What federal or state agency regulates Georgia nursing homes? In fact, Georgia nursing homes are overseen by the Georgia Department of Community Health as well as the United States Centers for Medicare and Medicaid Services. In this week’s episode, we dig deeper into the regulations and agencies in charge of enforcing them.
Hello out there. Welcome back to the podcast. My name is Rob. I will be your host for this episode. We’re going to be talking about nursing home regulations and oversight and who is in charge of that. Essentially nursing home regulations are going to come from two separate sources in the state of Georgia. One is at the federal level, meaning the U.S. government, the United States government, and the Georgia state government. So that’s the two levels of oversight and regulations that we have for nursing homes.
So the Department of Health and Human Services is the federal agency that is responsible for oversight of healthcare facilities and nursing homes across the country. The particular kind of subset of that, the actual agency that rolls up their sleeves and actually does the work is Centers for Medicare and Medicaid Services. And the reason why it’s not like the Department of Nursing Homes is because the Centers for Medicare and Medicaid Services is the agency that pays for most of the treatment provided by nursing homes, so therefore they are the ones that operate as the oversight body at the federal level of nursing homes. And also that’s the way in which federal regulations can apply to state nursing homes is that if the state nursing home accepts Medicare or Medicaid funding, they have to agree to the regulations imposed by the federal government. Not to get into a federalist commerce clause issue here because most people don’t care about that, but that’s the workaround for why the federal government can oversee a nursing home in Albany, Georgia, for example is if the nursing home takes Medicare funding, then they have to agree to regulations at the federal level. So Department of Health and Human Services – within that, the Centers for Medicare and Medicaid Services. That is the federal oversight agency in charge of nursing homes.
At the state level, at the Georgia level, we have what’s called the Georgia Department of Community Health. That’s kind of like the Health and Human Services at the federal level, we call it the Department of Community Health. Within that department in Georgia, there is the Department of Healthcare Facility Regulation – the Healthcare Facility Regulation Department within the Department of Community Health. That’s the state, or local agency, that regulates Georgia nursing homes.
Now in terms of the regulations, so you have the agencies and the agencies enforce the regulations, and the regulations exist again at the federal level and the state level. The federal regulations that govern nursing homes are quite extensive. They’re massive. There was a law that was passed in 1987 at the federal level called OBRA, the Omnibus Reconciliation Act of 1987, which is basically the Nursing Home Reform Act. And the Nursing Home Reform Act does everything from define what nursing services are to what a nurse aide can do, what an assessment is, how often they have to do assessments. Every component to running and nursing home is regulated by the federal government through that OBRA regulation, through the Nursing Home Reform Act. The Bill of Rights, staffing, nurse-to-resident ratio, all of that is covered in the federal regulations.
There are Georgia regulations. There are Georgia laws, but they only kind of fill in some of the gaps of the federal regulations. So in other words, the primary driver of how a nursing home behaves and how a nursing home conducts its business is based on federal regulations, not so much the Georgia state regulations, if that makes any sense. In some states, the state regulations are far more restrictive and far more extensive than the federal regulations. In Georgia, we said, “No, the federal has got most of it covered. We’re only going to fill in some of the gaps.” And again, like I said, if the nursing home in any way takes Medicare or Medicaid funding, they cannot get out of those regulations. They have to do what those regulations say. That’s the interaction between the state and federal government, in terms of how either regulates Georgia nursing homes.
So a part of those regulations, a part of the fact that they need to follow the law is that nursing homes are inspected to ensure that they’re doing those things on a regular basis. So typically a nursing home under the federal regulations must be inspected at least annually. This is a survey of the nursing home that members of the Department of Community Health go to a nursing home all across Georgia and do an assessment of that nursing home. Are they following emergency protocols, infection protocols? Are there fire extinguishers? Do the doors work? Is the food cold? That annual inspection lays all of that out. So that’s one way in which the nursing homes have to mind their P’s and Q’s.
Also the Department of Community Health can go in and do their inspection of a facility that is based on a complaint, so not an annual inspection, which has to happen under the law, but by way of a complaint. So if you have a grievance and you inform the Department of Community Health, then depending on the jeopardy level, they’ll immediately go out there and they’ll conduct their own investigation and figure out what’s going on at that facility.
And you as a person that has a loved one in a nursing home can actually go and read the annual inspections or the inspections based on complaints by going on the Medicare/Medicaid services website, which is Nursing Home Compare. If you just type in “Nursing Home Compare,” it’s probably going to be the first result. But CMS has its own website where you can read all of those documents, which is very important because you can find out what actually is going on at your loved one’s nursing home. Have they been cited for failing to have infection protocols or not adhering to care plans, that type of thing? You can read all about that in those inspection reports.
So not only are there annual inspections or inspections based on complaints but there can be penalties for failing to operate under those nursing home regulations. They’re called civil monetary penalties and we’ve had discussions about that on previous episodes. But unfortunately in my opinion, the civil monetary penalties for violating federal and state regulations don’t deter the poor conduct or poor behavior. If a nursing home is cited $5,000 or $10,000 or $25,000 for failing to be properly staffed or failing to adhere to care plans continuously, causing immediate jeopardy to a resident based on XYZ reason, a $25,000, $50,000 hit is not going to put a dent in some of these nursing home facilities. And that’s one of the main reasons why the civil justice system is so important with reform of nursing homes. A nursing home is not going to change its ways based on a $50,000 penalty, but a $500,000 jury verdict might do that. A $1 million arbitration award might do that. So that’s something we can get into in another podcast, but as a result of the surveys, a result of the inspections, a nursing home can be cited. They can be penalized, but oftentimes the penalizations, the penalties are not deterring the crimes essentially.
So you have Department of Community Health, the Healthcare Facilities Regulations Division – they inspect the nursing homes at these intervals. But it’s not necessarily so that they’re the only people that can help you, they’re the only people that can make a change. If you’re having issues with your nursing home, by all means, call the Department of Community Health, file your complaint. Definitely if it’s a serious allegation, get the Department of Community Health involved, get their complaint inspectors to come out and survey that nursing home.
But you also have the ombudsmen, the Georgia Long-Term Care Ombudsmen Program at your disposal. While they don’t “regulate” or “oversee” nursing homes, they do advocate on behalf of nursing home residents and they’re allowed under the law to go into the nursing home and try to effectuate a resolution to your particular situation. So the ombudsman is a great resource for you and your loved one.
Also depending on the severity of the issues, so for example, if your loved one was assaulted, physically assaulted, sexually assaulted, if your loved one was injured by another resident, maybe a staff member, then get the police involved. So there’s a time and place for the Department of Community Health. There’s a time and place for the ombudsman. There’s a time and place for the police, so if you need to get the police involved, by all means, do so. Again, local law enforcement doesn’t oversee nursing homes, but they can definitely conduct criminal investigations if criminal behavior has occurred in the nursing home.
And finally, again, an attorney might be an option for you if your loved one has been injured or seriously hurt or killed in a nursing home, then an attorney might be the one who can get justice for your loved one. So on the hierarchy on the oversight of the nursing home, typically it’s the Healthcare Regulation Division of the Georgia Department of Health that’s going to be involved with inspecting, surveying, making sure things are going right. To a lesser extent, it’s the ombudsmen who advocate on behalf of your loved one, the police, which will conduct criminal investigations of criminal occurrences in nursing homes, and then finally the civil justice system through the process of civil litigation can provide you with help and justice if you need it.
Quick episode this week. There’s not a lot to go into but I just wanted to make it known because we get asked that, “Well okay, does the police oversee the nursing homes? Does the governor do it?” No, it’s the Georgia Department of Community Health and the Centers for Medicare and Medicaid Services that oversee nursing homes based on federal and state regulations. It’s as simple as that.