Federal and state regulations governing nursing homes

No matter if it is you or a loved one entering a long-term care facility, it is important to understand your rights. Under federal law residents of nursing homes have clear rights.

Federal Nursing Home Regulations

In response to neglect and abuse suffered by nursing home residents, Congress enacted legislation in 1987 which required a nursing home participating in Medicaid and Medicare to follow certain regulations regarding care. The Nursing Home Reform Act states that a nursing home is required to provide services and activities to maintain the highest quality of life for each resident in accordance with a written plan of care. To maintain eligibility for participating in Medicare and Medicaid, nursing homes must:

• Have sufficient nursing staff. (42 CFR §483.30)
• Conduct initially a comprehensive and accurate assessment of each resident’s functional capacity. (42 CFR §483.20)
• Develop a comprehensive care plan for each resident. (42 CFR §483.20)
• Prevent the deterioration of a resident’s ability to bathe, dress, groom, transfer and ambulate, toilet, eat, and to communicate. (42 CFR §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 oral hygiene. (42 CFR §483.25)
• Ensure that residents receive proper treatment and assistive devices to maintain vision and hearing abilities. (42 CFR §483.25)
• Ensure that residents do not develop pressure sores and, if a resident has pressure sores, provide the necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing. (42 CFR §483.25)
• Provide appropriate treatment and services to incontinent residents to restore as much normal bladder functioning as possible. (42 CFR §483.25)
• Ensure that the resident receives adequate supervision and assistive devices to prevent accidents. (42 CFR §483.25)
• Maintain acceptable parameters of nutritional status. (42 CFR §483.25)
• Provide each resident with sufficient fluid intake to maintain proper hydration and health. (42 CFR §483.25)
• Ensure that residents are free of any significant medication errors. (42 CFR §483.25)
• Promote each resident’s quality of life. (42 CFR §483.15)
• Maintain dignity and respect of each resident. (42 CFR §483.15)
• Ensure that the resident has the right to choose activities, schedules, and health care. (42 CFR §483.40)
• Provide pharmaceutical services to meet the needs of each resident. (42 CFR §483.60)
• Be administered in a manner that enables it [the nursing home] to use its resources effectively and efficiently. (42 CFR §483.75)
• Maintain accurate, complete, and easily accessible clinical records on each resident . (42 CFR §483.75)

The 1987 Nursing Home Reform Law protects the following rights of nursing home residents:

The Right to Be Fully Informed of

• Available services and the charges for each service
• Facility rules and regulations, including a written copy of resident rights
• Address and telephone number of the State Ombudsman and state survey agency
• State survey reports and the nursing home’s plan of correction
• Advance plans of a change in rooms or roommates
• Assistance if a sensory impairment exists
• Residents have a right to receive information in a language they understand (Spanish, Braille, etc.)

Right to Complain

• Present grievances to staff or any other person, without fear of reprisal and with prompt efforts by the facility to resolve those grievances
• To complain to the ombudsman program
• To file a complaint with the state survey and certification agency

Right to Participate in One’s Own Care

• Receive adequate and appropriate care
• Be informed of all changes in medical condition
• Participate in their own assessment, care-planning, treatment, and discharge
• Refuse medication and treatment
• Refuse chemical and physical restraints
• Review one’s medical record
• Be free from charge for services covered by Medicaid or Medicare

Right to Privacy and Confidentiality

• Private and unrestricted communication with any person of their choice
• During treatment and care of one’s personal needs
• Regarding medical, personal, or financial affairs

Rights During Transfers and Discharges

• Remain in the nursing facility unless a transfer or discharge:
• (a) is necessary to meet the resident’s welfare;
• (b) is appropriate because the resident’s health has improved and s/he no longer requires nursing home care;
• (c) is needed to protect the health and safety of other residents or staff;
• (d) is required because the resident has failed, after reasonable notice, to pay the facility charge for an item or service provided at the resident’s request
• Receive thirty-day notice of transfer or discharge which includes the reason, effective date, location to which the resident is transferred or discharged, the right to appeal, and the name, address, and telephone number of the state long-term care ombudsman
• Safe transfer or discharge through sufficient preparation by the nursing home

Right to Dignity, Respect, and Freedom

• To be treated with consideration, respect, and dignity
• To be free from mental and physical abuse, corporal punishment, involuntary seclusion, and physical and chemical restraints
• To self-determination
• Security of possessions

Right to Visits

• By a resident’s personal physician and representatives from the state survey agency and ombudsman programs
• By relatives, friends, and others of the residents’ choosing
• By organizations or individuals providing health, social, legal, or other services
• Residents have the right to refuse visitors

Right to Make Independent Choices

• Make personal decisions, such as what to wear and how to spend free time
• Reasonable accommodation of one’s needs and preferences
• Choose a physician
• Participate in community activities, both inside and outside the nursing home
• Organize and participate in a Resident Council
• Manage one’s own financial affairs