top of page

How Long-Term Care Facilities are Regulated – What You Need to Know

Updated: Oct 6, 2022

How are long-term care faciliaties regulated? It’s a question many older adults and family caregivers ask.

Here’s an overview.

Nursing Homes & Assisted Living Centers Are Regulated Differently

Nursing homes are regulated by the federal government. Each state has an additional set of regulations. Assisted living centers are subject only to state regulation, not federal. The requirements assisted living facilities must meet are more liberal in comparison to nursing homes. The difference is best illustrated by comparing the regulatory documents. Nursing homes must comply with 750 pages of federal regulations; documents detailing regulations for assisted living centers are approximately 50 pages long. If you’re interested in reading the regulations, the links below will take you to each document.

Residents’ Rights Differ by Care Setting

The rights patients have in different care settings are essentially the same basic rights we all enjoy as Americans. What’s different is how the person accesses those rights. Access differs depending on the care setting. The more restrictive the care setting (and the regulations that govern it), the more difficult it is for a resident to access the full range of rights as we know them. That’s why it is important for family caregivers to understand residents’ rights.

Transitions and Bed Certification

When transitioning from a skilled care setting to a long-term care center, bed certification is often an issue. During this transition, a patient may not be required to move to another hall, depending on the way the beds are certified. When a patient transfers from a skilled setting to a long-term setting (also known as intermediate care), the payer usually transfers from Medicare to Medicaid or private pay. A resident has the right to refuse a room transfer if the reason for the transfer is to move the resident from a skilled hall to another hall that does not provide skilled care, or, simply speaking, when the payer source changes from Medicare to something else. This is the only time the resident has the right to refuse to move because the move could be viewed as financially motivated. Most facilities have their beds dually certified, meaning it doesn’t matter who is paying for the care. This is important because most skilled units have a larger staff than other halls with more therapists, nurses, and other staff members available. Facilities often like to keep their skilled rehabilitation residents together because it makes it easier on the staff. The resident may not be informed that he or she has the right to remain in the skilled area. Instead, the patient might be told something to the effect that “rehabilitation is over; it’s now time to move to our long-term care unit.”

Care Planning is Mandatory

A care plan should be created within the first few weeks of admission. After that, meetings to discuss care plans should be held at least quarterly at times that are convenient for the resident and family members. Family members have the right to request a meeting to discuss a care plan at any time.

Family Involvement Makes a Difference

During the meeting, one family member made an important point. He expressed that he feels his wife’s care is enhanced by his presence at the nursing home. He visits frequently and interacts with her direct caregivers as well as the administrative staff. Being an effective advocate for your loved one’s care is always easier when you are a regular visitor. As the old adage goes, the squeaky wheel gets the grease.


bottom of page