The quality of care provided in nursing homes has been a persistent concern for decades, with numerous studies identifying serious deficiencies in treatment and living conditions for residents. A landmark 1986 study by the Institute of Medicine exposed widespread inadequacies, reporting that some government-certified nursing homes provided care so deficient that it hastened residents’ physical, mental, and emotional decline.
Historical Efforts to Improve Nursing Home Care
Efforts to regulate nursing home care began with the 1965 Medicare and Medicaid legislation, which established standards for participating facilities. Key legislative milestones have since strengthened protections for residents:
- 1974 Nursing Home Bill of Rights: Required nursing homes accepting Medicare or Medicaid funds to meet federal care standards.
- 1987 Nursing Home Reform Act (OBRA): Introduced as part of the Omnibus Budget Reconciliation Act, this law enhanced federal regulations, mandating care plans for residents, maintaining residents’ quality of life, and codifying a Bill of Rights for nursing home residents.
The Centers for Medicare and Medicaid Services (CMS) established regulations aimed at ensuring the health, safety, and welfare of residents, working with states to conduct compliance surveys and investigate complaints. Facilities that fail to meet standards face penalties such as monetary fines, admission holds, or loss of participation in Medicare and Medicaid programs.
Persisting Deficiencies in Nursing Home Care
Despite these regulatory efforts, significant quality issues remain. A 2014 analysis showed that only 10.2% of nursing home surveys reported zero deficiencies, while 10.6% revealed deficiencies at a level that caused actual harm or worse to residents. Investigations consistently highlight underreporting of issues, delays in addressing complaints, and inconsistencies in state survey practices.
For-profit nursing homes have been found to exhibit greater deficiencies compared to nonprofit and government-operated facilities. Studies indicate that for-profit facilities often prioritize cost-cutting measures, such as reducing staff levels, which significantly impact care quality. Facilities owned by private equity firms and large chains have shown higher rates of deficiencies and worsening care standards after ownership changes.
The Role of Staffing in Quality Care
One of the key factors behind quality problems in nursing homes is inadequate staffing. Research has consistently demonstrated a positive correlation between higher staff-to-resident ratios and better care outcomes. However, staffing costs are often the largest and most controllable expense for nursing homes, making it a frequent target for cuts—especially in for-profit facilities.
Moving Toward Better Standards
Despite decades of reforms, improving nursing home care remains an ongoing effort. Increasing oversight, ensuring adequate staffing, and holding facilities accountable to regulatory standards are critical to addressing persistent quality issues. Strengthening the enforcement of regulations and enhancing transparency can pave the way for better outcomes for nursing home residents and their families.