Legal and Regulatory Considerations in Health Care Facility Design Planning

Legal and Regulatory Considerations in Health Care Facility Design Planning

Nursing homes provide specialized care to some populations. Their excellence in attaining their mandate is highly pegged on their compliance with diverse ethical and legal frameworks under the jurisdictions they operate. This paper analyzes the legal and regulatory issues in healthcare facility design through the lens of nursing homes.

Facility Type and Location

The proposed facility is a nursing home located in a city neighborhood. It seeks to integrate hospital-like and home-like design in its development. It will also include amenities such as a laundry area, a backup water supply system, a recreational area, and a living area. All these inclusions will impact its design and space considerations. They will also be influenced, in part, by diverse city regulations and zoning codes.

Overview of Compliance Requirements

Federal Compliance

The establishment of nursing homes and other long-term care facilities is protected by federal and state laws. Several policies exist to standardize care approaches provided within nursing homes and to protect patients residing in these facilities from potential neglect and abuse. Some of these policies include the Americans with Disability Act (ADA), the Center for Medicare and Medicaid Services (CMS), and the Occupational Safety and Health Administration, among others.

To begin with, the ADA is a progressive act of 1990 that prohibits any form of discrimination against disabilities in various sectors. This act protects the rights of persons with disability and ensures their unhindered access to programs and services provided for and regulated by federal and local government (Ordway et al., 2021). Nursing homes should abide by the ADA provisions as they are under federal and local regulations. Additionally, they are a potential resident for persons living with a disability. By following these regulations, nursing homes can guarantee freedom from discriminatory behaviors and their unhindered access to high-quality nursing care.

The CMS is another progressive federal program targeted at enhancing access to high-quality healthcare for all populations. Through Medicaid, the CMS helps ensure persons with disabilities have insurance coverage that further allows them to access healthcare services (Blackburn et al., 2021). The CMS also outlines quality improvement regulations for nursing homes, as well as sets a minimum nursing staff limit for each nursing home. The proposed nursing home must take into consideration, the provisions of CMS.

Following this, OSHA is another federal regulatory agency that ensures healthful and safe working conditions for workers. It establishes standards and conditions that foster safe and healthful working conditions and provides educational assistance and training to different organizations on safety maintenance (Dean et al., 2023). This act informs how the nursing home will be designed and the safety considerations that must be put in place for nurses and other healthcare professionals working in the facility.

Other federal policies that influence nursing homes include the Nursing Home Reforms Act (NHRA) and value-based programs under CMS, such as the Health Readmission Reduction Programs (HRRP), and the U.S. Equal Employment Opportunity Commission (EEOC). The NHRA requires that nurses provide healthcare services that ensure the highest practical physical, mental, and psychological health. Nursing staff within the proposed nursing home must, therefore, maintain excellence in their nursing roles and execute them diligently to the benefit of their residents. The HRRP also requires all care institutions to take active steps toward minimizing readmission. EEOC ensures that CMS provisions are observed in all care institutions.

State Zoning Codes

The zoning process is a legal provision that divides jurisdictions into specified zones or districts. Zoning codes restrict land usage within specific zones. In Texas, the recognized zoning categories are residential, agricultural, commercial, civic, and industrial areas. Each zone allows for multiple uses, including religious assembly, single-family residential, food stores, and retail services, among others. Further, regulations exist, provided for by the Planning and Zoning Department of Texas, which state how a building may be constructed and standards such as height, neighborhood compatibility, floor-to-area ratio, and landscaping, among others. Statewide zoning regulation does not give restrictions on the construction of nursing homes but recommends that they be established close to residential areas. In this respect, the proposed nursing home is more likely to be established near a single-family residential neighborhood.

Certificates of Need (CON)  

State Certificates of Need (CON) are state regulatory mechanisms for approving specific healthcare facilities and major capital expenditures. CON programs restrict duplicative services and ensure new capital expenditures meet the community needs in the communities in which they are established. Texas does not have CON laws or caps. In this respect, there are no approval requirements before establishing healthcare facilities such as nursing homes.

Local Zoning Code

The nursing home is set to be established in the city of Austin. In city neighborhoods, zoning codes define the type of physical structures that can be set up within an area, the land use, and the type of structures that can be developed in the area. Austin also distinguishes its zoning areas into residential, agricultural, commercial, civic, and industrial areas. Nursing homes can be established in all zoned areas as they allow mixed-use developments.

Facility Credentialing Opportunity

The credentialing process provides a systematic approach to collecting and verifying providers and professional qualifications. The credentialing processes help in ascertaining the legality and authenticity of nursing homes (Gershuni et al., 2023). In Texas, the credentialing and re-credentialing processes are applied to Medicaid Managed Care Organization and coordinated by the Texas Association of Health Plans (TAHP). The Joint Commission offers accreditation and certification for nursing homes. The facility, therefore, has the opportunity to initiate credentialing processes to demonstrate its observance of the law, as well as seek JSC accreditation as a demonstration of its commitment to high-quality healthcare services.

Three Compliance Requirement

The selected compliance requirements are zoning considerations, OSHA, and the CMS provisions. The zoning ordinances in various states and jurisdictions differ considerably. Traditionally, thought to be a preserve of highly dense neighborhoods, nursing homes, and convalescent can now exist in diverse residential neighborhoods, including single-family residential areas. Small-scale nursing homes, housing six or fewer residents have an insignificant impact on the neighborhood character in the city neighborhood and, therefore, have no zoning restrictions. Larger nursing homes, on the other hand, may have some visual effects, thereby attracting unnecessary attention. In this respect, consideration should be given to the architectural treatment of these facilities to diminish the visual effects of these facilities. When designing the proposed nursing home, due consideration will be given to the existing zoning codes. If the neighborhood is predominantly a single-family residential area, attempts will be made to select an architectural design that minimizes its visual effects.

The CMS also establishes regulations and guidance for nursing homes. Under the recently announced reforms by the Biden-Harris administration, nursing homes are expected to further quality improvement initiatives by ensuring that nursing homes meet the nurse staffing requirements for nursing homes. Other regulatory guidance provided by CMS includes the need for national partnerships to improve dementia care, the role of the state in certifying nursing homes, and the eligibility of a nursing home to participate in the Medicare and Medicaid program (Blackburn et al., 2021). As per these provisions, the proposed nursing home will be expected to meet the minimum nursing staff requirement, as outlined by the CMS, partner with national bodies to improve dementia care, and seek compliance certification from the state.

The OSHA establishes standards for healthful working and safety. In order to establish effective, highly efficient, and healthful nursing, the OSHA provisions must be taken into consideration. In this respect, the nursing home facility design will consider these provisions by instituting a periodic training program for all employees on safety enhancement and quality improvement. It will also ensure the design allows the free flow of nursing staff as they carry out their duties on their clients.

When enforcing OSHA provisions, it is important to understand the ethnic composition and cultural diversity that may be apparent within the organization. Cultural competencies for employees foster a workplace environment where each worker feels psychologically safe (Chowdhury et al., 2022). In such an environment, nursing staff recognizes the cultural diversity within the workplace and integrates cultural humility in their interpersonal interactions. This further ensures that the workplace is healthy.  The proposed nursing home seeks to improve the wellness of diverse clients. During its design and operationalization, the provision of diverse legal ordinances such as OSHA, ADA, and CMS will be put into consideration. Its development will also abide by the provisions of Austin zoning laws.

 References

Blackburn, J., Balio, C. P., Carnahan, J. L., Fowler, N. R., Hickman, S. E., Sachs, G. A., Tu, W., & Unroe, K. T. (2021). Facility and resident characteristics associated with variation in nursing home transfers: Evidence from The Optimistic Demonstration Project. BMC Health Services Research, 21(1). https://doi.org/10.1186/s12913-021-06419-y

Chowdhury, D., Baiocco-Romano, L., Sacco, V., El Hajj, K., & Stolee, P. (2022). Cultural competence interventions for health care providers working with racialized foreign-born older adults: Protocol for a systematic review. JMIR Research Protocols, 11(7). https://doi.org/10.2196/31691

Dean, A., McCallum, J., Venkataramani, A. S., & Michaels, D. (2023). The effect of labor unions on nursing home compliance with OSHA’s workplace injury and illness reporting requirement. Health Affairs, 42(9), 1260–1265. https://doi.org/10.1377/hlthaff.2023.00255

Gershuni, O., Orr, J. M., Vogel, A., Park, K., Leider, J. P., Resnick, B. A., & Czabanowska, K. (2023). A systematic review on professional regulation and credentialing of Public Health Workforce. International Journal of Environmental Research and Public Health, 20(5), 4101. https://doi.org/10.3390/ijerph20054101

Ordway, A., Garbaccio, C., Richardson, M., Matrone, K., & Johnson, K. L. (2021). Health Care Access and the Americans with disabilities act A mixed methods study. Disability and Health Journal, 14(1), 100967. https://doi.org/10.1016/

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Scenario
As the official project lead, you will use your skills in facility compliance to continue planning your facility. The legal team already knows about HIPAA, human resources, and medical malpractice liability, but has asked you to analyze legal and regulatory issues in healthcare facility design that may affect the facility design planning process.

Legal and Regulatory Considerations in Health Care Facility Design Planning

Preparation
Using the University Library, CMS.gov, or Google Scholar, research the legal and regulatory requirements that will impact the design of your facility.

Assessment Deliverable

Write a 1,050- to 1,400-word APA formatted report about your facility.

Include the following in your report:

1-Briefly restate your chosen facility type and location.

2- Provide an overview of EACH of the following types of compliance requirements and briefly evaluate their impact:

Federal requirements, including ADA, OSHA, CMS, etc.
State zoning codes for your chosen location, as applicable
State certificate of need (CON) requirements, as applicable
Local zoning codes specific to your chosen location
Facility credentialing opportunities, such as The Joint Commission

3-Choose three of the compliance requirements above in the overview for a separate discussion evaluate the impact of compliance o in your facility plan and include cultural competence in one. NOTE this is a separate focused content topic and needs to be separate from the overview.