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Federal laws and regulations are designed to put a stop to elder abuse and neglect in nursing homes. The enforcement of these laws is imperfect, and nursing home residents and their loved ones should be aware of their rights. Violations could be grounds for a nursing home lawsuit. 

The Nursing Home Reform Act 

The Nursing Home Reform Act (NHRA) is a federal law that was passed in 1987 with the goal of improving the quality of care in nursing homes. The law requires nursing homes to provide residents with certain rights and protections, such as the right to be free from abuse and neglect, the right to privacy, and the right to receive adequate care and services. The law also requires nursing homes to develop care plans for each resident and to provide necessary medical, nursing, and rehabilitative care. Additionally, the law requires nursing homes to undergo regular inspections and to maintain certain staffing levels. 

The NHRA has helped to improve the quality of care in nursing homes, although many nursing homes still fail to meet its requirements. 

What are Nurses Not Allowed to Do? 

Nurses who work in nursing homes are subject to a range of legal and ethical guidelines that dictate what they can and cannot do. They are held to high standards of professionalism and ethical behavior. They are expected to provide compassionate, competent care to residents, and to always prioritize residents’ well-being.

The following are examples of prohibited behaviors by nurses in nursing homes: 

  1. Engage in physical or emotional abuse: Nurses are not allowed to engage in any form of physical or emotional abuse towards residents. This includes hitting, slapping, yelling, or making threats.
  2. Administer medications without proper authorization: Nurses are required to follow specific protocols when administering medications to residents. They may only give medications that have been authorized by a physician, and they must ensure that the medication is administered safely and accurately.
  3. Provide medical treatment beyond their scope of practice: Nurses are only authorized to provide medical treatments that are within their scope of practice. They may not perform medical procedures that require a higher level of training or expertise.
  4. Share residents’ confidential information without permission: Nurses are required to maintain the privacy and confidentiality of residents’ personal and medical information. They may not share this information with anyone who is not authorized to receive it unless the resident has given permission.
  5. Engage in discriminatory behavior: Nurses are not allowed to engage in any form of discrimination towards residents, based on their race, ethnicity, religion, gender, sexual orientation, or any other characteristic.
  6. Neglect residents’ needs: Nurses have a duty to ensure that residents receive adequate care and support. They may not neglect residents’ needs, such as providing food, water, or medical attention.

Centers for Medicare and Medicaid (CMS): Nursing Home Regulations 

The Centers for Medicare and Medicaid Services (CMS) is a federal agency that oversees the administration of Medicare and Medicaid programs, as well as federal regulations for long-term facilities. CMS has established a set of regulations that nursing homes must comply with in order to participate in Medicare and Medicaid programs. These regulations are designed to ensure that nursing home residents receive high-quality care that meets their physical, mental, and emotional needs. Some examples of CMS nursing home regulations include:

  1. Resident Rights: Nursing homes must ensure that residents are aware of their rights and are able to exercise them. This includes the right to be free from abuse, neglect, and exploitation, the right to privacy, and the right to participate in their own care planning.
  2. Quality of Care: Nursing homes must provide residents with appropriate medical, nursing, and rehabilitative care to meet their individual needs. This includes ensuring that residents receive the necessary medications, treatments, and therapies to manage their health conditions and maintain their quality of life.
  3. Infection Control: Nursing homes must implement effective infection control measures to prevent the spread of infectious diseases among residents and staff. This includes establishing protocols for hand hygiene, cleaning and disinfection, and appropriate use of personal protective equipment.
  4. Staffing: Nursing homes must maintain appropriate staffing levels to ensure that residents receive adequate care and support. This includes ensuring that there are sufficient numbers of qualified nurses, aides, and other staff members to meet residents’ needs.
  5. Food and Nutrition: Nursing homes must provide residents with nutritious and appealing meals that meet their dietary needs and preferences. This includes accommodating residents with special dietary requirements and providing snacks and hydration as needed.

What Are F Tags in Nursing Homes?

“F Tags” are federal regulatory tags used to identify specific areas of nursing home care that are subject to inspection and oversight by the Centers for Medicare and Medicaid Services (CMS). Each F Tag represents a different aspect of nursing home care that is evaluated during the CMS survey process.

Each F Tag corresponds to a specific regulation or standard of care that nursing homes must follow. The F Tags cover a wide range of topics, including resident rights, quality of life, clinical care, infection control, and facility management. You can see a complete list of CMS F Tags here.

During a CMS survey, inspectors will evaluate each F Tag to determine if the nursing home complies with the associated regulation or standard of care. If the nursing home is found to be non-compliant, it may be subject to fines, sanctions, or other enforcement actions.

Some examples of F Tags include:

  • F157: Notification of Changes: This F Tag requires nursing homes to promptly notify residents and their families of any changes in the resident’s condition or care plan.
  • F325: Nutritional Status: Nursing homes are required to meet residents’ nutritional needs. 
  • F921: Safe/Functional/Sanitary/Comfortable Environment: Citations under this F Tag include citations for water damage, mold, bathrooms with scalding hot water, and dysfunctional fire alarm systems. 

The F Tags provide a standardized framework for evaluating nursing home care and ensuring that residents receive high-quality care that meets their individual needs.

New Nursing Home Laws and Regulations

States regularly aim to improve the care of their nursing home residents with new additions to their nursing home laws and regulations. For instance, on January 1, 2022, New York Public Health Law 2895-b(3)(a) took effect, establishing a new staffing minimum that would allow 3.5 hours of care per resident per day. In March 2023, the Biden administration ended the Covid-19 public health emergency, which means nursing homes will have to adhere to stricter requirements. This includes requirements for staff training. 

How Can I Be Sure My Nursing Home Follows Federal Regulations for Long-Term Care Facilities? 

Look up reviews of nursing homes on before selecting a provider. Your state may also publish evaluations of nursing homes. If you suspect a nursing home of violating nursing home abuse laws, contact the nursing home ombudsman in your state or your State Survey Agency.