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New Consumer Protection Rules for Nursing Homes

Almost every nursing home in the United States accepts either Medicare, Medicaid or both for payment for services provided to residents. As a condition of accepting federal money, nursing homes must follow federal rules, particularly care standards set by the Nursing Home Reform Law which became effective in 1990.

In September 2016, the Centers for Medicare and Medicaid issued a comprehensive revision to the regulations. Some of the new regulations provide new consumer protections to residents in nursing homes.

The protections include the following:

  • The original regulations allowed a resident to be without a care plan for as long as 21 days following admission. Now a nursing home must develop and implement a care plan within 48 hours of a resident's admission.
  • Nursing homes are now required to take reasonable care of resident belongings and can no longer seek waivers of their responsibility for lost or stolen property.
  • Nursing homes may no longer evict for non-payment when a third-party payor (such as Medicaid) is evaluating a claim for payment. This means that when a resident has spent down their resources and are waiting for Medicaid to approve an application for benefits, the nursing home cannot evict based on non-payment.
  • Many nursing homes include a mandatory arbitration clause in their admission agreements. These agreements compel residents to arbitration in any future claim about abuse and neglect. The revised regulations prohibit nursing homes from forcing residents to arbitrate such disputes. Arbitration can be used only if both sides agree to it after the claim arises.
  • Nursing homes often evade eviction safeguards by 'dumping' residents in hospitals and refusing to readmit them. The new rules make nursing homes follow eviction procedures and provide a hospitalized resident an opportunity to appeal, when the nursing home claims they cannot return.
  • The new rules focus on addressing a resident's individual needs and preferences: For example
    • Increased visitation rights. A resident can accept visitors at any time of the day.
    • Provide residents greater choices by learning about a resident's needs and preferences.
    • Treatment and services must include pain management, dialysis, and behavioral health services.

These new rules require more than promulgated regulations. Residents, families and advocates must argue forcefully for a strong voice in the planning process.

Edward Zetlin Law has advocated for patient rights in nursing homes and these rules provide new tools to ensure that resident rights and necessary services are in place when a resident enters in and moves from a nursing home.

Edward Zetlin Law is experienced in Elder Law and Special Needs Planning issues. Don't hesitate to call if you face such an issue or if you have additional questions. Edward Zetlin Law would be happy to discuss. Please contact us at 703-379-0442 or e-mail at ed@zetlinlaw.com.

Community Presentations in February 2017. Langston-Brown – February 22nd at 1:00 pm How to Prepare for Estate Planning Arlington Center 55+ at Langston-Brown Community Center, 2121 N Culpeper St, Arlington, VA 22207.

Contact us at (703)379-0442; ed@zetlinlaw.com


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