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Regulatory Agencies

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Submitted By AnitaKa
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Regulatory Agencies
HCS437
June 2, 2014

Regulatory Agencies
Several regulatory agencies are responsible for licensing long-term care facilities to ensure compliance of laws and regulations. Regulatory agencies also receive and investigate complaints that are related to the facility and the services in which the facility provides (Walsh, 2014). All long-term care facilities are expected to abide by these regulations in an effort to ensure long-term care patients proper care, ethical treatment, safe living environments, and health care reimbursement.
These agencies expect long-term care facilities to maintain an environment that will emphasize the importance of one’s quality of life and quality of care (Walsh, 2014).
This paper will discuss three regulatory agencies including the Centers for Medicare and Medicaid Services, the Department of Licensing and Regulatory Affairs, and the Administration on Aging/Long-Term Care Ombudsmen Program, which have made huge impacts on the way long-term care is delivered in the United States.
Centers for Medicare and Medicaid Services
The Centers for Medicare and Medicaid Services (CMS) has become a staple among regulating long-term care facility practices. The CMS produces and maintains federal regulations for long-term care facilities that choose to accept residents that rely on Medicare and Medicaid benefits as a form of payment (Long-Term Care Facilities, 1989). Local licensing agencies are responsible for surveying, licensing, and inspecting the long-term care facilities to ensure that they are compliant with the regulations of the CMS (Long-Term Care Facilities, 1989). These local licensing agencies are also responsible for investigating complaints and reporting to the CMS (Long-Term Care Facilities, 1989). When a long-term care facility is deemed non-compliant with various regulations, the licensing agency and the CMS share the task of enforcing action that will ensure compliance (Long-Term Care Facilities, 1989). The CMS provides the funding that may be necessary for the licensing agency to effectively evaluate the steps in which the long-term care facility must make in order to meet satisfactory federal regulations (Long-Term Care Facilities, 1989).
Department of Licensing and Regulatory Affairs
Most states also have their own regulations that long-term care facilities must also adhere to in conjunction with federal regulations. Generally, state regulations parallel or exceed federal regulations and have different methods of surveying, inspecting, investigating, and enforcing action (Department of Licensing and Regulatory Affairs, 2001-2014).
Long-term care facilities in Michigan are licensed and also regulated by the Department of Licensing and Regulatory Affairs (LARA) (Department of Licensing and Regulatory Affairs, 2001-2014). LARA is responsible for licensing and certifying long-term care facilities in Michigan (Department of Licensing and Regulatory Affairs, 2001-2014). LARA also establishes a bed capacity, policy of patient rights and responsibilities, and procedures to implement patient rights and responsibilities (Department of Licensing and Regulatory Affairs, 2001-2014). Complaints may also be directed to LARA for analysis, investigation, and recommendation for compliance to be met, if necessary (Department of Licensing and Regulatory Affairs, 2001-2014).
Administration on Aging/ Long-Term Care Ombudsman Program
The Administration on Aging (AoA) administers the ombudsman program and under the older Americans Act, each state is required to have a Long-Term Care Ombudsman Program that addresses complaints and advocates for improvements in the long-term care system (Strengthening the Long-Term Care Ombudsman Program Provisions in the Older Americans Act, n.d.). Long-term care ombudsmen advocate for residents of long-term care facilities and provide information about long-term care facility searches and how to obtain quality care within long-term care facilities. The staff of the ombudsman program consists of volunteers who are certified and trained to confidentially help patients of long-term care resolve issues and complaints (Strengthening the Long-Term Care Ombudsman Program Provisions in the Older Americans Act, n.d.). The ombudsman program strives to promote community involvement via volunteer opportunities (Strengthening the Long-Term Care Ombudsman Program Provisions in the Older Americans Act, n.d.). They also educate consumers and long-term providers about patient’s rights and quality care procedures and practices. They have also become detrimental in the recommendations of changing laws, regulations, and policies as necessary while complying with federal laws (Strengthening the Long-Term Care Ombudsman Program Provisions in the Older Americans Act, n.d.). As previously mentioned, ombudsman program volunteers advocate for patient’s rights, quality care including personal care, and residential care within long-term care facilities (Strengthening the Long-Term Care Ombudsman Program Provisions in the Older Americans Act, n.d.). Promotion of the development of citizen organizations, family councils, and resident councils are also administrated through the ombudsman program (Strengthening the Long-Term Care Ombudsman Program Provisions in the Older Americans Act, n.d.).
The assistance of ombudsman program volunteers has helped to protect patients who may be frail and vulnerable (Strengthening the Long-Term Care Ombudsman Program Provisions in the Older Americans Act, n.d.). However, increasing their autonomy may mean that greater action might be enacted if ombudsman program volunteers were not prohibited from taking advocacy actions like communicating with legislators, policy makers, and representatives of the media (Strengthening the Long-Term Care Ombudsman Program Provisions in the Older Americans Act, n.d.). An improvement of ombudsman access to patients may also be helpful because they often struggle with gaining access to patients and obtaining privacy when communicating with them (Strengthening the Long-Term Care Ombudsman Program Provisions in the Older Americans Act, n.d.). Finally, the ombudsmen program volunteers have other responsibilities that may create conflicts of interests among patients. As a result, patients and their families sometimes feel as the ombudsmen volunteers are effectively working for them (Strengthening the Long-Term Care Ombudsman Program Provisions in the Older Americans Act, n.d.).
As this paper has discussed, each of these agencies has been detrimental in ensuring long-term care patients and opportunity to obtain assistance when their care has been jeopardized. Providing high-quality, ethical health care in a safe environment is essential to one’s quality of life and there are laws and regulations that have been enacted to ensure patient protection.

References
Department of Licensing and Regulatory Affairs. (2001-2014). Retrieved from http://www.michigan.gov/lara/0,4601,7-154-35299_63294_63384-47199--,00.html
Long-Term Care Facilities. (1989). Retrieved from http://www.cms.gov/Regulations-and-Guidance/Legislation/CFCsAndCoPs/LTC.html
Strengthening the Long-Term Care Ombudsman Program Provisions in the Older Americans Act. (n.d.). Retrieved from http://www.theconsumervoice.org/ltcopandoaa
Walshe, K. (2014). Regulating U.S. Nursing Homes: Are We Learning From Experience?. Retrieved from http://content.healthaffairs.org/content/20/6/128.full

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