How are Nursing Homes Regulated?
Regulations Ensuring Adequate Nursing Home Care
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.
What does an inspection actually look at?
An inspection looks at resident care and the conditions inside the nursing home. AHCA surveyors review resident records, care plans, and medication records to see what care was planned and what was documented. They speak with residents and staff about daily care, and they check cleanliness, safety equipment, and infection control. Staffing is part of that picture; our guide to Florida nursing home staffing requirements explains why it matters to residents. These checks give surveyors more than the facility’s account of what happened. A family’s concerns about missed care or unsafe conditions may point them toward records or areas that need closer attention. If you are trying to understand a facility’s history, Florida nursing home ratings offer another place to start, although a rating cannot tell you what happened to one resident.
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.
What can happen to a facility that does not fix it?
A nursing home that fails to correct a cited problem may face fines, denial of Medicare or Medicaid payment, or, in serious cases, loss of certification. What happens depends on the problem found and whether the facility addresses it; a citation alone does not tell a family which consequence will follow. These measures are intended to press the facility to correct deficiencies and protect residents from further harm. Our post on federal laws that shape nursing home abuse protections in Florida explains the federal role in that process. A citation does not compensate the resident for harm; a civil claim may seek that compensation. If the same problem appears to be continuing, keep track of what you see and what the facility tells you it has done.
Are assisted living facilities regulated the same way?
No. AHCA also licenses assisted living facilities, but those facilities are regulated under Chapter 429, while Florida nursing homes fall under Chapter 400. The distinction matters when a family is reading a report or deciding where to send a complaint: a nursing home’s inspection findings should not be assumed to describe an assisted living facility. Federal Medicare and Medicaid certification rules generally apply to nursing homes, not assisted living facilities. Before relying on a nursing home rating or a discussion of federal nursing home standards, check how the residence is licensed. If you are unsure what kind of facility your loved one lives in, ask the facility for its license information and use that description when you report your concern.
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 AHCA’s Health Care Facility Complaint Form.
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.
Who handles abuse reports, as opposed to inspections?
Suspected abuse, neglect, or exploitation should be reported to the Florida Abuse Hotline, which is run by the Department of Children and Families. Call 1-800-962-2873 or report online. DCF’s Adult Protective Services investigates reports involving vulnerable adults. AHCA has a different role: it looks at complaints about licensed facilities and whether a nursing home is meeting care standards. A family may have reason to contact both agencies when a resident has been harmed and the facility’s care is in question. You do not need to settle which agency’s job it is before reporting what you know. Give the resident’s name, the facility, what happened, when it happened, and any immediate safety concern as clearly as you can. The State Long-Term Care Ombudsman Program also advocates for residents and works with them and their families on complaints about care and quality of life. If you want to understand who must make an abuse report, read our post on Florida’s mandatory reporting rules for nursing home abuse. Keep a record of your report and any response, then follow up if your loved one’s safety remains a concern.
