenty years earlier.
A Comprehensive Bill of Residents’ Rights
The Nursing Home Reform Act contemplated a set of principles rights for nursing home residents across the country. This includes a fundamental right to be free of abuse and maltreatment, as well as neglect, and an entitlement to treatment with respect and dignity. Under the broader abuse and neglect umbrella, residents have a right to be free from unnecessary physical restraints. As to a general level of care, the act recognized residents’ rights to be properly cared for based on their physical and psychological needs, and their medical needs.
This also includes the right to have input into their care plan (or for their family to have input), and to be notified when things such as medication or rehabilitation regiments change. And while residents live in a facility with many other patients in need and a staff that is supposed to be dedicated to serving all of them, this does not mean they must live in a prison. Rather, the ’87 law contemplated that residents should be able to enjoy their own privacy within their rooms, to be free to move about, make choices and decide for themselves what they wish to do with their time outside of treatments, and to be able to communicate openly. Consonant with that freedom to communicate was also a right to be able to raise concerns or complaints over poor treatment without a fear of retaliation from nursing home staff. All facilities were required under this law to provide the proper nutritional services, proper medications, proper rehabilitation programs, as well as social services in certain circumstances.
While not all nursing homes or nursing home staffers follow the law to the letter, the evolution of the law and nursing home regulations on the federal and state levels can be traced back to this 1987 landmark legislation. Its vision has served as a template for improvements today, such as more robust inspections and surveys, and recent developments such as a more stringent federal rating system for facilities, and in Illinois the possibility of permitting cameras in rooms to document abuse or more preferably deter it.
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