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Nursing Home Reform Act of 1987

Setting Federal Standards for Nursing Homes in the U.S

Quick Answer

The Nursing Home Reform Act (NHRA) sets the federal quality standards for nursing homes. Nursing homes are obligated to meet these standards if they receive Medicare or Medicaid. The goal of the act is to ensure that seniors in nursing homes receive high quality care. The act protects seniors from physical, emotional, and social abuse and neglect.

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The act establishes the minimum care standards for nursing homes and defines the legal rights of nursing home residents. It also set a certification process and requires states to conduct random surveys to make sure nursing homes are reaching NHRA Standards.

History of the NHRA

In 1986, Congress asked the Institute of Medicine (now the National Academy of Medicine) to analyze the state of nursing homes in the United States. Congress suspected that many nursing homes weren’t providing high-quality care to seniors. The results of the study proved that many nursing home residents were not receiving adequate care and that neglect and abuse were common.

After the study, the Institute of Medicine recommended many reforms for nursing homes. Congress used the institute’s recommendations to write the Nursing Home Reform Act. The NHRA was passed in 1987 as part of the Omnibus Budget Reconciliation Act.

In the years after the law was passed, some experts believe nursing home quality improved significantly. Inadequate care at nursing homes has often been attributed to understaffing. After the act passed, many nursing homes increased and improved their staff. Proper staffing is an important improvement.

The presence of pressure ulcers (bedsores), as well as the use of physical restraints and urinary catheters, have all decreased since the act passed. These are potential signs that the NHRA was effective in improving the quality of care at nursing homes.

Despite some improvements at nursing homes, serious issues were reported in California in ten years later. Upon further investigation, the Senate Committee on Aging found that many nursing homes were failing to meet the requirements of the NHRA.

At one point, only 2% of California nursing homes were found to have minimal or no deficiencies. Almost all California nursing homes had deficiencies and these problems were rarely remedied due to lack of enforcement power. The enforcement issues in California were indicative of a nationwide problem.

In 1998 the Nursing Home Initiative began with the goal of improving the enforcement issues. Since then, the federal government has been making efforts to remedy the enforcement issues. Some states have passed their own laws to improve the situation.

Standards Set by the NHRA

The Nursing Home Reform Act sets requirements for nursing homes to provide certain services to residents. The requirements established by the NHRA are intended to protect the health and safety of seniors living at nursing homes.

Nursing homes are required by the NHRA to provide the following:

  • Dietary services
  • Pharmaceutical services
  • Social services
  • Nursing services
  • Rehabilitation services
  • Periodic assessments for each patient
  • Comprehensive care plans for each patient
  • A full-time social worker (if the home has more than 120 beds)

These requirements are set by the federal government and enforced by state governments. Nursing homes that fail to meet the minimum standard care requirements may be subject to penalties from the federal government.

Nursing Home Residents’ Bill of Rights

A Bill of Rights is included in the NHRA. This part of the act officially defines the basic rights of nursing home residents. The NHRA requires that nursing homes protect and promote the rights of all of their residents.

According to the NHRA, nursing home residents have certain basic rights, including the rights to:

  • Necessary care (medical, physical, psychological, and social)
  • Privacy
  • Security of possessions
  • Welcome visitors or refuse visitors
  • Remain in the facility until transfer or discharge
  • Participate in resident and family groups
  • Be treated with dignity
  • Exercise self-determination (freedom to make their own choices)
  • Communicate freely
  • Participate in the review of their care plans
  • Be fully informed in advance about changes in care, treatment, or status in the facility
  • Voice grievances without retaliation or discrimination
  • Choose a physician
  • Refuse medication or other treatments
  • Freedom from abuse, mistreatment, and neglect
  • Freedom from physical restraints

Nursing homes that violate these rights may be subject to legal action. In some cases, a resident’s family may have the right to sue the nursing home if their loved one’s rights have been violated. The definitions of neglect and abuse may vary by location. An attorney may be able to help residents and their families decide if a lawsuit is a viable option.

NHRA Enforcement

Federal money in the form of Medicare and Medicaid make up the majority of payments for nursing home care. Nursing homes in the United States must comply with the standards of the NHRA in order to receive Medicare and Medicaid funding.

Though the federal government sets the standards for nursing homes in the NHRA, the states are responsible for monitoring their nursing homes. States certify and survey nursing homes and enforce the law. All of these state responsibilities are funded through Medicare and Medicaid.

States are required to perform random surveys of nursing homes at least once every 15 months. These surveys usually focus on residents’ rights, quality of care, quality of life, and the services provided to residents. States also conduct surveys when complaints are made.

Nursing homes found to be providing insufficient care that violates the NHRA are subject to penalties from the government. These sanctions include monetary penalties, denial of Medicare or Medicaid funds, state monitoring, and temporary state management.

Enforcement of the NHRA has been historically weak. Since the Nursing Home Initiative of 1998, improvements have been made but the system still needs improvement. Without proper enforcement, many nursing homes continue to provide inadequate care without federal or state government repercussions.

In cases that seniors are not receiving necessary services or are having their rights violated, legal action may need to be taken. An attorney can help families decide if they need to file a lawsuit against a nursing home. Some law firms are dedicated to elder law and specialize in defending seniors against abuse and neglect in nursing homes.

Nursing Home Abuse Support Team
Julie Rivers HeadshotReviewed by:Julie Rivers, MBA

Eldercare Advocate & Expert

  • Fact-Checked
  • Editor

Julie Rivers is an eldercare advocate with over 15 years of dedicated service to victims of nursing home abuse and neglect. Her journey in this field became deeply personal when she assumed the role of an unpaid caregiver during her mother’s battle with Alzheimer’s disease.

The Nursing Home Abuse Center (NHAC) was founded to bring justice to those affected by nursing home and elder abuse. Our mission is to educate and empower victims of abuse and their families to take a stand against this unlawful mistreatment. We work to return dignity back to those who have been broken down by nursing home abuse and neglect.