New rules for nursing home administrators put residents at risk

Over the last 12 months, both the federal and Pennsylvania governments have taken actions that could significantly impact safety at nursing facilities.

The United States has 15,452 nursing facilities according to the Kaiser Family Foundation, and 4.5 percent, or 702, are located in Pennsylvania, putting it behind only California, Illinois, Ohio, and Texas. As a result, Pennsylvania has a strong interest in the future of nursing homes. With Pennsylvania's median age of 40 and 32 percent of the state's population over the age of 55, Harrisburg has been turning its attention to this complex, highly-regulated industry.

Last week, the Pennsylvania Board of Examiners of Nursing Home Administrators voted to reduce the number of continuing education hours required of licensed nursing home administrators. The reduction was hotly opposed by both advocates for the elderly and the nursing home industry. This initiative, an effort to reduce employment barriers to entry, comes on the heels of the Trump Administration's policy change discouraging regulators from levying fines against nursing homes, even where behavior led to serious results, including death.

While the intent behind these changes is to encourage administrators to focus more on the care of the residents and less the regulatory "bureaucracy," in reality, they reduce the already limited legal remedies available for residents receiving substandard care.

Nursing facilities are extensively regulated at the federal level.  Traditionally, violations of these requirements could result in significant fines, either once for the specific violation or for each day the facility was in violation. Although, ideally, nursing home administrators should be incentivized to comply with regulations for the good of the residents, violations are not uncommon.

At best, the demand for care far exceeds the supply of caretakers, making it difficult for nursing home facilities to ensure that all residents are receiving quality care while also ensuring that administrative requirements are being met. At worst, for high reimbursement services, administrators are incentivized to take on more residents than can effectively be monitored and cared for. Additionally, as nursing home residents often suffer from a combination of physical and mental impairments, there are ample opportunities for administrators to bill for services that are not fully rendered, or in some instances, that are not rendered at all.

As nursing facilities across the country face similar challenges, and in an unstable political climate, it is essential that nursing home administrators stay informed and up-to-date on changes in nursing facility requirements, compliance needs, and penalties. The Pennsylvania Board of Examiners of Nursing Home Administrators' decision to reduce the number of required continuing education hours, while intended to benefit individuals hoping to enter and remain in nursing home administration, risks significantly harming the population these nursing facilities were created to help, the residents.

Mara Smith is an associate with the law firm of Montgomery McCracken specializing in health law.