How are Nursing Homes Regulated?

January 8, 2019

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In order to ensure nursing homes are providing an adequate standard of care, a variety of regulations are in effect at both federal and state levels. In Florida, nursing homes are regulated by the Florida Agency for Health Care Administration (AHCA). Nursing homes are also regulated federally by the U.S. Department of Health and Human Services via the Centers for Medicare and Medicaid Services.

The federal and state standards for nursing homes are intended to ensure every resident within a nursing home is properly cared for. It is important for every nursing home to comply with these standards. It is also just as important that when they fail to do so, residents and their families know the proper steps to take to protect themselves and correct the situation.

Following Federal and State Regulations

In Florida, AHCA provides annual licenses to nursing homes and also performs regular inspections to ensure these facilities abide by federal and state standards. During these inspections, a surveyor from AHCA will visit a nursing home and investigate any complaints of violations.

These inspections are unannounced and typically occur at least once a year, although nursing homes that have had prior complaints filed against them may be inspected more often than others with fewer complaints. Throughout the inspection, the surveyor notes any deficiencies or violations and includes them in a report. If there were past violations that the nursing home corrected before the inspection, these are typically not included in the report.

When Violations Are Found

When a nursing home is in violation of state or federal standards, the inspector would include the various violations and failures found during the inspection in a Statement of Deficiency. This report would then be sent to the violating nursing home, which must then respond with a Plan of Correction.

If the deficiencies violated federal standards, they are documented alongside a rating to represent the severity and scope of the violation. The severity of the violation is determined by the level of risk it posed to residents.

Filing a Complaint With AHCA

The Florida Agency for Health Care Administration also oversees any complaints filed against a specific nursing home. Complaints are an important part of nursing home regulation, as they alert AHCA if a nursing home is not providing proper care. Complaints can be filed via email, phone, fax, or through the Unlicensed Health Care Facility Complaint Form found on the AHCA’s website.

Individuals can file complaints anonymously if they wish to protect themselves from possible repercussions from the nursing home or its staff. However, those who want to know the outcome of the investigation must provide their name, address, and phone number. This is to ensure AHCA can contact the individual at a later time.

In addition to any penalties AHCA elects to level against a nursing home found to have violated state or federal regulations, injured individuals—or family members working on their behalf—may also file a lawsuit against the nursing home and/or its staff. This is another way nursing homes can be held responsible for violating standard regulations, as well as one that can provide injured individuals with compensation for their injuries.

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Domnick Cunningham & Whalen

Domnick Cunningham & Whalen

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