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New Maryland Nursing Home Law Could Improve Oversight

  • May 17, 2018
  • KBA Attorneys
  • No Comments

On May 9, 2018, Governor Larry Hogan signed into law the Maryland Nursing Home Resident Protection Act of 2018. Senator James Mathias, Jr. introduced the Bill, which appears to improve state nursing home oversight greatly.

The Bill was introduced on January 25, 2018 in response to a 2017 report of the U.S. Department of Health and Human Services Inspector General, which showed that Maryland is the 7th worst state in the nation for on-time investigations of nursing home complaints. The report showed that the State of Maryland did not investigate 74% of high-level nursing home complaints within the federally-mandated deadline of 10 days. 19 years ago, the U.S. General Accounting office found that the state did not investigate 79% of high priority nursing home complaints within the federal deadline of 10 days. In 2016, the Maryland Department of Health reported in 2016 that it takes 47 days to initiate an investigation into a nursing home.

The State of Maryland has a very poor recent record with nursing home and assisted-living facility safety. In 2017, NMS Healthcare of Hagerstown was forced to close following the Maryland Attorney General’s lawsuit alleging that the facility was engaged in a practice known in the industry as “dumping.” The facility would accept patients on Medicaid and, when their benefits were close to running out, discharge them to unsafe conditions, including sham assisted-living facilities and homeless shelters.

The Maryland Nursing Home Resident Protection Act of 2018 attempts to improve oversight of nursing home in the following ways:

10-day Response for All Complaints: The Maryland Department of Health must now initiate an investigation of a nursing home complaint alleging actual harm within 10 business days after receiving a complaint.

24-hour Response for Serious Complaints: The Maryland Department of Health must now “make every effort” to initiate an investigation of a nursing home complaint alleging actual harm within 24 hours of receiving a complaint alleging “immediate jeopardy” to a resident. The Department must have actually initiated an investigation within 48 hours.

More Transparency: The Maryland Department of Health must have a dashboard on its website that is updated every two weeks that provides data on the number of staff hired by the investigative agency and the number of vacancies.

More Staff to Investigate: The Maryland Department of Health will receive 10 new, full-time merit positions per year related to the survey, licensure, discipline, or regulation of facilities caring for vulnerable residents of assisted-living and nursing home residents. The increase aims for a total of 50 new positions by 2024.

As one of the worst states for nursing home and assisted living residents, Maryland is making a big push to improve patient safety. It remains to be seen whether such efforts will have an effect. Certainly, additional resources are warranted to improve Department of Health investigations.

These measures will improve Maryland’s ability to investigate injuries after they happen. However, more needs to be done to prevent long-term care residents from being injured in the first place.

Here are some measures the Maryland legislature could take to go even a step further than the Maryland Nursing Home Resident Protection Act of 2018:

Improved Staffing Ratios: It is no secret that low staffing leads to poor nursing home quality. When mandated staffing levels are implemented, quality improves. Under Maryland law, the ratio of nursing services personnel on duty to patients may not at any time be less than one to 25. COMAR 10.07.02.12. In terms of bedside care, Maryland nursing homes need only provide a minimum of 2 hours of bedside care per licensed bed per day, 7 days per week. In 2004, House Joint Resolution 8 was drafted requesting the nursing home industry to pursue a staffing goal of one nurse for every eight nursing home residents. Unfortunately, the Resolution died in the legislature with no action. These standards could be greatly improved. A ratio of 1 nurse to 25 residents its very low, especially when many residents are very ill and have major care issues.

Mandatory Minimum Salary for Nursing Home Workers: According to a report by the Paraprofessional Healthcare Institution, low pay and poor benefits for nursing assistants result in poor care in nursing homes. One in three nursing assistants rely on public benefits. Raising the floor for nursing assistants and paying competitive wages and benefits would certainly result in better care.

Mandatory Educational and Certification Standards: Raising the floor for nursing home worker salaries would certainly help, but also raising the threshold for who can become a nursing home worker. Legislated standards mandating nursing home workers having certain educational and certification standards would ensure that nursing home workers have been educated on proper patient care and safety standards.


If you, or a family member, has been neglected or injured in a nursing home, contact an attorney of Ketterer, Browne, and Associates, LLC.