Most nursing homes in the United States depend partially on funding from the US Government to compensate them for caring for Medicare and Medicaid patients. Therefore, they are federally regulated. In 1987, due to widespread complaints about the quality of care being received in nursing homes, US Congress enacted the Nursing Home Reform Act which sets forth certain regulations that all nursing homes which receive Medicare or Medicaid payments must follow.
Pennsylvania Department of Health
In Pennsylvania, nursing home accreditation and licensure regulation is run by the Pennsylvania Department of Health. This agency, like all state agencies, is overseen and reports back to the Centers for Medicare and Medicaid Services (CMS). In Addition, the Pennsylvania Department of Health has its own state code which it enforces at its discretion. The regulations in the state code do not undermine federal guidelines; rather, they add further rules for Pennsylvania state nursing homes.
Pennsylvania Regulations for Nursing Homes
Pennsylvania has six chapters of regulatory code for licensing and inspecting nursing homes in the state. In order to be licensed, long-term care facilities must comply with Pennsylvania law dictating the following.
Life Safety Code
This chapter of regulations states that the “facility shall meet the applicable edition of National Fire Protection Association 101 Life Safety Code.” The Life Safety Code is a widely used set of standards which lay out “strategies to protect people based on building construction, protection, and occupancy features that minimize the effects of fire and related hazards.”
Physical Plant and Equipment Standards
Regulations for the physical layout of nursing homes and the quality of equipment are extensive. They include specifications for basements, ceiling height, stairs, elevators, room size, bathing facilities, kitchens and serving areas, windows, janitor closets, and utility rooms, among other aspects. They also detail the maintenance schedule for heating and cooling systems, ventilation, and electrical systems.
Housekeeping and Maintenance Standards
For the most part, housekeeping and maintenance standards are left to the discretion of the facility's administration. In fact, the only two regulations guiding this area are:
- (a) The administrator shall be responsible for satisfactory housekeeping and maintenance of the buildings and grounds.
- (b) Nursing personnel may not be assigned housekeeping duties that are normally assigned to housekeeping personnel.
Fire Protection and Safety Program Standards
This section of the Pennsylvania code dictates where nursing homes must post emergency service numbers and lays out policies regarding smoking for both the employees and the residents of the nursing home.
Program standards for nursing homes in Pennsylvania include regulations on the majority of systems with which residents may interact. For example, this section of the code lays out rules for physician services, nursing services, social services, pharmacy services, and dietary services. It also covers resident care policies and plans, procedures in the event of a death or reportable disease, and how clinical records are to be handled.
In order to become and to remain a state licensed facility, nursing homes must adhere to all the preceding regulations. These regulations are enforced primarily through the process of periodic inspection.
The Pennsylvania Department of Health sends an inspector or a team of inspectors to a nursing home in response to one of three scenarios. Long term care facilities are inspected:
- Once every 12-15 months as part of an annual inspection. In this instance, the nursing home will not be aware of exactly when the inspector will arrive.
- In response to a complaint
- In response to an “adverse incident report” filed by the nursing home in the event of abuse, rape, or certain instances of death
In 2015, Pennsylvania had 119 inspectors. Although the number of nursing home residents has risen, this number has remained virtually static over the past decade. When a nursing home is going to be inspected, the Pennsylvania Department of Health sends one, two, or more inspectors as a team to the home. The team will include a registered nurse (RN) and possibly a social worker or a nutritionist depending on the facility's history and past concerns.
Process of Inspection
The inspection team, or “survey team,” as the Pennsylvania Department of Health refers to them, typically shows up to a nursing home unannounced and performs a detailed evaluation of the facility over a period of several days.
Surveyors perform a variety of analyses while inspecting a nursing home in order to gauge the standard of care being set for the residents. If you observe surveyors in a nursing home, you might see them
- Watching how staff interacts with the residents and how they speak to them
- Observing the type and quality of care that the staff is providing to residents
- Interviewing residents and their family members about their experience at the home
- Reviewing cases and charts to see if appropriate services are being provided
- Touring the facility and checking for compliance with federal and state regulations
- Observing meals to see the quality of the food
- Watching medication runs and medical treatment protocols
- Meeting with administrative staff to review problems brought up by staff, residents, or their families and evaluating the management's solutions to these problems
If the nursing home is found to be violating regulations in some way, they will receive a citation from the Pennsylvania Department of Health, after a period of discussion on the part of the inspectors. The surveyors then assign each citation in the nursing home a letter which signifies how dangerous and how widespread the problem is. An isolated incident with no actual harm done and a minimal potential for a negative impact will receive an “A,” while a widespread issue which is immediately jeopardizing residents' safety or health would receive an “L.”
The inspectors write a report on each citation and send the report to the nursing home with a request for a plan of correction. The facility then creates and submits a plan for remedying all of the problems discovered by the Department of Health. Depending on the severity of the nursing home's violations, they might receive a financial civil penalty, have their license revoked or suspended, or lose the right to participate in federal programs like Medicare and Medicaid.