Nursing Home Rules: The Front Line of Change

By Kane, Rosalie A.; Cutler, Lois J. | Aging Today, July/August 2007 | Go to article overview

Nursing Home Rules: The Front Line of Change


Kane, Rosalie A., Cutler, Lois J., Aging Today


State nursing home regulations make dull reading. Their plotlines are obscured by their very form: sections on definitions, content embodied in dated and numbered internal paragraphs and subparagraphs, amendments over time, and multiple cross-references to other parts of state administrative code or statutes. Nonetheless, buried in state law pertaining to nursing homes is an important and sometimes gripping story of how states have struggled to shape the quality and future of residential care and adapt to competing modern demands for accountability and creativity.

AWORK IN PROGRESS

In March 2005, we began a time-consuming and complex task: identifying, compiling and comparing all state regulations pertaining to nursing homes to show how they promote or hinder resident autonomy and quality of life. The resulting website, NH Regulations Plus (NHRegsPlus), is a seemingly endless work in progress located at www.hpm.u mn.edu/nhregsplus/index.htm. As we develop this website, we hope that detailed examination and comparison of state nursing home regulations will pave the way for a discussion of the ideal set of regulations, not only for nursing homes but also for their newer residential care cousins, assisted living settings.

It is undoubtedly easier to complain about nursing home regulations than to read them. A close reading reveals provisions that seem obvious, such as "toilet paper in a suitable dispenser must be provided within reach of each toilet," as well as rules that seem archaic: "Oil lanterns and other open-flame methods of illumination are prohibited." Ambiguous and vague stipulations abound. For example, states require such elements as "a cheerful space," "a satisfactory bedstead," "a comfortable space" and "good condition linens" in nursing homes. Within the regulatory minutiae are many rarities and oddities, as well as some language that holds out promise for resident autonomy. (See "The States of Minutia" adjacent on this page.)

In 2005 and 2006, we analyzed how all states elaborate on the federal regulations and on any additional new categories of state regulations. In spring 2007, we began a reexamination process to determine whether and how, if at all, state regulations had changed during those two years.

The relevant forces of change include:

* Gradually changing federal nursing home regulations (states must meet federal minimums but may develop more stringent regulations);

* Pressuring nursing homes to promote culture change that would transform them into individualized care settings where residents could exercise autonomy and establish real homes;

* Encouraging nursing homes to present a public record of excellent clinical outcomes, including low to nonexistent levels of new pressure wounds, malnutrition, and falls and other accidents.

FEDERAL RULES

Nursing homes have been the object of congressional scrutiny, journalistic exposé, advocacy attention and reform efforts ever since Medicare and Medicaid legislation in 1965 generated a huge expenditure of public money for nursing home care. The federal rules governing nursing homes today largely stem from the most far-reaching effort at regulatory reform embedded in the federal Omnibus Budget Reconciliation Act of 1987. Those amendments to the Social Security Act established 14 federal standards covering such concerns as residents' rights; admission, transfer and discharge rights; resident behavior and facility practices, including physical and chemical restraint, freedom from abuse, and reporting requirements for suspected staff abuse; and quality of Ufe, with language establishing residents' right to dignity and containing specific provisions for social services and activity departments. This detailed law also prescribed standards relating to resident assessment, quality of care, nursing services, dietary services, physician services, infection control, special rehabilitation services, physical environment and administration. …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Nursing Home Rules: The Front Line of Change
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.