What Is the Nursing Home Reform Act?

The Nursing Home Reform Act (NHRA) is a federal law passed in 1987 as part of the Omnibus Budget Reconciliation Act (OBRA). It applies to every nursing home that accepts Medicare or Medicaid. The law sets minimum care standards. It also creates a formal Residents' Bill of Rights that protects dignity, freedom from abuse, and the right to individualized care.

Do you have a parent or loved one in a nursing home in New York City? The NHRA is the single most important law shaping the care they are legally entitled to receive. It turned nursing homes from lightly regulated institutions into facilities held to enforceable national standards. The Orlow Firm has represented New York families harmed by institutional neglect and abuse for more than 40 years. Understanding this law is often the first step toward holding a facility accountable.

This guide explains what the Nursing Home Reform Act does and the rights it guarantees. It covers how the law is enforced and how it works with New York's own rules. It also covers what families should do when those rights are violated.

Why Congress Passed the Nursing Home Reform Act

Before 1987, there was no consistent national framework for nursing home care. Standards varied widely from state to state, and many facilities operated with little real oversight. Reports of neglect and mistreatment had been mounting for years.

In 1986, Congress asked the Institute of Medicine to study conditions in the nation's nursing homes. The findings were stark. Investigators confirmed that many residents were not getting adequate care and that neglect and abuse were common. The study recommended sweeping reforms, including national care standards and enforceable rights for residents.

Congress turned those recommendations into the Nursing Home Reform Act. It became law the following year as part of OBRA '87 (H.R.3545, 100th Congress). The law marked a turning point. In the years after it passed, researchers tracked real declines in the use of physical restraints, the overuse of catheters, and preventable bedsores. For the first time, residents had rights written into federal law rather than left to each facility's discretion.

Who the Nursing Home Reform Act Covers

The NHRA covers any nursing home that takes part in Medicare or Medicaid. Most facilities in New York City rely on these programs to operate. So the law reaches almost every nursing home a New York family is likely to consider.

A few distinctions matter:

• Covered facilities include skilled nursing facilities (SNFs), long-term care facilities, and nursing homes that accept federal funding.
• Residents are protected no matter how they pay. A private-pay resident in a covered facility still gets the full set of NHRA protections. The law follows the facility's participation in Medicare or Medicaid, not how the resident pays.
• A facility that accepts no federal funding at all is not directly subject to the NHRA's funding-based penalties. In New York, though, those facilities still answer to a parallel state framework under 10 NYCRR Part 415.
• Assisted living facilities are not covered by the NHRA. They fall under a different set of rules.

Not sure whether a facility takes part in Medicare or Medicaid? You can look it up with the federal Care Compare tool at medicare.gov.

The Residents' Bill of Rights: What the Law Guarantees

The core of the Nursing Home Reform Act is its Residents' Bill of Rights, written into federal regulation at 42 CFR § 483.10. These rights apply to every resident in a covered facility. The most important ones include:

• The right to quality care. A facility must provide the services each resident needs to reach or keep the highest practicable physical, mental, and psychosocial well-being.
• The right to dignity and respect. Staff must treat residents with respect and honor personal choices, including cultural and religious practices.
• The right to take part in care decisions. Residents must be told their health status, be involved in care planning, and may choose their own attending physician.
• The right to privacy. This covers private visits, confidential communications, and protected medical records.
• The right to freedom from abuse and neglect. The law sets a zero-tolerance standard for physical, verbal, sexual, and mental abuse, plus exploitation, involuntary seclusion, and neglect.
• The right to freedom from unnecessary restraints. Physical and chemical restraints are banned unless they are medically necessary as a last resort. This includes sedating drugs used for staff convenience rather than medical need.
• The right to manage personal finances. Residents control their own money unless they have legally handed that authority to someone else.
• The right to complain without retaliation. Facilities must have grievance procedures. They may not retaliate against residents or family members who report problems.
• The right to choose visitors and activities. Residents decide who may visit. They may take part in social and religious activities.
• The right to discharge and transfer protections. A resident cannot be transferred or discharged without meeting specific conditions and getting advance written notice.

The U.S. Supreme Court directly reinforced two of these rights in 2023. The case was Health and Hospital Corporation of Marion County v. Talevski. It involved a resident who said he had been chemically restrained with needless medication and moved without cause. The Court confirmed two things. Freedom from unnecessary restraints is an enforceable individual right. So is protection against improper discharge (Talevski, 599 U.S. 166 (2023)).

How the Law Is Enforced

The Nursing Home Reform Act is enforced through inspections, penalties, and, since 2023, private lawsuits.

The Centers for Medicare and Medicaid Services (CMS) oversees federal compliance. States handle the day-to-day inspection work through mandatory, unannounced surveys, and they also investigate complaints. In New York, the State Department of Health (DOH) runs both routine and complaint-triggered inspections of nursing homes.

When a facility falls short, the consequences can be serious. Enforcement tools include civil monetary penalties, a denial of payment for new admissions, and, in the most serious cases, termination of Medicare and Medicaid participation (CMS Nursing Home Enforcement). Federal funding is the financial lifeblood of most facilities, so the threat of losing it carries real weight.

The 2023 Talevski decision added another layer. In a 7-2 ruling, the Supreme Court held that the rights created by the NHRA can be enforced by individuals under Section 1983 of the Civil Rights Act. In plain terms, residents and their families may bring a lawsuit directly over a violation of these rights. They no longer have to rely only on regulators to act. The ruling confirmed that this legal path exists. It does not mean every claim will win, and the outcome of any case depends on its specific facts. New York also offers parallel avenues for civil liability under state law through Public Health Law Article 28 and Part 415.

How New York City Nursing Homes Are Regulated

For families in New York City, nursing home protections come in two layers. There is the federal floor set by the NHRA. On top of that sits a set of state rules that often go further.

Every NYC nursing home that accepts Medicare or Medicaid must follow the federal NHRA. New York's Public Health Law Article 28 governs residential health care facilities, including nursing homes. The minimum standards in 10 NYCRR Part 415 frequently go beyond the federal baseline.

Staffing is one important example. New York requires nursing homes to provide an average of 3.5 hours of direct care per resident per day. This rule stayed in effect even after the December 2025 federal rollback of broader staffing rules. So New York facilities are still held to the stricter standard. Adequate staffing is one of the most reliable predictors of safe care, so this rule matters directly to families.

Recent federal transparency rules add more protection. Ownership disclosure rules took effect at the start of 2026. They require facilities to report who actually owns and controls them. A facility that fails to report loses its Medicare billing privileges. This gives families a clearer picture of who is responsible for the care.

New York families also have a dedicated advocate. The New York State Long Term Care Ombudsman Program offers free help to residents and their families. It can mediate disputes and assist with complaints.

Common Violations to Watch For

Knowing your rights under the NHRA only helps if you can spot when they are being violated. Some of the most common violations include:

• Poor quality of care, including medication errors, untreated bedsores (pressure ulcers), dehydration, and malnutrition
• Physical, emotional, or sexual abuse by staff
• Overmedication or chemical restraint, meaning a resident is sedated without real clinical need
• Inadequate staffing that leaves too few nurses and aides to respond safely
• Unsanitary or unsafe conditions, such as fall hazards, infection risks, or broken equipment
• Failure to develop or follow an individualized care plan
• Improper discharge or transfer without the required conditions and notice
• Failure to investigate or report abuse and neglect
• Retaliation against residents or family members who file complaints

Families visiting a loved one should also watch for physical and behavioral warning signs, including:

• Unexplained bruises, cuts, or fractures
• Pressure ulcers (bedsores), especially advanced Stage 3 or Stage 4 wounds
• Sudden weight loss or signs of dehydration
• Poor hygiene or unchanged clothing
• Emotional withdrawal, fearfulness, or agitation around specific staff members
• A resident who seems heavily sedated or unusually confused

A single warning sign is not proof of abuse. But a pattern of them deserves immediate attention.

What to Do If You Suspect a Violation

Do you believe a nursing home is violating your loved one's rights? Acting quickly protects both your family member and any future legal claim.

1. Document everything. Record dates, times, and the names of staff involved. Photograph injuries and conditions, and keep copies of care plans and medical records.
2. Report internally. Notify the facility administrator in writing and ask for a written response. Keep proof that you reported the problem.
3. File a complaint with the New York State Department of Health. A DOH complaint triggers an inspection or investigation of the facility.
4. Contact the Long Term Care Ombudsman. The New York program offers free advocacy and can help you with the complaint process.
5. File with CMS if appropriate. A federal complaint can prompt federal enforcement action. You can also review a facility's record using Care Compare at medicare.gov.
6. Seek an independent medical evaluation. An outside assessment documents your loved one's injuries and current condition.
7. Consult an attorney. In New York, the statute of limitations is the deadline to file your lawsuit. For personal injury claims, it is generally three years under CPLR § 214. For wrongful death claims, it is generally two years from the date of death under EPTL § 5-4.1. These are general rules, and the deadline for a specific claim can vary, so early advice protects your options.

Frequently Asked Questions

Does the Nursing Home Reform Act apply in New York?

Yes. Every New York nursing home that accepts Medicare or Medicaid must follow the NHRA. New York then layers its own standards on top through Public Health Law Article 28 and Part 415. Several of those go beyond the federal minimum, such as the 3.5-hour daily direct-care staffing rule.

Can a nursing home discharge a resident against their will?

Only in limited cases. Under the NHRA, a facility may not transfer or discharge a resident unless specific conditions are met and advance written notice is given. Improper discharge is one of the rights the Supreme Court reinforced in Talevski (2023). A discharge that ignores these protections may be unlawful.

Can I sue a nursing home for violating the Nursing Home Reform Act?

In many cases, yes. The Supreme Court's 2023 Talevski decision confirmed that NHRA rights can be enforced by individuals under Section 1983. That means families may bring a direct lawsuit over a violation rather than relying only on regulators. Whether a specific claim will win depends entirely on its facts, so it is best to discuss your situation with an attorney.

What is OBRA '87?

OBRA '87 is the Omnibus Budget Reconciliation Act of 1987. It was the broad federal budget law that contained the Nursing Home Reform Act. People often use "OBRA '87" and "NHRA" to mean the same thing. But OBRA was the larger legislative package, and the NHRA was the nursing home reform inside it.

What is the statute of limitations for nursing home abuse in New York?

For personal injury claims, the deadline is generally three years under CPLR § 214. For wrongful death claims, it is generally two years from the date of death under EPTL § 5-4.1. These are general rules, and the exact deadline can vary with the facts, so consulting an attorney early helps protect the claim.

Sources & Official Resources

Federal Laws & Regulations Cited

1. H.R.3545 — Omnibus Budget Reconciliation Act of 1987 (OBRA '87)
2. 42 CFR § 483.10 — Nursing Home Resident Rights (eCFR)
3. 42 CFR § 483.15 — Admission, Transfer, and Discharge Rights (eCFR)

U.S. Supreme Court 4. Health and Hospital Corporation of Marion County v. Talevski, 599 U.S. 166 (2023)

New York State Laws Cited 5. New York Public Health Law Article 28 — Residential Health Care Facilities 6. CPLR § 214 — Statute of Limitations for Personal Injury (3 years) 7. EPTL § 5-4.1 — Wrongful Death Action (2 years)

New York State Regulations 8. 10 NYCRR Part 415 — Nursing Homes Minimum Standards

Federal Enforcement & Resources 9. CMS Nursing Home Enforcement 10. Medicare Care Compare — Find and Compare Nursing Homes

Helpful Resources 11. New York State Long Term Care Ombudsman Program 12. New York State Department of Health — Nursing Home Minimum Staffing

Contact The Orlow Firm

Do you believe a nursing home in New York City has violated your family member's rights under the Nursing Home Reform Act? This can happen through neglect, abuse, improper discharge, or a failure to provide required care. Understanding your legal options is an important first step. The Orlow Firm has represented New York families in institutional neglect and abuse cases for more than 40 years. That includes a $2,750,000 recovery for siblings who were neglected and abused in a foster home, a result that reflects our experience holding institutions accountable for harming the vulnerable people in their care.

Prior results do not guarantee a similar outcome.

Call (646) 647-3398 for a free consultation. We work on contingency, so you pay nothing unless we win.

Se Habla Español

This article provides general information and is not legal advice. Every case is different. Contact an attorney to discuss your specific situation.