Who Regulates Nursing Homes?

Many nursing home residents are vulnerable to neglect, abuse, and poor care due to their age and disability. This is why federal and state governments developed laws and regulations to ensure nursing home residents’ health, safety, and quality of care.

The Centers for Medicare and Medicaid Services (CMS) enforces regulations at the federal level, while state-level regulations vary and are usually enforced by departments of health and aging.

In this article, we will go through essential state and federal regulations, ways to report violations, and legal actions you can take to protect nursing home residents. 

Federal Regulations

The CMS is a federal government agency that operates under the US Department of Health and Human Services and ensures nursing homes comply with critical laws such as the Nursing Home Reform Act. All nursing homes that participate in Medicare and Medicaid programs must comply with federal requirements that oversee factors like:

• Resident rights
• Quality of care
• Assessment and care plans
• Health care and dietary services
• Staffing
• Infection control 
• Nursing home area safety

The CMS performs regular inspections to prevent elder abuse and neglect in skilled nursing facilities. If the agency notices any deficiencies in resident care, it develops plans to solve the issue and may punish the facility for lack of compliance.

It also runs Nursing Home Compare, which rates nursing facilities based on health inspections, staffing levels, and quality measures and helps family members make an informed choice.

State Regulations of Nursing Homes

Each state has agencies that oversee nursing homes and assisted living facilities, run mainly by the state’s Department of Health or Aging. While state agencies work alongside federal agencies, they may also have additional rules or more frequent inspections. 

State regulatory bodies also enforce regulations and may revoke a nursing home’s license. 

Reporting and Investigating Violations in Nursing Homes

Families, residents, or employees can report nursing home violations by doing one of the following:

• Contacting the state’s long-term care ombudsman
• Submitting a complaint to the State Department of Health
• Reporting directly to the CMS

State regulatory bodies must investigate allegations of abuse, neglect, or poor care. After regular inspections or complaint investigations, they issue an inspection report outlining deficiencies and the expected course of action. 

What Happens When Nursing Homes Fail to Meet Federal and State Standards?

Regulatory bodies can take enforcement actions such as:

• Payment denials – After a payment denial, the facility cannot receive reimbursement from the federal government for new residents. 
• Fines – Monetary penalties proportionate to the severity of the violation and the facility’s response. 
• Corrective actions –The nursing home may be forced to hire or train more staff or improve sanitation or health care.
• Loss of certification – Loss of federal funding.
• Closure – In severe cases, the skilled nursing care facility may close.

Failure to comply with regulations can also lead to cases of neglect or abuse, which could result in lawsuits and the loss of reputation.

The Role of a Nursing Home Abuse Lawyer in Regulatory Violations

A nursing home abuse lawyer can help family members hold the facility accountable when its lack of compliance results in resident harm. They can help by:

• Investigating regulatory failures
• Gathering evidence
• Consulting experts
• Representing families
• Filing claims to pursue compensation

Specialized nursing home abuse lawyers can protect residents and help families seek justice when nursing home negligence leads to injury.

Secure Expert Legal Representation

Nursing Home Law Center is a network of experienced lawyers dedicated to nursing home abuse and neglect cases. Our clients have recovered millions. We are deeply familiar with federal and state regulations and insurance company tactics, and we can help you pursue justice and financial compensation for medical, emotional, and financial damages. 

Contact us online or call (800) 926-7565 for a free consultation.