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The Role of U.S. Centers for Medicare and Medicaid Services | Guest Post

When most of us hear about Medicare, we probably think of the federal program that helps pay for older adults’ health care including staying at a nursing home.  CMS has another more important role to inspect health care facilities to make sure that patients receive safe and high-quality care and implement regulations that are the basis for the standard of care to be provided.

The United States has more than 15,000 nursing homes.  The vast majority accept taxpayer funds through Medicare and Medicaid.  Nursing homes that seek reimbursement for treating Medicare patients must be certified as meeting certain health and safety requirements. Trained health professionals called surveyors make unannounced visits to nursing homes to check whether the health and safety standards are being met and, if not met, to ensure the problems are addressed. However, many times the nursing homes are aware that the inspection is coming and will “staff up” to make it appear that the staffing is greater than it actually is before the inspection.  An inspection may also result from a complaint lodged by a patient or family member.

Nursing homes that continue to have the same violations and deficiencies may be subject to fines. However, the Trump Administration has placed a moratorium on most fines for 18 months.  If the health and safety violations persist and pose a serious enough threat to patients, the facilities may be terminated from the Medicare program and forbidden to bill the government for patient care.  Unfortunately, that is extremely rare and does not act as a deterrent for large for-profit chains.

You can see how the nursing homes in your community have fared in recent health and safety inspections by visiting Medicare’s Nursing Home Compare website at CMS.gov.  The website provides detailed information on ownership, inspections, staffing and such quality measures as whether residents are in pain, losing weight, or suffer from pressure ulcers or bedsores. The site uses a five-star rating system to help you understand the differences in the quality of care between nursing homes.  Families should avoid nursing homes with a one or two star rating.

If you or a loved one has been hospitalized, the physician, discharge planner or social worker can help identify an appropriate facility for your recovery.  You also might:

  • Visit the nursing homes that interest you. Make an appointment and think of the questions that are important to you. Nursing Home Compare contains a helpful checklist of questions that covers everything from care and safety to activities and food.
  • Ask for recommendations from friends, family or neighbors who may have had a loved one in a nursing home.
  • Call your state’s long-term care ombudsman to find out how many complaints have been filed against particular nursing homes, what kind of complaints they were and whether they were resolved.

For more tips on selecting a nursing home, visit the Nursing Home Compare website or call Medicare’s 24-7 customer service line at 1-800-633-4227. A free Medicare publication, a “Guide to Choosing a Nursing Home,” can also be downloaded from the website or requested by phone.

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When you or a family member become a patient in a nursing home, you have a right to expect the facility will comply with Medicare’s health and safety standards.

 As attorneys who specialize in nursing home neglect and abuse cases, please contact us for help if a loved one has been neglected or abused at a nursing home.

 Gary W. Poliakoff is the senior partner at Poliakoff & Associates who specializes in nursing home neglect and abuse cases, and has a blog called www.SCNursinghomelaw.com.

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Laurence Banville
Date Published: July 21, 2018
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