Friday, July 15, 2011

Standards of Care

Nursing Home Standards of Care :
Are there federal and state standards of care?

The Federal Nursing Home Reform acts and regulations set daily care requirements for nursing facilities. Federal law only applies to Medicare and Medicaid-approved nursing facilities. Almost all nursing facilities are Medicare or Medicaid-approved.

Federal law contains four key standards of care for nursing facilities:

1. The nursing facility must provide services to help each resident attain or maintain the highest practicable physical, mental, and psycho-social well-being.

2. A resident’s ability to bathe, dress, groom, transfer, walk, toilet, eat, and communicate must not decline unless it is medically unavoidable.

3. If a resident is unable to carry out activities of daily living, he or she must receive help to maintain good nutrition, grooming, and personal and oral hygiene.

4. Each resident has the right to make choices about his or her care.
Besides these general principles, federal laws set minimum requirements for daily care. Some of these requirements are described below:

General Hygiene

Assistance should be provided for any resident that needs help with general personal hygiene including: skin, oral, and hair care. Residents should also have the opportunity to shave daily with assistance if needed. Residents should receive help to take a full bath or shower as often as needed.

Pressure Sores

Residents who lie or sit in one position for long periods of time often develop pressure sores, also known as bed sores. Pressure on the skin prevents blood vessels from carrying nutrients to the affected area. This causes skin breakdown which can lead to large sores, infections, and severe pain if not treated. Poor nutrition and certain conditions may also lead to development of pressure ulcers.

Residents confined to a bed or a chair should be checked and their position changed (turned) every two hours or more often if the resident is uncomfortable. If needed, supportive devices, special mattresses, pads, and pillows should be used to maintain normal body posture and to relieve pressure. Residents should receive daily help with walking and exercise to help maintain or improve their circulation, strength, and use of the body.


Residents should be dressed in their own clean, comfortable clothing each day. Residents who walk should wear appropriate footwear, and non-ambulatory residents should have suitable foot coverings when out of bed.


Residents who have control of their bowel and bladder should receive help using the toilet as often as needed. However, some residents are incontinent, meaning they have lost control of their bowel or bladder. If this is the case, those who become wet or soiled should be cleaned and changed quickly. Incontinent residents should receive care to restore as much normal bowel and bladder functioning as possible.


Residents who need help eating should receive appropriate assistance during meal time. They may need packages opened or special eating utensils provided. In some cases, residents may require help feeding themselves. Food normally eaten hot should be served hot, and food normally eaten cold should be served cold.

Fluid Intake

The nursing facility must ensure that each resident receives sufficient fluids to maintain good health and prevent dehydration. Fresh water and drinking cups must be available on each bedside table.

Vital Signs

Upon admission residents must be weighed, have blood pressure, temperature, respiration rate, and pulse taken. These should be taken at least monthly or more often if ordered by a physician.

Family should always get a copy of the care plan. Monitor the care plan and talk with staff if questions arise.

See Standards of Care for Accidents: Accident Standard of Care

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