Since 1987, nursing home quality assurance has been defined largely by the Omnibus Budget Reconciliation Act of 1987 (OBRA), and by the associated regulations promulgated by the Centers for Medicare and Medicaid Services (CMS). To remain eligible for Medicare and Medicaid payments, nursing homes must meet the standards outlined in the regulations. States work to enforce these regulations through an annual inspection of every nursing home, and poor performers can be sanctioned by CMS, up to termination from the Medicare and Medicaid programs.
2016 was the first time changes to the regulations have been sought since 1987. The “Reform of Requirements for Long-Term Care Facilities” considerably expanded requirements in several key areas such as care planning, infection control, and quality improvement. Many of those regulations, however, have now been rolled back. One regulation, in particular, was the inability of nursing homes to require residents enter into pre-dispute arbitration agreements, limiting their ability to file lawsuits in court if injured in the nursing home. Now, that regulation hangs in the balance. Oftentimes, whether truly required to sign an arbitration agreement as a condition of admission or not, patients or their family members do, not fully understanding the consequences.
In Kentucky, the Cabinet for Health and Family Services, Division of Health Care, inspects, monitors, licenses and certifies all health care facilities, as well as investigates complaints. Information regarding specific nursing homes in Kentucky can be requested in an open records request from the Cabinet.
Oftentimes, problems at nursing homes stem from the underlying problem of understaffing. Often there are not enough nurses and aides on duty to adequately take care of residents. Kentucky does not have a minimum staff to patient ratio, but some states do. Nursing homes are private corporations and run for-profit. Sometimes residents and their families do not even know the names of the corporations that actually own the nursing home, because they market the nursing home by another name. Becoming aware of these issues and doing research into the nursing home is one way families can advocate for their loved ones who may be unable to advocate for themselves.