What Legal Rights Do Nursing Home Residents Have?
Your guide to the nursing home laws & resident rights you need to know about before moving into a nursing home.
When you move a loved one into a nursing home, it can feel like unfamiliar territory. Unless you’ve dealt with nursing homes in the past, there are countless unknowns on procedures, payments, and expectations. Whether you are starting a journey with a nursing facility or have been working with one for some time, it’s important to understand nursing home resident rights and nursing home laws and regulations. Just because someone is a resident of a nursing home doesn’t mean he/she loses all autonomy. Every nursing home resident should be informed about their rights, as they may be more extensive than you expected. Here are some of the most noteworthy rights all residents are entitled to:
- Residents have the right to be treated with dignity, respect, and consideration at all times.
- Residents have the right to meet with family members, visitors, service providers, and state and federal government representatives. Nursing homes must also provide a private space for resident or family councils.
- Residents may keep and use their personal items and clothing unless these items constitute a health and/or safety danger.
- Residents have the right to privacy in their rooms while receiving medical treatment and during communications such as phone calls and family meetings.
- Residents can choose their own personal doctor.
- Residents have the right to participate in the planning of their care and treatment, and to also be fully informed about their medical care.
- Residents can choose to keep their personal and clinical records confidential.
- Residents can refuse treatment.
- Residents have the right to live free of physical and mental abuse.
- Nursing home staff must not tie down or give drugs to restrain residents if restraint is not necessary to treat medical symptoms.
- Residents may participate in and organize social and religious activities as long as they do not interfere with the rights of other residents.
- Residents have the right to manage their own money, and may also request that the facility manage their personal funds, according to state and federal record-keeping requirements.
- Residents may not be kept away from one another against their will.
- Residents have the right to issue complaints and have them resolved quickly. If residents cannot resolve issues within the nursing home, their next step should be to contact the local ombudsman.
These rights and regulations apply to all nursing home residents, regardless of if they pay privately, or with Medicare or Medicaid.
Medicaid and Medicare Coverage
Nursing home residents using Medicare are only reimbursed for specific care, as Medicare is not a comprehensive health insurance program. Medicare puts stipulations on nursing home coverage. It is typically required for nursing home care to be connected to hospital care, and the patient must enter the nursing home within 30 days after a hospital stay of three or more nights. Usually, this requires a patient to become a resident of or transfer to a skilled nursing facility, since it is medically necessary. However, Medicare will not cover custodial care, which includes things such as medication management and assistance with bathing or dressing. Nursing homes may decide to not bill Medicare and must give the resident written notice. Medicaid accounts for about half of nursing homes’ revenue, but Medicaid also pays lower rates for services than private pay. Because of this, nursing homes may try to cut corners on services for residents with Medicaid, which is against federal law. The Nursing Home Reform law states that nursing homes “must establish and maintain identical policies and practices regarding transfer, discharge and the provision of services under the State [Medicaid] plan for all individuals regardless of the source of payment.” This means all nursing home residents are entitled to the same rights and treatment from all nursing home facilities.
Coordinating Care with the Nursing Home
The coordination of care may be another confusing factor for nursing home patients and family. Since nursing homes have experience in caring for their patient’s health, they may jump to certain care plans, leaving a new resident and their family feeling steamrolled. This shouldn’t be the case. As stated above, residents and their families are entitled to help create a care plan based on what the resident needs. In that same vein, families should never feel like they have to bring in outside assistance for treatments. Nursing facilities are obligated to provide all of the necessary care for its residents, which may include bringing in specialists. Again, this falls under the nursing home’s responsibility. Families can contact ombudsmen to resolve issues regarding long-term care improvements.
Eviction from a Nursing Home
Nursing home residents and family members are often worried about eviction from the facility. This issue can arise when the demand for space in nursing homes outweighs the number of vacancies. However, there are only six reasons nursing homes may evict a resident:
- The resident is a risk to others’ safety
- The resident is a risk to others’ health
- The resident’s need cannot be met in a nursing home
- The resident no longer needs nursing home care
- The nursing home is going out of business
If a resident is discharged for any of these reasons, written notice must be given, typically 30 days in advance, and supporting evidence must be included. Along with the written notice, the facility must also provide the phone numbers of the nursing home inspection and licensing authorities, plus instructions on how to appeal the decision.
Admitting Family Against Their Will
While admitting a loved one into a nursing home is difficult, it is often made even more difficult by an unwilling elderly relative. Many people have been in the situation of having a relative who can no longer live on their own for several reasons. While well-meaning adult children may demand their parents move to a nursing home for their own health and safety, it is almost impossible to put a refusing parent in a nursing home against their will. To do so, one would have to go through the court system to gain legal guardianship over the individual, and judges rarely grant this. Helping a loved one enter a nursing home can be intimidating, but it is a responsible decision. Take your time to get to know the facility and be familiar with local nursing home regulations and resident rights.