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A new federal rule has opened the door for more state agencies to investigate nursing homes, but the first national standards for adult protective services also could make such services more accessible when providers need their help.

The Health and Human Services Administration for Community Living on May 7 finalized the first nationwide rules for APS programs, which identify and investigate the mistreatment or neglect of older adults and people with disabilities.

The new rule establishes stronger protections for clients subject to, or at risk of, guardianship; requires state APS officials respond to reported cases that are “life-threatening or likely to cause irreparable harm or significant loss of income, assets, or resources” within 24 hours; and promotes coordination with state Medicaid agencies, long-term care ombudsmen, nursing home licensing divisions and others.

It does not specifically require states to respond to reports in specific settings, such as nursing homes, but it leaves it up to each state to determine where it will exercise its investigative and oversight powers.

“While the APS rule is more directed to protect vulnerable adults in the community, it is certainly broad enough to cover residential environments, including SNFs and assisted living,” said attorney Mark Reagan, managing shareholder and chair of the Post-Acute and Long-Term Care Practice at Hooper Lundy Bookman. “While it certainly comes with greater risks of redundancy and duplication, I am hopeful that APS agencies will work within the existing SNF framework mainly as cross-reporters and spend the bulk of their time focusing on suspected abuse/neglect in the community.”

The Centers for Medicare & Medicaid Services already requires that state survey agencies receive and investigate reports of suspected abuse or mistreatment in nursing homes, Reagan noted. At the state level, providers and others may be required to report their concerns to state surveyors, law enforcement or ombudsman. There’s already a strong system of cross-reporting in most states.

It’s the states without existing coordination where duplicate investigations might begin to occur, Reagan predicted.

“I would expect APS agencies to become significantly involved in SNF abuse/neglect investigations in those states without much, if any, state-based reporting/investigatory platforms,” he told McKnight’s Long-Term Care News this week.

But that could be a good thing when nursing homes need help intervening on behalf of their patients, particularly in the kinds of guardianship disputes the rule aims to address. Reagan noted that long-established APS programs have historically “not wanted to do much, if anything, in SNFs.”

“There have been times where we have sought to engage APS in really messy situations involving the families of SNF residents,” he recounted. “In those instances, the only times that we have been successful in doing so has been in instances where we believed that family members were not acting in the resident’s best interests or participating in questionable conduct relating to the resident’s finances. In other words, it has been difficult to get APS engaged in SNF matters, even if we wanted their involvement.”

The rule encourages APS programs to recommend guardianship “only as a last resort” and to exhaust other support measures first.

Some long-term care organizations have praised the rule’s attempts to standardize and professionalize the APS sector.

The National Association for Home Care & Hospice said the rule will “help to improve consistency in services across states, better protect the vulnerable elderly, and increase understanding of the APS processes and expectations” for providers. The new standards are expected to have the greatest impact on community-dwelling seniors.

ACL in a statement announcing the rule estimated that more than 1 in 10 older adults living in the community experience some form of maltreatment.

The new regulations take effect June 7, but regulated entities have four years to fully comply.