CHICAGO, IL – If a nursing home is found noncompliant with federal requirements, the infraction depends on the nursing home’s general history and the infraction itself. Every nursing home that accepts Medicare and Medicaid payments are subject to federal regulations under the Nursing Home Reform Act of 1987. The reform law was adopted to ensure each resident receives quality care free of all neglect, abuse, and mistreatment.
The law requires federal oversight of nursing homes and for states to also inspect nursing homes regularly for violations. The state uses specific criteria when inspecting facilities that includes whether a deficiency is an isolated incident or whether the deficiency causes immediate harm to a resident.
Understanding Federal Nursing Home Regulations
According to federal nursing home regulations, nursing homes must:
- Conduct comprehensive, accurate assessments of each individual’s functional capacity
- Provide necessary assistance needed for a resident to carry out regular daily activities, such as good hygiene, grooming, and healthy nutrition
- Prevent a resident’s ability to bathe, groom, dress, move around, use the bathroom, eat, and communicate from deteriorating
- Ensure residents receive proper treatment and supportive devices to maintain their vision and hearing
- Work to prevent residents from developing bed sores and pressure sores by prevention infection and encouraging mobility
- Have an adequate amount of trained nursing staff
- Develop a comprehensive care plan for each resident, which must involve the resident
- Ensure residents receive adequate supervision to prevent slips and falls in nursing homes
- Help residents avoid dehydration and malnutrition
- Ensure that residents receive adequate medical attention and medication, limiting medical mistakes
Nursing homes are required to treat each resident with respect, dignity, and courtesy to keep records about their progress and any regressions.
Factors That Determine the Severity of a Deficiency
There are four factors that determine the severity of a deficiency:
- Level 1 – No actual harm with potential for minimal harm: A deficiency that has the potential for causing no more than a minor negative impact on the residents or employees;
- Level 2 – No actual harm with a potential for more than minimal harm that is not immediate jeopardy: Noncompliance with the requirements that results in the potential for no more than minimal physical, mental, and/or psychosocial harm to the residents or employees and/or that result in minimal discomfort to the residents or employees of the facility, but has the potential to result in more than minimal harm that is not immediate jeopardy;
- Level 3 – Actual harm that is not immediate jeopardy: Noncompliance with the requirements that results in actual harm to residents or employees that is not immediate jeopardy;
- Level 4 – Immediate jeopardy to resident health or safety: Noncompliance with the requirements that results in immediate jeopardy to resident or employee health or safety in which immediate corrective action is necessary because the provider’s noncompliance with one or more of those requirements has caused, or is likely to cause, serious injury, harm, impairment or death to a resident receiving care in a facility or an employee of the facility.
Factors that Determine the Scope of a Deficiency
There are three levels that are used to determine the scope of a deficiency: isolated, pattern, or widespread. The scope levels reflect how residents were affected by the deficiencies cited:
- Isolated: When one or a very limited number of residents or employees is/are affected and/or a very limited area or number of locations within the facility are affected;
- Pattern: When more than a very limited number of residents or employees are affected, and/or the situation has occurred in more than a limited number of locations by the locations are not dispersed throughout the facility;
- Widespread: When the problems causing the deficiency are pervasive (affect many locations) throughout the facility and/or represent a systemic failure that affected, or has the potential to affect, a large portion or all of the residents or employees.
Punishment for Noncompliance
Any nursing home who fails to comply with federal regulations set forth by the Centers for Medicare and Medicaid (CMS) are subject to sanctions.
CMS and state agencies can punish nursing homes that fail to meet compliance, as well as those that regularly perform poor during inspections. Sanctions are based on the seriousness of offenses and may include:
- Appointing temporary managers for facilities
- Hosting training and other workshops for staff members
- Creating directed plans of correction
- Imposing a sliding scale of fines
- Removing homes from Medicare and Medicaid
Under federal guidelines, nursing facilities in violation can be terminated from Medicare and Medicaid if they fail to remedy issues within six months. Being removed from the program means the nursing home can no longer accept patients who pay with Medicare and Medicaid.
Notifications Nursing Homes Receive When They Are Noncompliant
When nursing homes are not in compliance with federal regulations, CMS or the state must give the facility notice of the remedy, including:
- The type of remedy being imposed
- The nature of the noncompliance
- The effective date of the remedy
- The home’s right to appeal the determination that led to the remedy
How to Find Information about Specific Nursing Homes
The Nursing Home Compare tool contains information on every Medicare and Medicaid certified nursing home in the country. For nursing homes not certified under Medicare or Medicaid, check specific State website if available.
Contact a Nursing Home Abuse Attorney in Chicago, Illinois
If you suspect your loved one is being abused or neglected by their nursing home facility that is noncompliant with federal regulations, please contact one of our experienced nursing home abuse attorneys today. Our attorneys are well-seasoned and know when our clients are being mistreated. Contact the Dinizulu Law Group located in Chicago, Illinois today at (312) 384-1920 for a free consultation or visit our website for more information.