If you or a loved one faces the need for nursing home care, there are many factors to consider. There’s an emotional adjustment that may come with less independence. There are financial considerations, depending on what your health plan will cover. And then there’s quality of care – not just the quality of the medical support you receive, but the quality of life that supports your mental wellbeing.
The country’s 15,600 facilities are vastly different in how they operate and the populations they serve. Yet, when asked to rate the overall quality of these nursing homes, experts agree that it is mediocre at best.
The Centers for Medicare and Medicaid Services (CMS) aims to change that with broad revisions to nursing home regulations issued last fall, which were highlighted in a recent article in the New York Times. The first changes took effect in November, and the rest will roll out this year and in 2019.
Some of the new regulations are designed to give residents more control over their environment:
- Enabling residents to see any type of visitor (beyond relatives) and decide the length of visits, as long as it doesn’t disturb other residents
- Allowing residents to choose their roommates (if both parties agree) so that friends, siblings, or same-sex couples may live together
- Meal time flexibility based on when residents want to eat
For residents who are struggling with a loss of independence, regaining these freedoms may allow them to feel that their desires are valued. It may help restore confidence in their abilities, which could motivate them to set goals and be more invested in their own care.
Other regulations focus on nursing home accountability:
- Taking “reasonable care” of residents’ personal belongings, instead of requiring them to sign waivers removing facilities’ responsibility for theft and loss
- Expanded staff training to prevent elder abuse and provide better care for patients with dementia
- A designated infection-control officer
- A system to monitor antibiotic use
Greater accountability for theft and loss will no doubt make a big difference to residents who went through the devastation of giving up many of their belongings when they moved into a facility.
Experts believe expanded staff training is of critical importance, particularly because most residents have a moderate to severe form of dementia, according to Medicare’s statistics. Better staffing is also tied to a higher quality of care. However, the regulations do not include specific staff ratios or minimum hours of care. They also don’t require registered nurses to be on site around the clock. Many advocates and nursing associations are disappointed and skeptical due to the lack of detail about how expanded staffing will be enforced.
Better protection, with some roadblocks
While current rules prevent nursing homes from evicting residents, they sometimes send residents with disruptive behaviors to hospitals, and then refuse to readmit them. New regulations offer protection against this and offer patients additional avenues to address grievances. However, one major change – giving residents and families the right to take nursing homes to court – has stalled. (Currently, many nursing homes require residents to sign agreements that any disputes be settled behind closed doors.) First, the American Health Care Association, which represents most for-profit nursing homes in the United States, filed a lawsuit aimed at stopping the provision that would allow patients to sue from taking effect. Then the Trump Administration proposed a federal rule change to allow nursing homes to bar residents and their families from filing lawsuits against them. In this interview an attorney for Public Citizen, a nonprofit consumer advocacy organization, explains what’s next for the rule.
Reason for hope?
This summer, Medicare anticipates providing more specific details on how nursing homes must comply with the new regulations. Resources are limited by shortfalls in funding, most of which depends on state and local government support. Yet the new regulations should offer some victories, encouraging residents to feel more empowered in their decisions and comforted by the increased presence of those they hold dear.
Families and residents who want to learn more can see this summary compiled by a consumer group. You can also contact your local “ombudsman” (a public advocate) to learn how the changes apply to you. Visit Consumer Voice.
ICS carefully and regularly evaluates all providers we work with to ensure that they meet the needs of our members. We conduct onsite assessments, provide education on cultural competency, and monitor performance through member feedback. Member feedback (both positive and negative) is very important to us and always encouraged.