What You Should Know About The Government’s New Nursing Home Rules

For the first time in 25 years the federal government has completed a comprehensive revision of the way it regulates nursing homes, where 1 million older adults and younger people with disabilities reside.

The new regulations—all 700 pages worth—govern everything from staffing and dispute resolution to enhancing the role of residents and families in designing care. They’ll take effect in stages over the next three years. And not surprisingly, both consumer groups and industry officials have already begun raising objections to some of the new rules.

The regulation getting the most attention concerns the way disputes between residents and facilities are resolved. The new rules limit the ability of nursing homes to keep such disputes out of court.

In recent years, it has become standard for nursing homes to require residents to agree at admission to use private arbitration to settle any disputes over their care. The practice has become widespread in many industries, especially among financial institutions. Yet, it is extremely controversial.

Supporters say it is a faster and less costly way for consumers to resolve disputes, since it is an alternative to expensive and drawn-out litigation. But consumer advocates claim industry arbitrators are biased and say the process is a way for facilities to keep major violations of health and safety rules private—since arbitration is confidential while litigation often is public.

The rules, which were issued by the Centers for Medicare and Medicaid Services, prohibit nursing homes from requiring residents to agree to arbitration at admission. However, once a dispute arises, the facility and the resident can still agree to use the process.

The arbitration regulation is just one of hundreds of new rules. Lawyers are pouring over them now, but here are few key changes:

Other disputes: Facilities are now required to set up a formal grievance policy that includes a written response to complaints by residents or their families.

Person-centered care. The new rules require facilities to give residents and their families more control over how they are treated. They must support patient preferences when it comes to, for instance, meals or hygiene. Residents and families must be involved in the process of writing a plan of care, which must be completed with 48 hours of admission.

Staffing: The new rules do not require specific staffing levels for either aides or nurses—a decision that has disappointed some consumer groups. However, the regs do require more training for staff, contract workers, and volunteers. Training must include topics such as patient’s rights and better communication skills.

Visiting hours:  Family members still have the right to visit residents at any time. However, facilities may limit visits by non-family members based on “clinical and safety” requirements.

Discharge for non-payment: Facilities are barred from discharging residents if they have submitted paperwork to Medicaid and other payers but payments have not yet been made. In the past, some facilities would discharge residents if Medicaid was slow to pay. In addition, every notice of discharge must be sent to state ombudsmen, who can help residents and their families work through the issues before they are transferred.

Hospital dumping: The rules bar an especially egregious practice by some facilities. If a facility wants to discharge, say, a low-income patient whose care is not being reimbursed by Medicaid (perhaps because of those paperwork slowdowns), it will sometimes send the patient to the hospital, and then refuse to readmit her. This will no longer be allowed.

More than ever, nursing homes regulations are a balancing act, especially for long-stay residents. On one hand, rules must be in place to protect the health, safety, and well-being of residents. On the other, it is important to acknowledge that many nursing homes already are shifting their long-term care beds to post-acute care, which is far more lucrative. Too much regulation will only accelerate that trend, leaving those who need nursing home care (and some older adults always will) with fewer choices.

The new rules try to find that balance. We’ll see over time how they do.

 

 

 

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