This document discusses regulations related to long-term care. It notes that there are many federal and state regulations imposed on long-term care facilities to ensure quality of care and protect consumers. Quality of care is measured through factors like resident outcomes, pain levels, restraint use, and functional status. The Centers for Medicare and Medicaid Services implements national standards to evaluate nursing home quality. Both public agencies and private organizations work to regulate various aspects of long-term care, including quality of services and costs.

1. To support your work, use scholarly sources and also use
outside sources. As in all assignments, cite your sources in your
work and provide references for the citations in APA format.
Regulations in Long-Term Care
There are many federal and state regulations when it comes to
long-term care. Using scholarly sources and the Internet
research any four specific regulations related to long-term care
and summarize them.
Based on the regulations you identified, respond to the
following questions:
· What are the benefits and shortcomings of your identified
regulations? Which of these shortcomings have an effect on the
quality and the cost of health care services? How?
· Do you believe there is a link between regulations and better
care? Why or why not?
· Why do you think long-term care services are subjected to so
much external control by government agencies? Provide a
rationale for your responses.
· How is quality measured in long-term care? Is there only one,
or are there several approaches to measure quality? What are
they? Who should be given the responsibility to measure
quality?
Notes from class
The increasing need for long-term care has caused several
public and private agencies to participate in its managing
process. These public and private agencies are increasingly
attempting to control costs, providing protection to consumers
considered unable to protect themselves. Public controls are
nonvoluntary and are imposed by government agencies through
the implementation of laws and regulations. Private controls are

2. provided by nongovernment agencies and organizations, and
compliance is voluntary.
Public Control
Public control on long-term care is imposed by federal, state, or
local (including county and municipal) government units. These
units set laws, regulations, and standards to be followed by
long-term facilities in order to:
· Give better care facilities to the poor, who are unable to take
care of themselves, by making them formal or informal wards of
the state.
· Provide quality health care facilities to consumers.
· Create awareness in consumers regarding the types of services
provided in the facilities and let the consumers themselves
judge the quality of the services.
· Set the minimum level of staffing, cleanliness, and safety,
ensuring consumers needing long-term care are treated properly
and receive the necessary services.
· Follow all long-term care regulations to provide quality care.
Private Control
Besides government agencies, several private organizations are
involved in managing long-term care. Both public and private
control focus on long-term care organizations as well as the
individuals in those organizations. The only difference is public
control can maintain both the cost and the quality of care, while
private care can focus only on measuring, evaluating, and
ensuring the quality of care.
Private control agencies focusing on the quality of care of long-
term organizations are known as accreditation bodies, while
those focusing on the quality of care provided by individual
health care professionals or practitioners are known as
certification bodies.
Let's discuss some of the most common private control
agencies.
Long-term care regulations cover both organizational providers

3. and individuals working in the field of long-term care. Most of
the regulations are aimed at either maintaining the level of
quality in the goods and services produced or minimizing the
level of payment for goods or services.
Regulation of Quality
The primary reason for the regulation of long-term care is to
maintain quality. Consumers have the right to receive high-
quality care. However, to maintain the level of quality, you
must be able to measure quality. Quality can be measured on the
basis of processes, structures, and outcomes. Process-based
measurement looks at how tasks are accomplished and whether
they follow accepted procedures. Structure-based measurement
focuses on the capacity of an organization to provide care.
Outcome-based measurement focuses on the result of treatment
by measuring changes in the functional status accrued from the
care provided.
In November 2002, the Centers for Medicare & Medicaid
Services (CMS), an agency of the United States Department of
Health and Human Services, began a national Nursing Home
Quality Initiative (NHQI). This is a federal standard measure
that all residents in a nursing home are being evaluated and
compared with to monitor care. The nursing home quality
measures come from resident assessment data that nursing
homes routinely collect on the residents at specified intervals
during their stay. These measures assess residents' physical and
clinical conditions and abilities, as well as preferences and life
care wishes. These assessment data have been converted to
develop quality measures that give consumers another source of
information that shows how well nursing homes are caring for
their residents' physical and clinical needs.
Long-term (chronic care) care residents are evaluated on the
percent of:
· Residents whose need for help with daily activities has
increased
· Residents who have moderate to severe pain
· Residents who were physically restrained

4. · High-risk residents who have pressure sores
· Low-risk residents who have pressure sores
· Residents with a urinary tract infection
· Residents who spent most of their time in bed or in a chair
· Residents who have become more depressed or anxious
· Low-risk residents who lose control of their bowel or bladder
· Chronic or long term care residents who lose too much weight
· Residents who have or had a catheter inserted and left in their
bladder
· Residents whose ability to move about in and around their
room got worse
Short-stay (temporary) care residents are evaluated on the
percent of residents:
· Who had moderate to severe pain
· With delirium
· With pressure sores
Regulation of Payment
The primary purpose of the regulation of payment is to avoid
excessive payment, save money for government agencies, and
prevent fraud and abuse in government funding programs. The
two sources of payment regulation are Medicare and Medicaid.
These two programs represent a major source of reimbursement
for long-term care organizations.
The Health Insurance Portability and Accountability Act
The primary purpose of Health Insurance Portability and
Accountability Act (HIPAA) is to protect the consumers' health
insurance, security, and health care data and promote
standardization and efficiency in the health care industry.
HIPAA requires everyone to use the standard format for
processing claims and payments. It has standards for several
types of electronic health information transactions and
maintenance of information and data.
Next, let's discuss the roles of federal and state governments in
long-term care.
n the United States, reimbursement of long-term care depends

5. on how the care is financed. The type of reimbursement and the
amount reimbursed dictate the access to care, availability of
specific services, and equality of care. Both public and private
sources are available for long-term care reimbursement.
However, neither sector has satisfactory mechanisms for helping
individuals anticipate and pay for their care.
One of the most important aspects of managing long-term care
is to maintain the quality of care and control the cost of
services. In this respect, several quality improvement programs
have been developed in long-term care that focus on monitoring
and evaluating physical, functional, and psychological
indicators over time. To establish effective quality improvement
programs, health care organizations should:
· Define customers.
· Identify the demands of customers in terms of quality and
determine standards against which quality is to be measured.
· Monitor the key indicators to measure quality.
· Evaluate whether the data produced is sufficient enough to
draw a conclusion.
· Identify appropriate corrective steps to improve the
measurement of quality in particular areas.
· Continue the process of quality measurement against
standards.
Besides internal programs for quality improvement, quality
assurance, and quality management, organizations also take
several external initiatives so as to improve the overall quality
of the long-term care system.
As discussed earlier, both federal and state governments
regulate and monitor the quality of care provided to consumers
covered by government-run plans such as Medicaid and
Medicare. Several government agencies are involved in quality-
related research, such as the Agency for Healthcare Research
and Quality (AHRQ). These agencies develop quality indicators
that serve as valuable measures, both for researchers and for
individuals, to maintain the quality of care. The government

6. agencies also develop several nationwide quality initiatives to
provide information to the public about health care quality and
ways to judge quality for themselves.
Some of the significant private quality improvement programs
include Quality First, the American Association of Homes and
Services for Aging (AAHSA), the American Health Care
Association (AHCA), and the American Health Quality
Association (AHQA).