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The Nursing Home Reform Act

In order to ensure that elderly residents of nursing homes receive the best care, the Nursing Home Reform Act, also called NHRA, was passed in the United States. It is designed to look after the mental and physical wellbeing of residents of these homes by ensuring a high quality of care through a resident’s bill of rights. Essentially, the NHRA works as a way to provide nursing facilities a method of following the right guidelines and it is vital that all of these rules are followed if facilities wish to receive funding for Medicare and Medicaid. All criteria of the Nursing Home Reform Act must be met by each facility before they can receive such funding. This is another way to ensure all residents are treated properly.

Where It Came From

Back in 1986, the Institute of Medicine, on behest of Congress, performed an evaluation of the care residents were receiving. This evaluation found that there was a serious issue with nursing homes, and it led to inadequate care as well as patient neglect. At that time, the Institute of Medicine proposed the reforms that became a law in 1987. This is the NHRA and it was a part of the 1987 Omnibus Budget Reconciliation Act.

The Bill of Rights

The NHRA has a set of resident’s bill of rights that are determined to ensure each patient receives proper medical care and protection of privacy, individuality, and dignity. Each resident, under this bill of rights, should have proper care that does not involve abuse or neglect. The actual bill of rights from the Nursing Home Reform Act is listed below.

Each patient has the right to:

  • Privacy in the nursing facility
  • Proper accommodations to manage all needs, including physical, mental, and social.
  • Communication freely with people within and without the facility
  • Dignity in all types of treatment
  • Freedom to not be abused or neglected
  • Ability to use self determination
  • Ability to explain or voice grievances
  • Freedom from physical restraint
  • Freedom to spend time with family or groups within the facility
  • Ability to participate in their own plan of care, including changes in treatments

In addition to the bill of rights, the act also covers the standard of care provided by the facility as well as the specific services that will be available to the residents.

Rules on Standard of Care

The NHRA requires that all facilities provide a certain standard of care as mentioned above. These standards include providing each resident with access to the services they will need, including rehabilitation and social welfare. Additionally, the resident should have the food and medications they need, assessments from professionals, and a comprehensive plan of care that will cover everything they require. Additionally, there must be a social worker available for larger facilities that have more than 120 residents.


According to the act, all nursing homes are required to have the proper certification and can be subject to interviews and evaluations without notice. These unannounced surveys can happen at any time, must be done within 15 months of each other, and must evaluate the patient’s quality of life in the facility. It will also look over any patient complaints that have been made.

Nursing homes that violate any of the criteria within the act can be handled differently depending on the type of violation. If the violation harmed patient care and rights, then the penalty can be much larger. Violation reparations can include payment denial, monetary fees, temporary management of the facility, and more. The Nursing Home Reform Act is designed to ensure patients maintain their quality of life and that is why it is so stringent.

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