Who is it that requires long-term care facilities to follow safety policies and procedures?

According to the Centers for Medicare & Medicaid Services (CMS), skilled nursing facilities must comply with specific federal requirements to receive Medicare or Medicaid payments. A complex network of federal and state entities is responsible for overseeing and enforcing the safety and procedural standards that require long-term care facilities to follow safety policies and procedures.

Quick Summary

Multiple governmental agencies, including federal, state, and local bodies, are responsible for regulating long-term care facilities to ensure safety. The Centers for Medicare & Medicaid Services establishes federal standards, while State Health Departments conduct unannounced inspections to verify compliance. The Occupational Safety and Health Administration focuses on employee safety, and the Long-Term Care Ombudsman Program advocates for residents' rights.

Key Points

• Centers for Medicare & Medicaid Services (CMS): Sets the federal health and safety standards that nursing homes must meet to receive Medicare and Medicaid funding.

• State Health Departments: Contracted by CMS to conduct unannounced, on-site inspections (surveys) to check for compliance with federal and state regulations.

• Occupational Safety and Health Administration (OSHA): Regulates employee safety and health within the facility, ensuring a safe workplace for staff.

• Long-Term Care Ombudsman Program: A federally mandated program that advocates for residents' rights, investigates and resolves complaints, and ensures residents have a voice.

• The Joint Commission (Accreditation): An independent, voluntary accrediting body that assesses a facility's quality and safety standards, sometimes required for licensing.

• Facility Administration: Ultimately responsible for implementing and maintaining safety protocols, following regulations, and instituting a Quality Assurance program.

The Core Regulators: CMS and State Health Departments

The primary oversight for long-term care facilities in the United States comes from the federal and state governments. For a facility to participate in Medicare and Medicaid programs—a necessity for most—it must comply with a stringent set of federal regulations. The Centers for Medicare & Medicaid Services (CMS) is the federal agency responsible for setting these standards.

State Health Departments, or their equivalent state-level agencies, are on the front lines of enforcing these regulations. CMS contracts with these state agencies to conduct unannounced, on-site inspections, also known as surveys. These surveys evaluate various aspects of a facility's operations, including the quality of care, resident rights, medication management, and overall environment. If a facility is found to have deficiencies, the state agency issues a Statement of Deficiencies, and the facility must submit a Plan of Correction. Failure to correct issues can result in penalties, including fines or the loss of Medicare/Medicaid payments.

The Federal Framework and Key Regulations

The foundation for many federal nursing home regulations is the Nursing Home Reform Act of 1987 (NHRA), passed as part of the Omnibus Budget Reconciliation Act (OBRA 87). This landmark legislation established a Bill of Rights for nursing home residents and mandated minimum standards for facilities that receive federal funding.

The regulations that CMS enforces through state surveys cover a wide range of safety and procedural areas, including:

• Quality of Care and Life: Facilities must provide services that support each resident's highest practicable physical, mental, and psychosocial well-being.
• Resident Rights: This ensures residents are free from abuse, neglect, and exploitation, and have the right to voice grievances without reprisal.
• Infection Control: Strict protocols are required to minimize the spread of illness, including proper hand hygiene and handling of contaminated materials.
• Emergency Preparedness: Facilities must have emergency plans, policies, and procedures for various disasters, including communication protocols and evacuation plans.
• Staffing Requirements: Federal regulations mandate specific staffing levels to ensure residents receive adequate care.
• Safe Environment: This includes standards related to electrical safety, fire safety, and general sanitation.

The Role of the Long-Term Care Ombudsman Program

An Ombudsman program exists in every state as a federal mandate under the Older Americans Act. This program serves as a critical advocate for residents, working independently of facility management and state health departments to protect residents' rights and quality of life.

Key functions of an Ombudsman include:

• Investigating and resolving complaints made by or on behalf of residents.
• Educating residents, families, and staff on residents' rights and good care practices.
• Promoting the development of resident and family councils.
• Advocating for legislative and policy changes to improve long-term care systems.

Other Federal and Accreditation Bodies

In addition to CMS and state authorities, other organizations play a significant role in requiring safety policies.

Occupational Safety and Health Administration (OSHA)

OSHA is responsible for ensuring the safety of employees in the workplace, which includes long-term care facilities. While CMS focuses on resident care and safety, OSHA enforces standards related to staff safety, such as proper lifting techniques to prevent injury and protocols for handling hazardous materials. An intersection of these rules occurs with infection control and emergency action plans.

The Joint Commission

While not a governmental body, The Joint Commission is an independent, non-profit organization that offers accreditation programs for healthcare organizations, including long-term care facilities. Obtaining accreditation is often voluntary but serves as a measure of quality and can be a requirement for licensing or certain reimbursements in some states. The accreditation process involves a rigorous, on-site evaluation of the facility's safety and quality standards, including medication management and infection control.

Comparison of Oversight Entities

Feature	Centers for Medicare & Medicaid Services (CMS)	State Health Departments	Occupational Safety and Health Administration (OSHA)	Long-Term Care Ombudsman Program	The Joint Commission (Accreditation)
Primary Mandate	Set federal standards for facilities receiving Medicare/Medicaid funding.	Enforce federal and state standards via surveys and complaint investigations.	Ensure a safe and healthy workplace for employees.	Advocate for residents' rights and quality of life.	Voluntarily accredit organizations based on performance standards.
Key Focus Area	Overall resident care, quality of life, facility management.	Local, on-site inspection and enforcement.	Employee safety, handling hazards, ergonomics, bloodborne pathogens.	Individual resident complaints, systemic advocacy.	All aspects of patient care and safety for accredited organizations.
Inspection Schedule	Federal surveys required every 9-15 months for certified facilities.	Conduct unannounced surveys, with annual and complaint-driven visits.	Responds to complaints, investigates fatalities, or initiates targeted inspections.	Ongoing, through volunteer and staff visits to facilities.	On-site evaluation every 24 to 36 months for accredited facilities.
Enforcement Power	Can impose penalties, denial of payments, or termination of federal funding.	Can issue deficiency citations, fines, or revoke licenses.	Can issue citations, fines, or take legal action against employers.	Can refer unresolved complaints to state agencies or law enforcement.	Can grant or revoke accreditation; impacts facility's reputation and eligibility.

The Facility's Internal Responsibilities

Ultimately, the responsibility to implement safety protocols and procedures rests with the long-term care facility itself. Federal regulations require facilities to have a comprehensive Quality Assurance and Performance Improvement (QAPI) program to continuously monitor and improve resident care and safety. This internal oversight includes regular audits, staff training, and the development of corrective action plans. While external agencies ensure compliance, a facility's internal commitment to a strong safety culture is the most direct influence on resident well-being.

Conclusion

In summary, the complex regulatory landscape for long-term care facilities involves a multi-layered approach. The Centers for Medicare & Medicaid Services establishes the foundational requirements, which are then enforced by state health departments through regular, unannounced inspections. The Occupational Safety and Health Administration safeguards the facility's employees, while the Long-Term Care Ombudsman Program provides an independent voice for resident rights. Finally, for accredited facilities, The Joint Commission adds another layer of quality oversight. This intricate web of oversight is designed to ensure that the most vulnerable members of our society receive care in a safe and dignified environment. A facility's ability to navigate and proactively exceed these standards is crucial for providing the highest quality of care and safety.

Long-Term Care Ombudsman Program: What You Must Know

Frequently Asked Questions

What is the Nursing Home Reform Act of 1987?

The Nursing Home Reform Act of 1987 established foundational federal standards for nursing homes that receive Medicare and Medicaid funding. It created a residents' Bill of Rights and set criteria for quality of care and facility operations.

How often are long-term care facilities inspected?

State health agencies conduct unannounced, standard health inspections at least once every 9 to 15 months for facilities certified for Medicare and/or Medicaid. They may also conduct more frequent inspections in response to complaints or performance issues.

What happens if a facility violates safety regulations?

If a facility is found to have deficiencies, it is issued a citation and must submit a Plan of Correction. Uncorrected deficiencies can lead to penalties, including fines, denial of payments for new admissions, or termination from the Medicare/Medicaid program.

Who does the Ombudsman program help?

The Long-Term Care Ombudsman program advocates for residents of nursing homes, assisted living facilities, and other licensed long-term care centers. An Ombudsman helps residents, their families, and friends with issues related to quality of care and residents' rights.

Does OSHA regulate patient safety in long-term care facilities?

OSHA's regulations primarily focus on employee safety and health in the workplace, including long-term care facilities. While this overlaps with some resident safety concerns, CMS and state departments are the main regulators for direct patient care and safety.

What is the Life Safety Code?

The Life Safety Code is a set of fire safety and emergency preparedness requirements developed by the National Fire Protection Association. It is enforced in certified long-term care facilities during state health surveys to ensure the safety of both residents and staff.

Can I report a safety concern directly?

Yes. You can report concerns by contacting your local Long-Term Care Ombudsman, the State Survey Agency (part of the State Health Department), or the facility's administration.