Nursing Homes
About Nursing Home Inspections
The Centers for Medicare & Medicaid Services (CMS) is the component
of the Federal government's Department of Health and Human Services
that oversees the Medicare and Medicaid programs. A large portion
of Medicare and Medicaid dollars is used each year to cover
nursing home care and services for the elderly and disabled.
State
governments oversee the licensing of nursing homes. In addition,
States have a contract with CMS to monitor those nursing homes
that want to be eligible to provide care to Medicare and Medicaid
beneficiaries. Congress established minimum requirements for
nursing homes that want to provide services under Medicare and
Medicaid. These requirements are broadly outlined in the Social
Security Act (the Act). The Act also entrusts the Secretary
of Health and Human Services (DHHS) with the responsibility
of monitoring and enforcing these requirements. CMS, a DHHS Agency,
is also charged with the responsibility of working out the details of
the law and how it will be implemented, which it does by writing
regulations and manuals.
CMS
contracts with each State to conduct onsite inspections that
determine whether its nursing homes meet the minimum Medicare
and Medicaid quality and performance standards. Typically, the
part of State government that takes care of this duty is the
health department or department of human services. The State
conducts inspections of each nursing home that participates
in Medicare and/or Medicaid on average about once a year. If
the nursing home is performing poorly, however, the State inspectors may
go in more frequently. The State also investigates complaints
about nursing home care.
During
the nursing home inspection, the State looks at many aspects
of quality. The inspection team observes resident care processes,
staff/resident interaction, and environment. Using an established
protocol, the team interviews a sample of residents and family
members about their life within the nursing home, and interviews
caregivers and administrative staff. The team reviews clinical
records.
The
inspection team consists of trained inspectors, including at
least one registered nurse. This team evaluates whether the
nursing home meets individual resident needs. In addition, fire
safety specialists evaluate whether a nursing home meets standards
for safe construction. When an inspection team finds that a
home does not meet a specific regulation, it issues a deficiency
citation.
The
regulations cover a wide range of aspects of resident life,
from specifying standards for the safe storage and preparation
of food to protecting residents from physical or mental abuse
or inadequate care practices. There are over 150 regulatory
standards that nursing homes must meet at all times. Many are
related.
Depending
on the nature of the problem, CMS can take action against the
nursing home. The law permits CMS to take a variety of actions;
for example, CMS may fine the nursing home, deny payment to
the nursing home, assign a temporary manager, or install a State
monitor. CMS considers the extent of harm caused by the failure
to meet requirements when it takes an enforcement action. If
the nursing home does not correct its problems, CMS terminates
its agreement with the nursing home. As a result, the nursing
home is no longer certified to provide care to Medicare and
Medicaid beneficiaries. Any beneficiaries residing in the home
at the time of the termination are transferred to certified
facilities.
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