This week, Prof. Gittler generally discussed the regulation of nursing homes and the care they provide for residents, especially residents with Alzheimer’s disease and other dementias. She began by describing the vulnerability of nursing home residents and why the regulation of facilities is important. Next, she outlined a variety of regulatory schemes, including state licensing laws, elder abuse laws, health care fraud and abuse laws, and laws introducing long-term care ombudsmen. She also described how Medicare/Medicaid certification requirements can serve as de facto regulation; because providers want to be eligible to receive Medicare/Medicaid reimbursement, CMS has the power to require that facilities meet certain levels of care.
Next, Dr. Buckwalter examined the nursing home environment and the kinds of care such facilities should provide. She emphasized that quality of life often equates to quality of care in the nursing home environment. Dr. Buckwalter explained the various factors a nursing home regulatory scheme should consider, including accidents, pressure sores, vision and hearing loss, and activities of daily living.
Finally, we were joined by Dr. Brian Kaskie, Ph.D., M.A., Associate Professor at the University of Iowa’s College of Public Health. Dr. Kaskie addressed the regulation of assisted living facilities in the various states. He noted that as more individuals move to assisted living facilities, these facilities begin to have populations similar to those of nursing homes. Yet he also described how few states stridently regulate assisted living facilities. Of those states, he noted, enforcement of regulations often is uneven and not necessarily effective.