Guide to New Jersey Nursing Home Complaints

Every year thousands of elderly New Jersey citizens are abused and exploited by someone they depend on for care and protection. The New Jersey State Ombudsman receives over 6,000 complaints alone.  Use this guide to New Jersey Nursing Home Complaints to quickly resolve or correct an abusive situation or to get justice for a loved one that is no longer with us.  You do not need to be a relative to register a complaint.

Where To Complain About Nursing Home Abuse and Neglect

When There Is an Immediate and Serious Threat to Patient Health and Safety then contact the person (s) that can immediately correct the problem. Options include:

  1. Head Nurse, Social Worker or Nursing Home Complaint Coordinator in the Nursing Home where a loved on resides
  2. New Jersey State or other State Ombudsman; call 1 (877) 592-6995 to file a complaint
  3. Local law enforcement

If these do not remedy the situation, then contact our legal team via our nursing home complaint hotline at (201) 488-4644.

For all other cases, we suggest contacting the Head Nursing Home Complaint Coordinator first. If the issue is not addressed within a week, then escalate the complaint to the New Jersey State Ombudsman or consult with our team.

While complaints can be made to the Federal Agencies listed below, most inquiries are turned over to the New Jersey State Ombudsman for further review.

When to Contact A Nursing Home Attorney

  1. Abuse That Has Not Been Corrected
  2. Justice For A Patient That Is Deceased
  3. If you believe a nursing home or nursing home employees have acted negligently

If you aren’t sure who to contact, call the legal experts at Gartenberg Howard at (201) 488-4644 for a free consultation.

State and Local Roles

The primary responsibility for designing, operating and coordinating services for the elderly lies with the State of New Jersey for nursing homes and elderly care facilities located in the State, NOT the Federal Government. Several State agencies are responsible for resolving nursing home problems including:

Federal Nursing Home Complaints

In the Federal government three Department of Health and Human Services (HHS) agencies have either direct or indirect involvement with nursing homes and services to residents of nursing homes:

Office of Human Development Services/Administration on Ageing (OHDS/AoA)

The Administration on Aging (AoA) is responsible for the establishment of a State Long-Term Care Ombudsman (called the State Ombudsman Program.) The program gives grants to State Agencies under Title III of the Older Americans Act (OAa.) Title III authorizes activities for the prevention of elder abuse. The Act requires each State Agency on Aging to establish and operate a State Ombudsman program to receive and review complaints concerning nursing home residents.

Health Care Financing Administration

The Health Care Financing Administration (HCFA) administers Medicaid and Medicare programs. HCFA has a Health Standards and Quality Bureau (HSQ) has oversight responsibility for Medicare and Medicaid nursing home standards of care designed in part to ensure an environment free from abuse. To meet this obligation, HCF A administers and develops the regulatory requirements for nursing homes participating in either Medicare or Medicaid, develops training requirements for surveyors who conduct nursing home inspections, conducts yearly compliance surveys of five percent of those facilities previously surveyed by the State, and monitors State compliance surveys for quality assurance. The HCF A may directly receive complaints of abuse involving nursing home residents. However,

The HCF A may directly receive complaints of abuse involving nursing home residents. However, these will usually be referred to the applicable State agency for nursing home certification unless the allegation involves an “immediate and serious threat” to patient health and safety. 

Office of Inspector General

Through Public Law (P.L.) 94-505, enacted in 1976, the OIG (Office of Inspector General) was established as an independent unit in HHS with the authority to prevent and detect fraud and abuse in Department programs. The OIG is required to:

  1. Recommend policies for the detection and prevention of fraud and abuse within programs and operations administered or financed by the Department
  2. Conduct, supervise or coordinate investigations related to such fraud and abuse. Under Section 1128 of the Social Security Act, the OIG was provided authority to impose sanctions against health care providers convicted of Medicare or Medicaid offenses or suspended or excluded or otherwise legally or administratively sanctioned by appropriate State entities. In meeting this statutory authority, the OIG works with other Federal, State, and local governmental agencies and nongovernmental entities. As a further part of this authority, the OIG/Office of Investigations (01) has oversight of and grant certification responsibility for State Medicaid Fraud Control Units (MFCUs).The Medicare and Medicaid Patient and Program Protection Act of 1987 amends titles XI, XVIII, and XIX of the Social Security Act to protect beneficiaries from unfit health care practitioners. The Act states that if an individual is convicted of patient abuse in connection with the delivery of a health care item or service exclusion from the Medicare and Medicaid programs is mandatory. In September of 1986, the OIG/OI published an “Investigative Guide for the Detection of Patient Abuse.” The guide was made available to State MFCUs for training and reference purposes.

Medicare and Medicaid Nursing Home Rules and Regulations

The Medicare and Medicaid programs traditionally have used a condition of participation (COP) format to define requirements which must be met by facilities in order to participate in the programs. This format is based on the principle that each condition level statement would be a statutory requirement while standard level statements would be lesser requirements within a condition. Under current law, a skiIed nursing facility (SNF) must meet COPs to participate in the Medicare or Medicaid programs; intermediate care

Under current law, a skilled nursing facility (SNF) must meet COPs to participate in the Medicare or Medicaid programs; intermediate care facilities (ICFs) must meet standards. Current COPs and standards were originally published in 1974. The SNFs have a single uniform definition which extends the same level of care requirements to both Medicaid and Medicare programs. The ICF benefit was intended to allow facilities which did not meet SNF COPs to participate as ICFs and provide health-related care, not at the skilled level, to Medicaid patients. Provisions for resident rights are ambiguous and enforcement is difficult because a resident’s rights and a facility s obligations are sometimes unclear. Recognizing that a resident s rights, living conditions, and medical care are essential components of the quality of life in a

Provisions for resident rights are ambiguous and enforcement is difficult because a resident’s rights and a facility s obligations are sometimes unclear. Recognizing that a resident’s rights, living conditions, and medical care are essential components of the quality of life in a facility, HCF A developed outcome-oriented survey instruments in June 1988. The emphasis of current regulations is on process, not outcomes of that process as is relates to residents. The regulations do not contain any SNF COP or ICF standard for a resident assessment. Also, there is no quality of care COP utilizing resident care outcomes, especially negative ones, to assess whether residents are receiving satisfactory care.

Social Security Act

Existing Medicare COPs are located at 42 CFR, Part 405, Subpart K and implement Section 1861U) of the Social Security Act. Current Medicaid standards are in 42 CFR, Part 442, Subparts D, E, and F. Omnibus Budget Reconciliation Act of 1987 (OBRA ‘ 87). P.L. 100-203 On December 22, 1987, OBRA ’87 was enacted. The law includes extensive revisions to the Medicare/Medicaid statutory requirements for nursing facilities. Nursing home reform provisions, to be implemented October 1, 1990, establish uniform requirements for Medicaid SNFs and ICFs. The law revises the conditions under which nursing homes may participate in the Medicaid/Medicare programs, the process for monitoring compliance with law, and the remedies available to Federal and State agencies in the event of noncompliance.

It further expands nursing facility resident rights to include freedom from:

  1. Inappropriate use of physical or chemical restraints
  2. Physical or mental abuse or punishment.

The NF (any Medicare SNF or Medicaid facility which is not an ICF for the mentally retarded) must inform residents orally and in writing of their legal rights. The HCFA draft regulations provide all incidents of abuse be reported to the nursing home administrator of to any other agency designated by State law. Residents may file a complaint concerning abuse or neglect with the State survey/certification agency. The NF must permit the State Ombudsmen access to the resident and the resident’s clinical records with the permission of the resident or the resident’s legal representative.

The NFs will be required to verify the competency of applicants prior to their employment as nurse aides. No nurse aide may be employed for more than four months unless the individual has completed State-approved training or successfully passed a competency test. Verification of a nurse aides competency will be strengthened through the required use of a State maintained nurse aide registry. This registry will certify that the individual has met the required training requirements and indicate the documented findings, not limited to convictions, of resident abuse, neglect, or misappropriation of resident property involving an individual listed in the registry. If the State determines a nurse aide has been involved in these activities, the State will, after notice and reasonable opportunity to rebut allegations in a hearing, notify the nurse aide and the nurse aide registry.

Sources of Nursing Home and Elderly Care Complaints

Complaints come from may places. According to the NJ Sate Annual Ombudsman Report for the Federal Government (2015) cases, Complainants and Complaints came from the following places:

Resident 127
Relative/Friend of Resident 545
Non-relative guardian, legal representative 12
Ombudsman/ombudsman volunteer 36
Facility administrator/staff or former staff 1,023
Other medica: physician/staff 38
Representative of other health or social service agency or program 21
Unknown or Anonymous 30
Other: Bankers, Clergy, Law Enforcement, Public Officals 46

Source: NJ State Annual Ombudsman Report for Federal FY2015 – Ombudsman, Institutionalized Elderly (5/16)

Complaints By A Relative or Friend of A Nursing Home Resident

In New Jersey, most complaints (after complaints by facility administrators or former staff) is by a relative or friend of a resident. With a simple phone call, we can quickly determine if a case requires legal attention or if there is a better route to protect a patient or seek justice for an individual that is deceased.

Give our team a call at (201) 488-4644.