For the first time in more than two decades, Pennsylvania enacts new facility regulations for long-term nursing care.


Professional Elderly Care

By: Patrick Cosgrove and Heather McFeeley

Pennsylvania took steps to address its increasing aging population as it enacted new major nursing home regulations for the first time since 1997. At present, approximately 72,000 Pennsylvanians reside in the 682 long-term care nursing facilities throughout the Commonwealth. Recognizing these facts, along with the increased focus on nursing homes arising out of the Covid-19 Pandemic and nursing homes’ means of delivering care and providing a safe environment for residents, Pennsylvania’s Independent Regulatory Review Commission approved new rules on October 28, 2022.

The new regulations provide for increased resident’s rights, prudent use of restraints, and heightened staffing minimums, among others. In terms of resident’s rights, the rules now require facilities to notify the resident, or resident representative, 30 days prior to any changes occurring during the residents stay. Additionally, experimental research or treatment, such as drug therapies not approved by the FDA, may not be carried out without approval from the Department of Health, and without the written approval and informed consent of the resident, or resident representative. The newly promulgated rules also provide a resident the right to care without discrimination based upon race, color, religions, age, sex, national origin, ability to pay, handicap or disability, and use of a guide or support animal.

Furthermore, the new regulations detail protocols for the limited use of restraints, along with proper documentation. Effective, July 1, 2024, if restraints are used, facilities must “use the least restrictive method for the least amount of time” to respond to individual resident needs safely and adequately whereas the current rule only requires that the facility “ensure that appropriate interventions are in place.” Also, when a recurring restraint is ordered, the facility will be required to document the need for the restraint and the personnel responsible for performing the intervention on each shift.

Regarding heightened staffing minimums, the new regulations limit the staff-to-resident ratios. As of July 1, 2023, a minimum of 1 nurse aide per 12 residents will be required during the day, 1 nurse aide per 12 residents will be required during the evening, and 1 nurse aide per 20 residents will be required overnight. Thereafter, effective July 1, 2024, the minimum requirement will be 1 nurse aide per 10 residents during the day, 1 nurse aide per 11 residents during the evening, and 1 nurse aid per 15 residents overnight.

The regulations also increase the minimum number of general nursing care hours to be provided for each 24-hour period. Currently, the minimum requirement is 2.7 hours of direct resident care for each 24-hour period. But effective, July 1, 2023, the minimum requirement for direct resident care for each resident is 2.87 hours for each 24-hour period. And as of July 1, 2024, that minimum increases to 3.2 hours of general nursing care provided in each 24-hour period.

Nursing homes throughout the Commonwealth of Pennsylvania should be aware that there is an increased spotlight on them as we slowly make our way out of the Covid-19 Pandemic. With the increased spotlight, comes increased scrutiny from regulators. It is critical that nursing homes review the new regulations and follow each requirement carefully as the regulators are sure to follow up the passage of the regulations with a corresponding emphasis on enforcement.

For more information on this topic, please contact Patrick Cosgrove or Heather McFeeley.