While some nursing home workers may bemoan the looming periodic visits by state surveyors to their facilities, in the defense of state health departments, the need to uphold nursing home regulations in the interest of the safety and security of residents across the United States is of paramount importance. To date, standards are fairly strict when it comes to long-term, out-of-home care.
As it may be expected, though, this was not always the case. Much in the way Dorothea Dix and other activists were forced to advocate for the rights of patients in “mental asylums”, medical organizations and concerned community members also had to put in their hard work to effect nursing home reform. Thankfully, the resonance of their achievements is still felt today. The Nursing Home Reform Act of 1987 is a landmark piece of legislation as far as the quality of care in nursing facilities goes. The following are considerations of what the Act did for nursing home regulations:
In terms of the origins of the Nursing Home Reform Act, its biggest precursor lay in a report filed and published by the Institute of Medicine (IOM), a non-partisan, non-governmental agency affiliated with the National Academy of Sciences that advises policymakers on recommended courses of action based on its research.
In 1986, the IOM found that nursing home regulations nationwide were either not enforced or severely lacking, with rates of abuse and neglect rampant, and proposed major changes to standards of institutionalized care. The Nursing Home Reform Act, consequently, was Congress’ assimilation of these suggestions, and went into effect in 1987 with the passage of the Omnibus Budget Reconciliation Act of the same year.
As for the main mission of the Act, its broad goal is to ensure the welfare of nursing home residents in the “highest practicable” way possible, covering all elements of their health. This applies not only to their physical well-being and their feelings of being protected without being restricted, but also their being of sound mind, psychological well-adjustment and their emotional stability.
As part of this outlook, the Nursing Home Reform Act was instrumental in getting nursing home directors and administrators to include and uphold a Patient Bill of Rights in their facility. True, in effect these standards have a moral tint to them and are oriented more towards the individual than legally binding nursing home regulations, but just the same, these are an actionable set of guidelines.
In addition, the Nursing Home Reform Act is responsible for the greater insistence on the visits by state and federal surveyors alluded to above. It would be some time after the initial enactment of the Act before an overhaul of the survey process was realized, but in due time, the level of accountability for both surveyors and the surveyed grew to approximate the accountability of the modern day.
As for today’s standards of review, unannounced visits are to be conducted at least once every 15 months, and scrutinize the enforcement of nursing home regulations in the areas of adherence to the Bill of Rights, attention to the livelihood and proper treatment of residents, and the quality of services provided. To boot, the Nursing Home Reform Act outlines how remedies for failure to meet coded standards may be assessed.