Like all facilities which receive federal funding to compensate them for participation in government programs like Medicare and Medicaid, Maryland nursing homes are regulated by federal government. Therefore, they must abide by the rules set forth in the 1987 Nursing Home Reform Act, passed by Congress to address widespread complaints about the quality of care that residents were receiving in nursing homes around the country.
Maryland Office of Health Care Quality
In Maryland, the Department of Health and Mental Hygiene governs a wide variety of public health issues in the state. They also house the Office of Health Care Quality (OHCQ), which is responsible for the licensing, review of complaints, and inspection of nursing homes across the state. Technically, this office reports back to the federal agency, the Centers for Medicare and Medicaid Services (CMS), which ensures that the state agency is following federal protocols. In addition, Maryland has a set of code which state nursing homes must follow on top of federal regulations.
The OHCQ has definitions for each of the many health care facilities that fall under its purview. They define a nursing home as a “facility which admits two or more unrelated persons who do not need the intensive care provided by a hospital but who are unable to be cared for appropriately in a home, or other assisted living facility.” The particular license required for a nursing home certification is based on the assumption that the facility will “provide the admitted residents with medical service and nursing service rendered by or under the supervision of a registered nurse.”
Code of Maryland Regulations (COMAR)
The Code of Maryland Regulations, or COMAR, sets forth rules for all nursing homes. In order to become a licensed facility in the state of Maryland, facilities must apply and be inspected by the OHCQ to make sure that all standards are being met. There is regulatory code for almost everything related to the layout, staffing, and safety of the facilities themselves, but of particular interest to Maryland, nursing home residents and their families are the statutes surrounding legal rights of residents, complaint and reporting processes, and financial protections.
Residents' Right to Information
Certain aspects of COMAR include the nursing home's legal obligation to accept the authority of the resident's representative, be it a legal guardian, power of attorney, or surrogate decision maker. Nursing homes are also banned from discriminating against anyone for their race, religion, ethnicity, or mental or physical handicap when they are considering admittance into the home. The code lays out policies for acceptance, rejection, and transfers within nursing homes as well as financial protections to shield residents from unfair treatment.
Standards of Care
The Maryland code also lays out regulations for pharmaceutical services, including the way medication must be delivered, stored, labeled, and administered. Relatedly, the code dictates the number of supervisory and assistant nurses necessary during each shift and day, as well as the organizational structure of the nursing services. The code also specifies how the individualized care plans for each resident should be developed, maintained, and followed.
Preventing and Reporting Abuse
COMAR takes specific precautions against abuse of residents. They lay out rules for chemical and physical restraints, dictating, for example, that physical restraints may only be used if four conditions are met, including being administered by a licensed professional and medical necessity. The code also states the each nursing home must have their own policies and procedures which lay out the ways in which they will protect their residents from abuse of all kinds. They are prohibited from hiring any staff member who has been convicted of neglecting or abusing a nursing home resident in their past.
Inspections of Maryland nursing homes will typically occur every 12-15 months, or in response to a complaint filed with the state. The OHCQ is also referred to as a “state survey agency,” meaning that it is responsible for inspecting state homes to determine whether or not they comply with federal (and state) regulations. During the inspection process, the OHCQ is required to interview about 10% of the residents of the facility. This is an important opportunity for residents and their families to speak out about any abuse, mistreatment, or safety concerns that they may have about the nursing home. In addition, the inspection team will:
- Review the residents' medical records and observe carefully to see that the care given to residents is sufficient to prevent an unnecessary decline in the residents' health
- Meet with and observe residents to determine whether the residents have a good quality of life at the nursing home
- Determine whether residents' rights are respected
- Inspect the nursing home for cleanliness and safety
- Determine whether dietary/food services are in compliance with the law
After inspecting the nursing home, the OHCQ will compile a list of violations and put it in a formal report, commonly known as a “deficiency report,” which will be given to the nursing home. The home then has a set period of time in which to create a plan of correction addressing each violation which they send to the OHCQ. Maryland requires that nursing homes make the most recent survey and report by the OHCQ available to the nursing home residents, their family, and any other visitor who might wish to see it. They should have a copy available in the main lobby and upon request.
Protecting Nursing Home Residents in Maryland
Although nursing homes are highly regulated, because of the sheer number of facilities in Maryland and the relatively low number of inspectors, it is difficult for regulating agencies to effectively investigate all claims of abuse and/or neglect in a timely manner. For this reason, legal counsel is sometimes necessary to get immediate and effective action. Charles Gilman and Briggs Bedigian handle elder abuse cases in Maryland, Pennsylvania, and D.C., and have valuable knowledge of local statutes and codes. For a free case evaluation, call them today at 800.529.6162 or contact them online.