Basic Provisions for Minimum Standards of Care Under the NHRA

Hands protecting seniors at nursing home

The Nursing Home Reform Act (NHRA) helps ensure that residents receive the proper mental and physical care. It establishes guidelines that any nursing home receiving state funding for Medicare and Medicaid services must follow. It also establishes a Bill of Rights for nursing home residents that outlines the basic rights they are entitled to which, in addition to proper medical care includes privacy, individuality, dignity. It is important for residents and their loved ones to familiarize themselves with the NHRA and the rights and privileges they are entitled to under the law.

Required Care and Services

The NHRA requires nursing home facilities to provide essential services to their residents. These include providing access to medical, nursing, and rehabilitation services. It includes providing access to pharmaceutical services, dietary services, and social activities scheduled for nursing home residents.

Nursing homes are required to develop and implement a comprehensive care and treatment plan that is tailored specifically to the resident’s needs. In instances where the nursing home facility has more than 120 beds, they must also provide access to a full-time social worker.

In all, there are eight specific areas that nursing home facilities are required to adhere to in order to remain eligible for Medicare and Medicaid payments. First, they must provide for the quality of life of each resident. As part of this, they must provide a plan of care for each resident that will protect them from nursing home neglect and give the resident the best possible outcome.

Nursing homes must maintain a team of licensed professionals that includes nurses and other care providers who regularly assess the health and functional capacity of each resident. Similarly, nursing homes must provide standard services that include 24-hour nursing, access to dental care, pharmaceutical care, rehabilitation services, social services, and nutritional needs.

The NHRA requires that all medical care be supervised by a trained and licensed physician. This care must be provided in accordance with established standards of care and all records are to be maintained in a manner that protects patient safety and privacy. Finally, the NHRA requires that nursing staffing schedules, for both licensed and unlicensed staff, be posted daily.

The Bill of Rights for Nursing Home Residents

Nursing home residents are entitled to a wide range of rights while living within a nursing home or assisted living facility. These include the right to privacy and the ability to communicate freely with their caregivers, family, and legal counsel. It includes the right to be treated with dignity and to exercise self-determination in regard to medical care, financial matters, treatment plans, continued residency, etc. Individuals have the right to be free from all forms of mistreatment, abuse, and neglect at the hands of caregivers or other nursing home personnel. Other rights granted to residents under the NHRA include the right to file complaints and voice grievances without fear of reprisal or discrimination. Residents also have the right to participate in family and resident activities.

In the era of COVID-19, the NHRA has taken on a new importance. That’s because the NHRA also requires nursing facilities to implement effective infection and disease control measures. Nursing home facilities that fail to prevent outbreaks of COVID-19 are negligent in their responsibility to patients. The failure to isolate patients and protect them from acquiring the virus is negligent and has caused significant suffering and numerous deaths in nursing home facilities across the country.

Guidelines for Certification and Regulation

The NHRA requires states to conduct unannounced surveys of nursing home facilities. This includes direct interviews with residents within these facilities. The NHRA requires that these occur at irregular intervals that are no further than 15 months apart from one another. The purpose of these surveys is to ensure that resident’s rights are preserved, and that facilities are delivering quality care and maintaining the quality of life of each resident. in instances where specific complaints have been filed against the facility, the NHRA requires surveyors to review these complaints via targeted surveys and investigations.

It is not uncommon for these surveys to determine that a nursing home facility is non-compliant. Often, surveyors will determine that corrective action is required. Many times, nursing home facilities are provided opportunities to correct the deficiency. This depends on whether the deficiency presents an immediate threat to residents, or whether the deficiency is an isolated event or part of a much larger pattern of problems within the facility. In instance where a nursing home fails to correct the deficiency, or in instances where there are egregious violations, the state can impose a series of corrective remedies. These can include formal monitoring of the facility or placing the facility under temporary management. The state may also withhold Medicare and Medicaid payments or issue fines. Finally, the state also has the authority to terminate the agreement with the nursing home facility.


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