Florida Elder Law & Estate Planning Blog

Nursing Home Regulations updated

The Centers for Medicare and Medicaid Services have issued new and far-reaching federal regulations for long-term care facilities that receive federal Medicare or Medicaid funds (which is almost all of them). The new rules will be phased in, with the final phase completed in 2019. These changes are intended to provide residents and families with more “person-centered” care, and also introduce other improvements. Here is a brief outline of some of the highlights:

Residents will have the right to:


  • Receive visitors of their choosing at any time of their choosing, provided such visits do not impose on other residents’ rights.


  • Have alternative meals and snacks outside of “official” meal times


  • Select their own roommates. This will allow same-sex partners, friends and siblings to share a room if both parties agree.


Rules protecting residents from being discharged and grievance procedures have been made more robust:


  • Residents may not be discharged while awaiting a decision on Medicaid or other insurance, or while an appeal is pending.


  • Residents who enter a hospital and are denied re-entry into the facility may appeal.


  • Residents who are accepted back into the facility after a hospital stay must be allowed to return the same bed occupied previously, if it is available.


  • Facilities must have a “grievance officer” on staff to handle complaints, and all decisions must be in writing.


  • Involuntary discharges must be reported, in writing, to the long-term care ombudsman.


Other changes include:


  • The definition of “abuse” has been expanded to include financial abuse.


  • Staffing must be provided commensurate with the needs of the residents. Staff members dealing with residents with dementia must have certain training for this. Staff must also be trained in identifying elder abuse. (Some advocates contend that this ruling does not go far enough since it does not set specific staff-to-resident ratios.)


  • To better control infections, an infection control office will be assigned to monitor antibiotic use and other factors related to the prevention and spread of infection.


  • When discharged to home or another facility, the nursing home’s interdisciplinary staff must provide more support and services.


  • Nursing homes are required to do a better job of safeguarding residents’ personal possessions. Some homes have required residents to sign waivers holding the home harmless for loss.


Note: One hotly contested component of the new rules is a ban on binding arbitration agreements. That policy is not yet in effect. It is in litigation and the courts are reviewing.

You can read the new rules here . (Warning:it’s 713 pages)