Nursing Home Protections

This rule ensures nursing home residents receive good care and are not abused or neglected.  The rule also eliminates the use of forced arbitration clauses against residents and their families.


Over 70 percent of nursing home revenue comes from the Medicare and Medicaid programs. To protect nursing home residents and to ensure accountability of federal monies, President Ronald Reagan in 1987 approved the Nursing Home Reform Law.  Implementing regulations were enacted in 1991.

Because those regulations had become sorely outdated and there was a growing body of evidence showing that nursing home residents’ health and safety were at severe risk, the federal government issued revised regulations in Sept. 2016. These new regulations address every aspect of nursing home care, including quality of care, resident rights, nursing services, physician services and protection from abuse and neglect.

Protections included in the September rule that were not included in the 1991 regulations:

  • Comprehensive care. Treatment and services expanded to include pain management, dialysis and behavioral health services.
  • Improved staff training. All staff, contractual employees and volunteers must be trained in areas such as caring for people with dementia, communication and resident rights.
  • Safeguards against abuse, neglect and exploitation. A nursing home cannot employ a licensed individual with a disciplinary action, must report suspicions of a crime to law enforcement and must train all staff on abuse prevention.
  • Increased visitation rights. A resident can accept visitors at any time of day.
  • Elimination of care plan gap. Nursing homes must develop an initial care plan within 48 hours; previously residents could be without a care plan for up to 21 days.
  • Protection against “dumping” residents in hospitals. If a nursing home refuses to allow a resident to return from a hospital stay, the resident now has an immediate appeal right.
  • Prohibiting forced arbitration. Nursing homes cannot force residents into private arbitration for claims of abuse, neglect or other instances of substandard care.

Nursing homes care for some of the sickest and most frail among the U.S. population, and many residents have multiple chronic conditions, physical or cognitive disabilities that make it difficult for them to successfully advocate for themselves. The consequences of inadequate care in these situations is disastrous. Residents endure unbearable living conditions and neglect by those who are entrusted with their care and in some cases have been subject to psychological and sexual abuse as well.

  • While living in a nursing home, Mrs. R was raped twice by a male caregiver. She suffered severe lacerations, vaginal bleeding and broken teeth. No one in the facility called the police either time. Three allegations of abuse had previously been made against this same caregiver. The abuse stopped only when the rapist confessed to his minister, who convinced the caregiver to turn himself into police.
  • Upon admission to a nursing home, Mrs. A was assessed by staff as being at risk for pressure ulcers (bed sores). Nevertheless, staff did not use even basic measures to prevent their development. In the space of two months, Mrs. A developed two pressure ulcers. Less than three weeks later, she had seven. When she was sent to a wound care center, she was found to have numerous pressure ulcers and to be suffering from fever, infection and malnutrition. The wounds on her left leg were so infected and gangrenous that her leg had to be amputated to save her life.

Like Mrs. R and Mrs. A, 1.3 million Americans receive care in nursing homes and their safety depends in large part on strong quality of care standards. After 25 years, in Sept. 2016, the federal government issued a complete revision of nursing home regulations.

Under this revision, nursing homes now must provide more staff training (including training in abuse prevention and dementia care); report suspected crimes to the police; and ensure that nurses and aides have the appropriate skills to provide necessary care. The revised rule could have made a difference in the lives of Mrs. R and Mrs. A and surely will benefit the millions of frail and dependent people who will be living in nursing homes now and in the future.


Nursing homes oppose the rule: “On the CRA track, AHCA (American Health Care Association)/NCAL’s approach is to seek to have the requirements of participation rule repealed.”  Provider: Long-Term and Post-Acute Care. January 2017

TABLE: Political Spending by Opponents of the Nursing Home Protections

Industry/Group Lobbying Political Spending % Political Spending to Republicans
 U.S. Chamber  $79,205,000 (2016)  $29,420,085 (2016) 99%
 AHCA  $4,002,000 (2015)  $1,249,132 (2016) 45%



Eric Carlson, Justice in Aging,; (213) 674-2813

Julia Duncan, American Association for Justice,, (202) 944-2819

Robyn Grant, National Consumer Voice for Quality Long-Term Care,, (202) 332-2275, ext. 205


Why the Recently-Revised Nursing Home Regulations are Vital for Nursing Home Residents
Justice in Aging; National Consumer Voice for Quality Long-Term Care: January 2017

A Closer Look at the Revised Nursing Facility Regulations: Assessment, Care Planning, and Discharge Planning
Justice in Aging; National Consumer Voice for Quality Long-Term Care; Center for Medicare Advocacy: December 2016

Forced Arbitration: How Corporations Use the Fine Print to Bully Americans
American Association for Justice: July 2016