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Nursing Home Residents' Rights

The federal bill of rights every Medicare- or Medicaid-certified nursing home must honour - dignity, choice, freedom from restraints and abuse, notice before transfer or discharge - and the inspection and complaint system that enforces it.

Informational only - this is not legal advice. These definitions explain general legal vocabulary in plain English. They are not advice about your situation, reading them creates no attorney-client relationship, and the law differs from state to state and changes over time. For advice you can rely on, speak to a lawyer licensed in your state.

What it means

Every nursing home that accepts Medicare or Medicaid - almost all of them - is bound by a federal set of resident rights enacted after a national study documented widespread neglect. A resident has the right to be treated with dignity and to make their own choices about their schedule, activities and care; to be free from physical or chemical restraints used for discipline or convenience rather than to treat a medical symptom; to be free from abuse, neglect and misappropriation of property; to privacy, to their own physician, to see their records, to manage their own money or have it properly accounted for; to participate in their care plan and to refuse treatment; and to voice grievances without retaliation. The facility must give each resident a written statement of these rights.

The transfer and discharge rules are the ones families meet most often. A facility may move a resident out only for reasons the statute lists - the resident's needs cannot be met, their health has improved, the safety or health of others is endangered, non-payment, or the facility closes - and must give written notice, in advance, with the reason, the destination, and the right to appeal to the state. A discharge to a hospital must come with a bed-hold notice explaining the right to return. "Resident dumping" - refusing to readmit a resident after a hospital stay, or discharging a resident whose Medicare coverage has ended - is a recurring subject of enforcement.

Enforcement runs through the state survey agency, which inspects on an unannounced cycle and on complaint, and can impose federal remedies from a plan of correction up to civil money penalties and termination from Medicare. Every state has a long-term-care ombudsman programme, created by federal law, that investigates complaints on residents' behalf at no charge. The federal rights supplement, and do not replace, state licensing law and the ordinary law of negligence and elder abuse under which a facility can be sued.

Where this comes from

The Nursing Home Reform Act, part of the Omnibus Budget Reconciliation Act of 1987, is codified at 42 U.S.C. § 1395i-3 (Medicare) and § 1396r (Medicaid); the resident-rights, transfer-and-discharge and quality-of-care requirements are at 42 C.F.R. part 483, subpart B, with the rights at § 483.10 and the transfer and discharge rules at § 483.15. The state long-term-care ombudsman programme is required by the Older Americans Act, 42 U.S.C. § 3058g. The federal regulations create no private right of action of their own; suits proceed under state law, and some states allow the federal standards to be used as evidence of the standard of care.

When people hire a lawyer for this

Two situations call for a lawyer quickly. The first is a transfer or discharge notice - the appeal window is short and the facility cannot move the resident while a timely appeal is pending in most circumstances, so the timing of the appeal is the whole case. The second is injury: a fall, a pressure sore, dehydration, an unexplained bruise, a medication error. For those, a complaint to the survey agency and the ombudsman can run alongside a civil claim, and the facility's own incident reports and staffing records, which a lawyer can compel, are the evidence. An arbitration agreement in the admission papers is a separate question with rules of its own.

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Part of the LawyerLand plain-English legal glossary. Definitions are written from primary sources - statutes and court rules - and each entry states the authority it rests on, or says plainly when the doctrine is state law with no national rule.

If you cannot afford a lawyer, civil legal aid programmes provide free help with many of these problems: civil legal aid programmes by state.

Related free reference tools: statute of limitations for a personal-injury claim, by state, quoted from each state's official text - part of LawyerLand's legal reference tools.