What Are the Rights of Nursing Home Residents?

Though the majority of nursing homes provide excellent care, the placement of elderly patients in an institutional environment with the complication of what is often a debilitating medical condition creates the possibility for poor quality of care or even outright neglect or abuse. Laws at both the state and federal levels are designed to protect nursing home residents, and the 1987 Nursing Home Reform Law was ultimately incorporated into Medicare and Medicaid regulations. It establishes a broad range of rights, all guided by the fundamental principle that the nursing home patient must receive the services necessary to allow him or her to function at the highest possible level.

Here we'll examine specific rights set forth in the law.

Respectful treatment: The staff must treat you with dignity and respect. You are entitled to set your own schedule (including the times you go to bed, get up, and eat) and choose your activities.

Participation in activities: You must have the opportunity to participate in the facility's activities program, subject to your right to choose your own activities.

No discrimination: While a nursing home is not required to accept every applicant, all facilities must adhere to all applicable civil rights laws in making admission decisions.

No abuse or neglect: Your personal and medical needs must be adequately met, and you must not be subjected to any form of abuse (verbal, physical, mental, or sexual). You may not be involuntarily segregated from other residents.

No restraints: You may not be placed in any type of physical restraints or "chemically restrained" (through the use of sedatives, for example) for disciplinary reasons or for the convenience of the nursing home staff.

Right to complain: You are entitled to complain to the nursing home staff without retribution, and the staff must evaluate and respond to your complaint.

Proper medical care: You are entitled to receive proper medical care. Because this is such an important part of the services provided by a skilled nursing facility, this right covers many specific issues:

• You must be fully informed of your medical conditions and overall health in terms you can understand.
• You must similarly be fully informed regarding any prescription or over-the-counter drugs, vitamins, or supplements you are given.
• You must be permitted to have a say in choosing your doctor.
• You must be permitted to have a say in making decisions that affect your health care.
• You must have the opportunity to have a say in your medical care plan. You are also entitled to involve family members if you so choose.
• You must have access to your medical records in a timely manner during regular business hours. If you have a legal guardian, they are similarly entitled to review your records and to make decisions on your behalf.
• You are entitled to lodge any grievances you may have regarding your medical care.
• You have the right to create an advance health directive (sometimes called a "living will") or to grant someone else power of attorney to make medical decisions for you if you become incapacitated.
• You may not be required to participate in experimental medical treatments.

Notification of representative: Your doctor and your legal representative (if any) or a family member must be notified of any of these events:

• You are injured and/or require a doctor's care.
• Your physical, mental, or psychosocial condition gets worse.
• You develop a condition that is life-threatening.
• You encounter medical complications.
• The need arises to make significant changes to your medical treatment.
• The nursing home decides to discharge or transfer you.

Disclosure of fees and services: The nursing home must disclose to you, in advance and in writing, the nature and amount of all fees and services, whether you will use or be charged them or not. You must also be notified any time those fees or services change. Entrance fees are prohibited for patients whose care is covered by Medicare or Medicaid, you must be advised how to apply for Medicare and Medicaid benefits, and you must be told how to get reimbursed for any Medicare- or Medicaid-covered services that you paid for out of pocket.

Money management: You are entitled to manage your own money or choose someone to do so for you, and you must be allowed full access to your money, financial records, and bank accounts. You must give written permission for the nursing home to hold your money for you, and if you do, the nursing home must fully account for your funds and cannot commingle them (combine them with its own money, for example by depositing them into the same bank account). It must also provide reasonable protection for your money through appropriate insurance or surety bonds.

Privacy, property, and living arrangements: You are entitled to privacy in your visits, telephone calls, mail, and e-mail. You are entitled to keep and use your personal belongings as long as they don't interfere with the safety, health, or rights of others, and the nursing home must take reasonable measures to protect your property from theft. You must be allowed to share a room with your spouse if you both agree to do so, and the nursing home may not change your room assignment or roommate without notifying you first and, to the extent possible, taking your wishes into account.

Visitation: In addition to having the right to private visits, you are entitled to have visitors at any time and for as long as you like, as long as this does not interfere with the rights of other residents. You are also entitled to see your medical, social, legal, or similar representative at any time.

Social services: You are entitled to receive necessary social services, including counseling, assistance in finding legal or financial representatives, assistance in solving problems with other residents, and discharge planning, from the nursing home.

Leaving: You are entitled to take a "leave of absence" from the nursing home for part of a day or overnight in order to spend time with family or friends, assuming that your doctor agrees and your medical condition permits it. (Note that some health insurance that covers nursing home stays may stop paying if you take a leave of absence, and that is not regulated by these rights.) You are entitled to move out of the nursing home, although the nursing home is allowed to charge a fee if you leave without giving advance notice.

No unfair discharge or transfer: You may not be discharged or transferred to another nursing home unless you no longer medically require nursing home care, the nursing home has not been paid for services rendered to you, the nursing home closes, or the discharge or transfer is for the health, safety, or welfare of you or other residents. You have the right to appeal a discharge or transfer to the appropriate agency in your state, to be given a 30-day notice unless in the case of emergency, and to have a discharge or transfer plan from the nursing home.

Resident groups: You are entitled to join, or even to form, a group of residents intended to discuss and voice concerns about the nursing home. These groups are often called "resident councils." The nursing home is required to provide space for resident council meetings and to evaluate and act on any grievances it presents.

Involvement of family and friends: You are entitled to have your family and friends involved in your residence and care at the nursing home, including participation in the family council (if applicable) and involvement in your care plan if you so permit.

As you can see, the law provides a very robust set of protections to nursing homes. For information on what to do in the event of problems with a nursing home, see "What Are the Options for Dealing with Nursing Home Problems?"