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In 1965, Medicare
and Medicaid came into existence and
along with it came federal nursing
home regulations. Nursing homes that
qualify and voluntarily elect Medicare
and Medicaid to their facility must
follow a set of nursing home regulations
put forth by federal standards. The
Health Care Finance Administration
that is part of the United States
Department of Health and Human Services
enforces these nursing home regulations.
Congress authorized the first set
of standards that were to be met by
nursing facilities in 1967 and created
classifications for the Skilled Nursing
Facilities and Intermediate Care Facilities.
In 1980 and again in 1987 these standards
were updated with the most current
nursing home regulations imposed under
the Omnibus Budget Reconciliation
Act of 1987.
So what changes
can be made at the Federal level to
continue positive change in nursing
home care and to eliminate nursing
home abuse? According to Susan Eaton,
an assistant professor of public policy
and who has studied the link between
human resource personnel management
and the quality of patient care in
nursing homes, “The federal government,
through the Health Care Financing
Administration (HCFA), which is part
of the US Department of Health and
Human Services, has commissioned several
studies to examine mandating minimum
staff ratios. Many quality problems,
including safety, arise from under-staffing,
either because of too few trained
staff or because of poor management
practices. If such ratios are mandated,
nursing home managers will have to
rethink their human resource policies
and allocate more money to recruiting,
attracting, and retaining nursing
staffs. In addition, federal funds
are needed to study best practices
and to increase enforcement to punish
egregious repeat offenders as well
as to encourage states to experiment
with solutions.”
OBRA 87 requires that the facility
provide each patient with care that
will enable the patient "to attain
or maintain the highest practicable
physical, mental and psychosocial
well-being."
- Quality of life
for patients is the goal. The facility
must allow patient choice in activities,
schedules and health care decisions.
- OBRA 87 requires
that SNFs and ICFs provide 24-hour
licensed practical nurse care seven
days a week, and have at least one
RN on duty at least 8 hours per
day, seven days a week. Nurse’s
aides are required to undergo special
training.
- OBRA 87
makes it the State's responsibility
to establish, monitor and enforce
state licensing and federal standards.
States are required to maintain
investigatory units and Ombudsman
units, and to fund and staff them
adequately.
The Patient Self Determination Act
covers all long-term care facilities
that participate in Medicare or Medicaid.
At the time of admission to a hospital
or nursing home, at the time of enrollment
with an HMO, Hospice, or Home Health
Care Agency, the following must happen:
- The facility
must provide the patient written
information concerning the patient's
rights under state law to participate
in decisions concerning medical
care, including the right to accept
or refuse medical or surgical treatment,
the right to formulate advance directives.
- The facility
must provide a written statement
of its policy regarding implementation
of these rights.
- The facility
must document in its records whether
the patient has executed an advance
directive. Note: the facility is
not required to provide advance
directives to patients.
- The facility
is forbidden to discriminate in
the provision of medical care on
the basis of whether a patient has
or has not executed an advance directive.
- The facility
is required to comply with all state
laws regarding advance directives.
- The facility
must provide for staff and community
education on issues related to advance
directives.
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