With an increasingly aging population, the U.S. has seen a consistent rise in the number of Americans living in senior living residences, including nursing homes. Approximately half of Americans who reach the age of 65 will need long-term living services. With an increase in seniors living in nursing homes comes an increased awareness of the issues that face those who live there.
Elder abuse is an issue facing nearly 1 in 10 American seniors. As more Americans report experiencing abuse in nursing home care, the legal system must respond with laws and regulations that help protect the rights of elder citizens.
Since the Older Americans Act was put in place in 1965 in order to increase the standard of living for Americans over the age of 65, the legal system has responded with laws related to the abuse, neglect, and financial exploitation of the country’s elderly residents.
For the most part, elder abuse laws are handled at the state level. Most of these laws were developed in the 1980s, and are found in a variety of state legal codes.
State Regulations on Nursing Homes
Residential care facilities are typically licensed and regulated at the state level, with every state having at least one legal category for residential care. While many states have laws and regulations that cover the same general areas, the contents of these regulations tend to vary considerably from state to state.
For example, training and staffing requirements are handled different from one state to the next. Ten out of 50 states have no direct care worker training requirements. Out of the states that do, the number of training hours ranges from one hour to up to 80 hours of staff training.
As recently as 2014, the Centers for Medicare and Medicaid Services introduced requirements for service providers, including all long-term care residences that are paid through Medicare. As a result, many states will be required to amend their laws in order to satisfy the minimum requirements of Medicare and Medicaid services. This includes regulations on choice of roommates, access to food, personal privacy, planning requirements, and more issues regarding personal autonomy.
State regulatory provisions cover a wide range of nursing home topics, including:
- Residency agreements, including policies on admission and retention
- Disclosure requirements
- Service planning
- Requirements of third-party providers
- Medication delivery provisions
- Food and dietary regulations
- Requirements of staffing and staff training, including background checks
- Provisions for dementia care
- Inspection requirements
Some elements of nursing home laws are more consistent from state to state. Nearly all states have regulations on residency agreements and have specific requirements for what must be contained in these agreements. Thirty-nine states also require Disclosure Statements, where a residence must provide detailed and complete information to prospective residents about their potential place of living, but only 16 out of the 39 states provide a template that the care facilities must follow.
Only 10 states require residency agreements to include provisions about how medication services are delivered. For example, Oregon state law requires facilities to detail how medications will be packaged, and requires that patients are allowed to select their pharmacy.
States also differ widely on admission requirements, or what qualifies a potential resident for a long-term care facility. These normally depend on physical and mental factors, and the type of medical procedures that are required. It’s important to know your state’s laws for what qualifies you for residence in a particular living facility, and what conditions must be met in order to retain residence.
For example, state laws regulate how promptly payments must be made, the level of health you must maintain to qualify for certain facilities, and more. It’s crucial to know your rights or the rights of your family members so that you can sufficiently prepare for every stage of life.
States don’t vary too much in the scope of services they allow nursing homes to provide, but they do differ in the detail of services they must provide. These provisions cover things like how often laundry and housekeeping must be performed, how transportation must be handled, and how often services must be available. Only 6 states do not require facilities to provide three meals per day.
State Laws and Abuse
One major point of variation is how nursing and medical services must be administered. Some states do not allow nursing homes to furnish full-time nurses, whereas other states require that full-time nurses be on-hand 24/7. Some states allow nurses to delegate nursing tasks to unskilled or unlicensed staff members, whereas 15 states require a licensed healthcare professional to administer all medications.
Another significant difference between states is the staffing ratios or numbers that they require, and the degree to which they must be trained. When living in nursing home care, if you’re receiving insufficient care, or you’re the victim of neglect resulting from understaffing or poorly trained staff, consult your state’s laws to know if you have the right to demand a higher level of care.
States also differ on the degree to which background checks are performed, which can result in a lack of safety in states that don’t have sufficient provisions. There is an increased risk of elder abuse when background checks are not required.
Resources for Elder Abuse State Laws
If you believe you have been the victim of abuse or mistreatment in a nursing home, there are a number of online resources available that provide a state-by-state summary of nursing home laws.
- The National Care on Elder Abuse has a state-by-state breakdown of resources available to residents, including state reporting numbers, government agencies, state laws, state-specific statistics, and other useful resources:
- Nursing Home Regulations Plus is an online directory of both state and federal nursing home regulations. The site features an analysis comparing the differences between nursing home regulations on a state-by-state basis.
- The Long-Term Care Ombudsman Program offers several resources on state laws and regulations, including a chart of program statutes and regulations, and a summary of LTCOP enabling statutes and regulations by state.