Regulatory Changes and Their Effects
(click on author's name for summary or abstract)
Overview: Only a handful of articles were identified as falling into the category of regulation. Two of these are attempts to measure the effects of specific regulatory changes. First, Boyce et al. (2003) examine the impact of the regulations implemented in Maryland concerning nursing home attending physicians and medical directors and nursing home quality assurance requirements. Second, Zhang and Grabowski (2004) look at whether the Nursing Home Reform Act (NHRA) improved nursing home quality and design. The other articles discuss the need for additional regulations in specific areas such as for minimum staff-to-patient ratios (Tanner, 2003) and for the assisted living industry (Kissam et al., 2003). Finally, Schnelle et al. (2004) discuss the problem of the dependence of regulatory agencies on medical record documentation along with the lack of incentives for staff and facilities to record such information accurately, and Grant and Tellis-Nayak (2004), discuss regulatory goals as a test of quality performance.
In March, 2005, the University of Minnesota was awarded a grant from the Hulda B. and Maurice L. Rothschild Foundation, Chicago, Illinois for a project called: Comparing State Regulations Affecting Nursing Homes: Implications for Culture Change and Resident Autonomy. The impetus to this initiative arose because regulatory barriers are widely cited for failure to innovate with nursing homes in ways that increase resident autonomy and quality of life, but no convenient repository exists for actual state regulations and the way that they are applied. The project has yielded a searchable website, NHRegsPlus that allows users to examine and compare the content of state regulations related to nursing homes, the processes of regulation and exceptions to regulations within a state, recent state changes, innovative nursing-home designs and programs that were accomplished within existing regulations, and innovative state regulatory initiatives.
Below is a six minute video clip featuring a discussion between Karen Schoeneman of the CMS Division of Nursing Homes and Thomas Hamilton, Director of the Survey and Certification Group at CMS. They discuss how person-directed care is consistent with existing federal regulations.
Quicktime (MOV)