The nation's 15,000 nursing homes will have to meet higher standards of care and give patients more say in their treatment, under new regulations for Medicaid and Medicare reimbursement.

The final regulations, announced Monday, cap several years of efforts by the Health Care Financing Administration to meet the terms of a law passed by Congress in 1987 to improve the quality of nursing home care."These regulations change our focus in regulating nursing homes, away from looking to see merely if a facility has the capacity to deliver care, to looking at the quality of care that is actually being delivered," said Dr. William L. Roper, HCFA administrator.

Among other things, the regulations will:

-Give patients the right to refuse treatment, manage their own money, receive visitors, manage their own privacy, express grievances, be free of physical restraints and not be transferred or discharged against their will.

-Offer patients services needed to treat specific conditions and guard against such things as inappropriate weight gain and loss and bed sores.

-Require nursing homes to have 24-hour nursing capability, including a registered nurse for eight hours of every day.

-Require facilities to train nurses' aides, provide dental, vision and hearing care, and offer an activities program by a qualified professional.

The final regulations will apply to nearly 15,000 long-term facilities.