Nursing homes who receive federal funds are required to comply with federal laws that specify that residents receive a high quality of care. In response to reports of widespread neglect and abuse in nursing homes in the 1980s, the Congress, in 1987, enacted legislation to reform nursing home regulations and require nursing homes participating in the Medicare and Medicaid programs to comply with certain requirements for quality of care. The legislations, included in the Omnibus Budget Reconciliation Act of 1987 (OBRA 1987), also known as the Nursing Home Reform Act, specifies that a nursing home "must provide services and activities to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident in accordance with a written plan of care…"

Federal Law Requirement
To participate in the Medicare and Medicaid programs, nursing homes must be in compliance with the federal requirements for long term care as prescribed in the U.S. Code of Federal Regulation (42 CFR Part 483). Under the regulations, the nursing home must:

Provide appropriate treatment and services to incontinent residents to restore as much normal bladder functioning as possible and prevent urinary tract infections and to restore as much normal bladder function as possible (42 CFR § 483.25).
Ensure that the resident receives adequate supervision and assistive devices to prevent accidents (42 § 483.25). · Ensure that a resident maintains acceptable parameters of nutritional status, such as body weight and protein level (42 § 483.25).
Provide each resident with sufficient fluid intake to maintain proper hydrations and health (42 § 483.25).
Have sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care (42 § 483.30).
Conduct initially (no later than 14 days after admission) and periodically (after a significant change in the resident's physical or mental condition and, in no case, less than once every 12 months) a comprehensive, accurate, standardized, reproducible assessment of each resident's functional capacity (42 § 483.20).
Develop a comprehensive care plan for each resident that includes measurable objectives and timetables to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment. The care plan must be developed within 7 days after completion of the comprehensive assessment and describe the services that are to be furnished. Also, the care plan must be periodically reviewed and revised by a team of qualified persons after each assessment (42 § 483.20).
Based on the resident's comprehensive assessment, ensure that a resident who enters the facility without pressure sores, does not develop pressure sores, unless unavoidable, and, a resident having pressure sores shall receive the necessary treatment and services to promote healing, prevent infection and prevent new sores from developing (42 § 483.25).
Prevent the deterioration of a resident's ability to bathe, dress, groom, transfer and ambulate, toilet, eat, and to use speech, language or other functional communication systems (42 § 483.25).
Provide, if a resident is unable to carry out activities of daily living, the necessary services to maintain good nutrition, grooming, and personal and oral hygiene (42 § 483.25).
Ensure that residents receive proper treatment and assistive devices to maintain vision and hearing abilities (42 § 483.25).
Ensure that residents are free of any significant medication errors (42 § 483.15).
Care of its residents in a manner and in an environment that promotes maintenance or enhancement of each resident's quality of life (42 § 483.15).
Promote care for residents in a manner and in an environment that maintains or enhances each resident's dignity and respect in full recognition of his or her individuality (42 § 483.15).
Ensure that the resident has the right to choose activities, schedules, and health care consistent with his or her interests, assessments and plan of care (42 § 483.15).
Ensure that the medical care of each resident is supervised by a physician and must provide or arrange for the provision of physician services 24 hours a day, in case of an emergency (42 § 483.40).
Provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident (42 § 483.75).
Maintain clinical records on each resident in accordance with accepted professional standards and practices that are complete, accurately documented, readily accessible, and systematically organized (42 § 483.75).
In addition to federal laws regulating the quality of care in nursing homes, Tennessee, Kentucky, Georgia, North Carolina, Alabama, Virginia and most other states have enacted laws as well. State laws must be as stringent as the federal laws. In some cases, state laws are, in fact, tougher than federal law.

Summary
In summary, a nursing home must conduct an initial comprehensive assessment of each resident and periodic reassessments quarterly or as needed if there is a significant change in the condition of the resident. From this assessment, a plan of care must be developed that specifies the necessary care that the resident must be provided. The facility must have sufficient nursing personnel to provide all the necessary care to each resident in accordance with the assessment and plan of care. Assessments, plans of care and the actual care provided are all required to be documented in the resident's clinical record. Almost every aspect of a nursing home's operation, including resident care, is covered under state and federal regulations. Therefore, when a nursing home willfully refuses to provide the required care resulting in injury and/or death of a resident, the nursing home may have violated federal and state laws which may constitute fraud if the resident's care was being reimbursed by Medicare or Medicaid.