Currently, 1.6 million elderly and disabled people receive care in about 17,000 nursing homes across the United States. In 1987, Congress passed major nursing home reforms that defined the role of the State survey and certification process in determining the compliance of nursing homes with Federal standards. In 1998, the President announced new steps to increase Federal oversight of nursing homes' performance, including enhanced monitoring of poorly performing homes, collection of new fines from non-compliant homes, and an increased focus on special care areas such as nutrition, pressure sores, and abuse. HCFA responded with the Nursing Home Initiative (NHI), which was intended to improve the quality of care for nursing home residents. Many of the new activities from the NHI have already been implemented, but it will take more time before we have all of them fully in operation.
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