Nursing Home Legislation

Proposed Nursing Home Reforms Highlight Prevalence of Abuse and Neglect Affecting Maryland Residents

May 6, 2021 | Lebowitz & Mzhen

Over a year into the COVID-19 pandemic, some states are proposing—and passing—reforms to address the issues prevalent in Maryland nursing homes and those across the country. New York state recently passed a law set to be signed into law that would require for-profit nursing homes to spend at least 70% of revenue on direct patient care. In addition, any profits over 5% would be given to the state. The law would direct 40% of a nursing home’s budget to be spent on staff who work directly with residents. A law professor commented that a state immunity law that was recently repealed had allowed homes to engage in practices that created “unreasonable risk to residents.” One family member whose husband, a Navy veteran, was a resident in a nursing home said that he had not been given a shower in weeks.

Maryland lawmakers have considered a reform bill that would impose additional requirements on out-of-state nursing home purchasers, along with other reform bills. The bill would require state inspections after owners from outside of Maryland purchase nursing homes in the state. The bill would require unannounced inspections three and six months after the purchases are made.

Nursing home residents in Maryland continue to be at risk for abuse and neglect by staff members, medical providers, and other residents. Abuse may be physical, sexual, emotional, or financial. Signs of abuse can vary but could include unsanitary living conditions, broken bones, unexplained injuries, a history of repeated injuries, fear of certain people, bedsores, missing property, and missing funds. Neglect can be more difficult to detect in some cases, but it could include a lack of mobility, poor personal hygiene, and psychological distress.

Maryland Considers Immunity for Nursing Homes as Some States Roll Back Protections

April 13, 2021 | Lebowitz & Mzhen

New York state recently passed a law that revokes the immunity of nursing homes from liability for decisions concerning the COVID-19 pandemic, according to a recent article. Over 15,000 residents and staff died in nursing homes, assisted living facilities, and other long-term care facilities in that state. New York had originally passed a bill granting immunity to nursing homes during the pandemic, preventing residents and their families from suing nursing homes in court for an injury or death based on negligence. Meanwhile, Maryland has considered increasing immunity for COVID-related injuries.

In January of this year, the state Senate introduced a bill that would expand immunity from claims based on COVID-19. As introduced, it would protect anyone who acts in compliance with certain regulations, statutes, and orders (including Maryland nursing homes and long-term care facilities). However, the bill would not protect people who act with gross negligence or intentional wrongdoing. The Senate bill remains pending, and a similar bill was introduced in the House. Proponents’ of New York’s law argued that the immunity protected nursing homes that made decisions even in bad faith.

Under Md. Code Ann. Pub. Safety section 14-3A-06, a healthcare provider is shielded from liability if the healthcare provider acts in good faith while there is a “catastrophic health emergency” proclamation. This law was in place before the COVID-19 pandemic. Even if Maryland’s proposed bill becomes law, facilities must follow state and federal guidelines to receive immunity. As of March 1, 2021, under a Maryland directive, licensed nursing homes must comply with the guidance on COVID-19 issued by the U.S. Centers for Disease Control and Prevention, U.S. Centers for Medicare and Medicaid Services, and the Maryland Department of Health. If a resident or staff member tests positive for COVID-19, all residents who have not tested positive for COVID-19 within the previous 90 days must be tested. Maryland has had more than 30,000 COVID-19 cases in nursing homes and over 3,500 deaths in nursing homes, group homes, and assisted living facilities.

How Could a President Biden Affect Nursing Home Regulations in Maryland?

November 4, 2020 | Lebowitz & Mzhen

Maryland nursing homes must meet certain standards under state and federal regulations. They must follow state laws and regulations applicable to nursing homes. In addition, facilities that accept Medicare and Medicaid patients are also required to meet federal nursing home standards. Federal and state regulators ensure compliance by conducting surveys, visits, and investigations.

According to a recent news report, the Democratic candidate for president Joe Biden has said that he plans to spend $775 billion to expand community-based senior services if elected. He also wants to enact nursing home reform in the wake of the coronavirus pandemic. The current administration has generally maintained less oversight with a goal of reducing perceived paperwork burdens and focusing on public-private partnerships to tackle issues. For example, the administration plans to rely on retail pharmacies CVS and Walgreens to distribute a COVID-19 vaccine in nursing homes. The administration has proposed less frequent surveys of the highest-ranked nursing facilities to concentrate on “low performers.”

Biden has said he would make federal nursing home surveys more frequent and increase the current penalties to force compliance with federal standards. He also proposed requiring that each facility have a mandatory infection disease specialist, requiring the federal Department of Health and Human Services (HHS) to audit nursing home cost reports, and increasing personal protection equipment (PPE) supplies by invoking the Defense Production Act. The proposal also calls for restoring a previous ban implemented by President Obama on forced arbitration agreements for residents—a ban that President Trump reversed.

How COVID-19 May Affect Maryland Nursing Home Abuse and Neglect Lawsuits

July 28, 2020 | Lebowitz & Mzhen

Recently, an industry news source recorded a fascinating podcast including an interview with a former assistant U.S. attorney who discussed legal issues that could arise for nursing homes from the COVID-19 pandemic. The podcast discusses how nursing home abuse and neglect cases may be affected by the virus. The information is very important for residents of Maryland nursing homes or those who have loved ones in these facilities.

The podcast discussed the various immunity laws passed for health care providers as a result of the pandemic in states across the country. These laws are not brand new—some states have long had immunity provisions that kick in automatically whenever a state of emergency is declared. Most of the current immunity provisions in effect now during the COVID-19 pandemic change the level of culpability that facilities can be held to in nursing home abuse or neglect cases that have to do with the disease.

Typically, someone bringing a nursing home abuse or neglect case has to prove that the actions of the facility amounted to negligence and contributed to resulting injuries, illness, or death. However, the immunity provisions typically increase the standards. According to the podcast speaker, the provisions basically say that nursing home facilities and the individuals working within them will no longer be responsible for negligent behavior. Instead, they can only be held liable at a higher standard, such as gross negligence or reckless disregard. This makes it much harder for victims of nursing home abuse or neglect to hold the facilities responsible, because it’s a higher bar of proof to reach. In other words, it might not be enough to show that the nursing home or employees acted negligently or carelessly and caused the spread of COVID-19 or even a COVID-related death. Instead, potential plaintiffs might have to prove that the nursing home was extremely careless, perhaps even maliciously or willingly, which is much harder to prove as a matter of law.

Will Maryland Be the Next State to Enact Strict Nursing Home Camera Laws?

February 4, 2020 | Lebowitz & Mzhen

Each year, more states enact laws that allow for cameras in nursing homes and assisted living homes, which provide much-needed protection for residents. The laws allow residents and their families to place cameras in the residents’ rooms. In 2003, Maryland enacted a law requiring the Maryland Department of Health and Mental Hygiene to develop guidelines for electronic monitoring. Under those guidelines, the state currently allows electronic monitoring in Maryland nursing homes with resident consent—but only if the nursing home allows it.

Meanwhile, other states continue to enact electronic monitoring laws, many that provide much greater protections to residents. According to a local news source, Minnesota recently passed an electronic monitoring law to protected elderly adults. The law, entitled the Elder Care and Vulnerable Adult Protection Act of 2019, took effect on January 1, 2020. A state ombudsman said that electronic monitoring is a right included in the state’s Home Care Bill of Rights.

The law was advocated for by families whose loved ones were abused or mistreated. Under that state’s law, there is a consent form required in order to obtain the monitoring device. Providers such as nursing homes must tell residents about the law and have the forms available to use. Consent is required from all people living in the same room. Before the law was enacted, according to the ombudsman, residents and their families were installing cameras, but there was nothing to stop others from removing the cameras. Under the new law, residents there can install cameras without letting the providers know.

Centers for Medicare and Medicaid Services 2020 Priorities Signal Increased Protections for Maryland Nursing Home Residents

January 28, 2020 | Lebowitz & Mzhen

The Centers for Medicare and Medicaid Services (CMS), an agency that oversees Medicare and Medicaid and works to identify and eliminate nursing home fraud and abuse, recently released a memorandum detailing their 2020 priorities. These updated priorities are important for Maryland families to understand, as they affect the rights of nursing home residents as well as a resident’s ability to recover in case of nursing home neglect or abuse.

One of the major updates included in the 2020 memorandum concerns arbitration agreements. Arbitration agreements, if signed, require an injured nursing home resident to settle disputes with the home through a confidential arbitration process, rather than in court. This process operates privately, and while it is much faster than traditional litigation, plaintiffs lose any right to appeal and evidence shows plaintiffs are more likely to lose in arbitration. CMS’s recent memorandum states that the agency will allow nursing homes to use binding arbitration agreements with their residents, but that such agreements cannot be required as a condition of receiving care. For instance, if a resident refuses to sign the agreement, nursing homes cannot refuse to care for them solely on that basis. Additionally, CMS indicated in the memorandum that nursing homes must also explain to residents or their representatives that they can still receive care without signing.

CMS also stated that it plans to make changes to how instances of abuse and neglect are reported and investigated. For instance, new guidelines released later this year may include changes in the time frame required for investigations, the collection of certain evidence and investigative report, and general new policies and procedures to be implemented in nursing homes to catch instances of abuse.

New Legislation May Impact Maryland Nursing Homes’ Ability to Force Arbitration on Residents and Their Families

March 14, 2019 | Lebowitz & Mzhen

Historically, Maryland nursing homes have been able to avoid costly lawsuits brought by residents or their family members by including arbitration clauses in the pre-admission paperwork that is presented to residents prior to their admission. By signing an arbitration clause, a nursing home resident gives up their right to a trial by jury, and agrees to resolve any dispute that may arise between the parties through binding arbitration.

While in theory arbitration may not sound like a bad thing for nursing home residents, by agreeing to arbitration, nursing home residents give up important rights and get little to nothing in return. That being the case, it is not surprising that long-term historical data shows that nursing homes fare better in arbitration than they do in traditional courts.

For the past few years, nursing home arbitration contracts have been the subject of much debate. During the Obama Administration, nursing home arbitration contracts were disfavored, and those nursing homes that included these clauses in their pre-admission paperwork were ineligible for federal funding. However, more recently that policy has been stepped back, and nursing homes have seized the opportunity, and have started to rely on arbitration clauses once again.

Federal Agency Takes Steps to Counter Low Nursing Home Staffing Levels in Maryland and Nationwide

December 14, 2018 | Lebowitz & Mzhen

Study after study has shown that one of the root causes of Maryland nursing home abuse and neglect is understaffing. Federal regulations require that a Registered Nurse is on staff seven days a week for at least eight consecutive hours a day. And in general, the fewer qualified staff members a nursing home has, the more work each staff member must take on. Without a registered nurse on staff, the level of care a nursing home can provide is greatly limited. At some point, overworked employees face a reduced ability to perform the functions of their job with the patience and care that is required.

According to a recent industry news report, a few weeks ago the Center for Medicare and Medicaid Services (CMS) issued a new rule that will increase the agency’s oversight of nursing homes in an attempt to lower the number of homes that operate with reduced staffing levels. States have always been required to survey nursing home staffing levels. However, under the old rule, only 10% of those surveys had to be conducted during the weekend and off-peak hours. However, the new rule requires that state conduct 50% of surveys during weekend and off-peak times.

The new rule uses payroll-based journal data to identify the 20% of nursing homes in each state with the lowest level of staffing on the weekends and during off-peak hours. Once the 20% in each state is identified, the CMS will provide the names of the facilities to state agencies. Each state will then be responsible for following up with additional surveys. If a facility remains out of compliance, it will be sanctioned accordingly. Understaffing can also result in a nursing home receiving a low star-rating.

Federal Government Attempts to Combat Underreporting of Nursing Home Abuse and Neglect in Maryland and Nationwide

November 14, 2018 | Lebowitz & Mzhen

As the average lifespan in America continues to increase, more and more families will need to rely on Maryland nursing homes to provide care for their aging loved ones. Indeed, nursing homes offer a necessary service; however, reports have recently come to light that nursing home abuse and neglect are rampant. Perhaps more alarming are the results of a recent government study indicating that of all the cases of nursing home abuse requiring hospitalization, 28% went unreported until the resident arrived at the hospital.

Instances of nursing home abuse and neglect are underreported for several reasons. One reason is that many residents are embarrassed to report what happened to them, or fear that they will be seen as troublesome by family members. Another reason is that the residents who are victims of abuse or neglect are often not in a condition to articulate what they are experiencing, and in some cases, residents have no one to report the abuse or neglect to.

According to a recent industry news source, the Centers for Medicare & Medicaid Services proposed a new regulation that would impose significant monetary fines upon employees of skilled nursing facilities who fail to report abuse, neglect, or other crimes within a certain period. Not only would the new regulation require an employee to report abuse or neglect that was witnessed, but it would also require an employee to report a “reasonable suspicion” that abuse or neglect was occurring. The idea behind the newly proposed regulation would be to encourage employees in these facilities to speak up on behalf of the residents who are the victims of abuse or neglect.

State Attorneys General Call Nursing Home Reforms into Question and Call for a Reevaluation

June 7, 2018 | Lebowitz & Mzhen

Earlier last year, the current administration rolled back certain regulations that the Obama administration put into place regarding the issuance of Civil Money Penalties (CMPs) to nursing homes that were found to have provided inadequate care to residents. Essentially, the regulations allowed for the federal government to fine nursing homes that were not in compliance, including Maryland nursing homes.

Those in favor of the rollbacks claimed that the additional regulations took caregivers’ attention away from residents, requiring that they focus on meeting the regulatory framework set forth by the lawmakers. However, in reality, it seems as though the rollback of the previous regulations has merely allowed for nursing homes to act with impunity as it relates to the level of care they provide to residents.

According to a recent news article, 17 state attorneys general – including those in Washington, D.C. and Virginia – authored a letter to the Trump administration. The letter discusses the importance of senior care, noting that by 2060, the number of people dependent on skilled nursing facilities is expected to double. This means that one in three people will find themselves in a nursing home at some point in their life. Given the fact that about 35% of all nursing homes were cited for a violation of the quality of care being provided to residents, these figures are alarming to say the least.