Free Essay on Non-Profit Nursing Home

Today one of the significant decisions patients and families encounter when they require to care for an extended period is selecting a facility. A primary aspect that is supposed to be considered in choosing a non-profit nursing home or for-profit corporate facility. Broad research found that the form of nursing facility sponsorship and ownership affects the quality of care given to the patients (Grabowski 2014). A study by the Institute of Medicine (IoM) found that nursing facilities that are owned by investors for profit-making had negative implications on the quality of care for their residents (Gray 1986). IoM examined the growing privatization of hospitals since 1970 through empirical research, the study found impressionistic evidence and documented differences in the quality of care associated with ownership (Gray 1986). For-profit nursing facilities allocate fewer resources to guide patient care, which results in poorer care quality for patients (Harrington 2001. Examinations of license violations, resource inputs, and outcome-oriented measures of quality, and complaints all found that non-profit nursing homes offered better quality care in comparison with for-profit (Harrington 2001). These crucial early results have been replicated in many other studies.

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For instance, in 2011 an analysis of ten most extensive for-profit nursing facilities compared to other ownership groups documented that from 2003-2008 these facilities had lowest staffing levels, the highest number of deficiencies causing jeopardy or harm to the patients and the highest number of deficiencies identified by the public regulatory agencies (Harrington 2012). The Government Accountability Office (GAO) in 2011 reported that for-profit nursing residences had lower total nurse staffing ratios, had higher deficiencies, capital-associated cost rises and had better profit margins than non-profit facilities. LeadingAge New York (2012) found that non-profit nursing homes in the New York State performed well on many measures in comparison to for-profit facilities. In essence, lesser hospitalization rates, and more home clearances, had more nursing staff and used more resources in a day on nursing food and other costs. A review comparing the care quality for-profit and non-profit nursing homes found that almost all of the 82 studies concluded that there is more staffing, more quality, and fewer restraints prevalence, and lower government-cited deficiencies and lower ulcer prevalence in non-profit homes (Ronald 2016). Therefore, sponsorship and ownership type has been proved to make a variation in the care quality provided to residents. The Affordable Care Act highlights the significance of ownership information. It demands that nursing homes account, and the Centres for Medicare & Medicaid Services (CMS) to ensure the comprehensive ownership data is available to the public (Centers for Medicaid and Medicare Services 2016). In essence, this paper will discuss in detail the process of establishing a not-for-profit nursing home, considering federal and state laws.

Process of Establishing Non-Profit Nursing Home

Incorporating a not-for-profit entity sets the legal protections that help to keep the nursing home and its director's assets separate from the facilities liabilities. There are several benefits that non-profit organizations generally enjoy. For instance, in the US, not-for-profit organizations enjoy limited liability protection: the directors of the organization cannot be personally liable for its liabilities and debts (Agard 2010). The entity continues even after the directors pass away or leave the business. Besides, non-profit companies are eligible for specific public and private grants (Agard, 2010). As such, non-profits organizations are bound by different federal and states in comparison with for-profit organizations; nonetheless, their formation process is quite similar. Like regular corporations, a non-profit entity must file articles of incorporation with the state in which they wish to incorporate.'

Articles of Incorporation

For an organization to be considered as a public, non-profit entity, a nursing facility has to be incorporated in the state in which they seek to operate. The organizations must have bylaws and the list of boards of directors (Thompson 2017). Further, the nursing facility must follow all the Federal and state laws, including governing the staff bottom wage, ensuring workers' safety, and payroll tax withholding (Thompson 2017). It is common to find nursing facilities homes that are non-profit homes. However, not all nursing facilities qualify or are suitable to receive such a status. Rather, Public Charity status insinuates how a facility controls its resources instead of the kind of enterprise it runs. To establish the not-for-profit facility, the company have to apply for such category via the Internal Revenue Service (IRS) and are not supposed to refer to the facility as a non-profit nursing home until they receive approval from the body as mentioned above (Thompson 2017).

Seeking Tax-Exempt Status

After incorporation, the nursing facility has to file paperwork with IRS seeking to acquire 501 (c) (3) not-for-profit status by filling form 1023 (Thompson 2017). The applying organization has to offer data about its enterprise structure, yearly proceeds, and the service they provide to the public (Agard 2010). Hence, to be eligible for a not-for-profit nursing facility, profits cannot be disbursed to shareholders; rather, gains must be rolled back into the business. Acquiring the public charity status infers that the nursing home will not have to pay taxes on its income on the condition that the profits are not disbursed to the facility's shareholders. As such, tax donations make it easier to request donations. According to the US tax deductions laws, the taxpayer is not supposed to deduct charitable contributions that they make to non-profit organizations that are not recognized (Thompson 2017). Thus, when a nursing home becomes a registered non-profit organization, donors can deduct any donations made to the facility when they file their tax returns

Nonetheless, not-for-profit nursing homes must file salary taxes for their staff. While a non-profit nursing facility does not have to pay taxes on its revenues, the organization has to keep income records for its staff and to withhold income taxes (Thompson 2017). Moreover, the facility may also pay taxes when it gives sweepstakes and gifts. Besides, if the nursing facility frequently engages in profit-making activities that are profitable and not related to the facility it has to pay taxes on those incomes

Federal Nursing Home Regulation and states Laws

The federal government started getting involved in nursing home regulations by enacting the Social Security Act of 1935, which helped create a federal-state public assistance program for the elderly. Since then states there has been increased involvement of the federal government in regulating nursing homes. States have been mandated to license these facilities, monitor and ensure that all the rules are followed. Failure to which they are authorized to enforce them. Thus, the fundamental rules seek to ensure the care quality received by the patient in contrast to surveying the physical facility.

Several federal and state laws protect both profit and non-profit nursing homes, residents, from neglect and abuse. Also, residents are entitled to security, privacy, and other rights. In 1987 the congress enacted legislation, the Nursing Home Reform Act, which requires nursing facilities that partake in Medicare and Medicaid to comply with specific laws that target at increasing quality of care (Carder 2015). For instance, a new non-profit nursing entity must offer activities and services to maintain and achieve the most attainable mental, psychological, and physical wellbeing of residents in line with the written care plan. In order to participate in Medicare and Medicaid, a nursing facility is required to comply with the regulations set by the federal government for extended care homes (Carder 2015).

The federal government nursing home regulations 42 CFR s 483.30 states that the nursing home must have enough staff. As such, in establishing a new non-profit nursing facility, the owners must ensure that it has adequate staffing to enjoy Medicaid and Medicare services. Rule 42 CFR s483.20 requires that the nursing facility create a comprehensive plan of care for residents, which means that care in the new facility should be provided on a person-centered approach failure. Moreover, the nursing home should prevent any further deterioration of the resident's capacity from dressing, bath, groom, ambulating and transferring, eat, toilet, communicating, and to groom as outlined in 42 CFR s483.25. Thus, the resident's wellbeing should improve instead of worsening as a result of care quality. The facilities staff should be well trained, and they should be provided with continuous in-service training. It handles residents with different problems.

Moreover, the company should have in place measures that ensure that the caregivers are motivated and their health is well-taken care of. The non-profit nursing home should provide the self-care as mentioned above-outlined services if the residents are unable to undertake these services and daily living activities, which are essential services to ensure grooming, personal oral hygiene, and proper nutrition (Carder 2015). As stated in rule 42 CFR s483.15, the new non-profit nursing facility should strive to promote the resident's quality of life. Additionally, the health facility before inception must ensure that it can provide pharmaceutical services to meet the requirements of every resident as required by law (42 CFR S483.60).

Non-profit nursing home board of directors listed in its articles of incorporation should ensure that the facility is run in a manner that facilitates efficient and effective use of resources (Carder 2015). Thus, this would enable smooth learning of the facility, ensuring that it is self-sufficient and can raise resources to improve its services to the public. Nursing facilities should maintain complete, easily accessible, and accurate clinical records for each resident (42 CFR S483.75), which ensures that all patients are taken care of in conformity with the patient nursing care plan. At a minimum, nursing homes that intend to receive Medicare or Medicaid funds must at least comply with federal nursing facility regulations (Carder 2015). States have adopted more stringent laws in enforcing that non-profit nursing home rules and regulations are followed.

States Laws

Nursing homes are crucial elements of a state's extended period of supports and services. The main reason for this care is due to the need for unscheduled assistance, inability to pray privately in their homes, and insufficient informal care. Most states require a residency agreement between the nursing home and the resident as it established a legal requirement, such as the rights of both the residents and the care providers. The 2014 CMS HCBS setting regulations expounds that any nursing facility serving residents under section 1915 (c, I, and k) Medicaid rules give a residency agreement. Which follows the necessary landlord/tenant laws that clarify eviction and appeal processes, and their rights and responsibilities (Carder 2015). As such, almost all states require a residency agreement.

Some states require that not-for-profit nursing facility to file a separate document that informs their probable clients about the rates and services. The document is referred to as a disclosure statement.