Residents' Rights
Upon admission into a nursing home, residents are afforded a special set of rights guaranteed by the federal Nursing Home Reform Law. Nursing home administration and staff are to promote and protect resident rights—not just tolerate them. Residents may exercise these rights free of interference, coercion, discrimination, and reprisal from the facility.
From deciding when to attend an activity to what time you would like to get out of bed in the morning for breakfast, these rights ensure that residents live a dignified existence with individual choice maximized in everyday decision-making.
A summary of resident rights include:
Access and Visitation Rights
Access to Survey Results
Admission, Transfer and Discharge
Bed-Hold Policy and Readmission
Filing Grievances
Freedom of Choice
Management of Personal Funds
Medicare or Medicaid Services
Notification of Changes
Notification of Rights and Services
Requests for Items
Working in a Facility
- The resident has the right and the facility must provide immediate access to any resident by the following:
- Any representative of the Secretary
- Any representative of the State
- The resident's individual physician
- The State Long-Term Care Ombudsman
- The agency responsible for the protection and advocacy system for developmentally disabled individuals
- The agency responsible for the protection and advocacy system for mentally ill individuals
- Immediate family or other relatives of the resident
- Others who are visiting with the consent of the resident
- The facility must allow representatives of the State Ombudsman to examine a resident's clinical records permission of the resident or the resident's legal representative, and consistent with State law.
- The resident has the right to have reasonable access to the use of a telephone where calls can be made without being overheard.
- The resident has the right to retain and use personal possessions, including some furnishings, and appropriate clothing, as space permits, unless to do so would infringe upon the rights or health and safety of other residents.
- The resident has the right to share a room with his or her spouse when married residents
A resident has the right to:
- The right to examine the results of the most recent survey of the facility any corresponding plan of correction.
- The facility must make the results available in an area that is readily accessible to residents and post a notice of their availability
Admission, Transfer and Discharge Rights
Transfers and discharges are common occurrences in many nursing homes. A transfer and discharge includes movement of a resident to a bed outside of the nursing home. Transfer and discharge does not apply to the relocation of a resident to a different bed within the same nursing home.
Transfer and discharge requirements
- The facility must permit each resident to remain in the facility
- The facility can only transfer or discharge a resident for the following reasons:
- The resident's needs cannot be met in the facility
- The resident's health has improved sufficiently so the resident no longer needs the services provided by the facility
- The safety of individuals in the facility is endangered
- The health of individuals in the facility would otherwise be endangered
- Nonpayment
- The facility ceases to operate
Documentation required by the facility before a transfer or discharge is initiated
- A resident’s physician must document the necessity of a transfer or discharge within the resident’s medical record
- A physician may order a transfer or discharge if the safety of other individuals is endangered
Notice before transfer
Before a facility transfers or discharges a resident, the facility must:
- Notify the resident and, if known, a family member or legal representative of the resident of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand
- Record the reasons in the resident's clinical record
- Include in the notice the specified reason(s) for transfer or discharge
Timing of the notice
- The facility must provide notice at least 30 days before the resident is transferred or discharged except in those cases when a resident is a danger to self or others or the facility ceases to operate
- The facility may provide notice as soon as practicable before a transfer or discharge when:
- A resident is a danger to self or others
- A resident’s health improves to allow an immediate transfer or discharge
- A resident requires urgent medical attention
- A resident has not resided in the facility for 30 days
Contents of the notice
The written notice must include:
- The reason for transfer or discharge
- The effective date of transfer or discharge
- The location to which the resident is transferred or discharged
- A statement that the resident has the right to appeal the action to the State
- The name, address and telephone number of the State Long-Term Care Ombudsman
- For nursing facility residents with developmental disabilities, the mailing address and telephone number of the agency responsible for the protection and advocacy of developmentally disabled
- For nursing facility residents who are mentally ill, the mailing address and telephone number of the agency responsible for the protection and advocacy of mentally ill
Orientation for transfer or discharge
- A facility must provide sufficient preparation and orientation to residents to ensure safe and orderly transfer or discharge from the facility.
Notice in advance of facility closure
- In the case of facility closure, the administrator of the facility must provide written notification prior to the impending closure to:
- The Secretary
- The State Long-Term Care Ombudsman
- Residents or legal representatives, as well as the plan for the transfer and adequate relocation
Bed-Hold Policy and Readmission
Notice before transfer
- Before a nursing facility transfers a resident to a hospital or allows a resident to go on therapeutic leave, the nursing facility must provide written information to the resident and a family member or legal representative that specifies—
- The duration of the bed-hold policy under the State plan, if any, during which the resident is permitted to return and resume residence in the nursing facility
- The nursing facility's policies regarding bed-hold periods permitting a resident to return
Bed-hold notice upon transfer
- At the time of transfer of a resident for hospitalization or therapeutic leave, a nursing facility must provide to the resident and a family member or legal representative written notice which specifies the duration of the bed-hold policy.
Permitting resident to return to facility
- A nursing facility must establish and follow a written policy under which a resident, whose hospitalization or therapeutic leave exceeds the bed-hold period under the State plan, is readmitted to the facility immediately upon the first availability of a bed in a semi-private room if the resident is eligible for Medicaid nursing facility services and requires the facility’s services.
Readmission to a composite distinct part
- When the nursing facility to which a resident is readmitted is a composite distinct part, the resident must be permitted to return to an available bed in the particular location of the composite distinct part in which he or she resided previously. If a bed is not available in that location at the time of readmission, the resident must be given the option to return to that location upon the first availability of a bed there.
Equal access to quality care
- A facility must establish and maintain identical policies and practices regarding transfer, discharge, and the provision of services under the State plan for all individuals regardless of payment
- The facility may charge any amount for services furnished to non-Medicaid residents consistent with the notice requirement and describe the charges
Refusal of certain transfers
A resident has the right to:
- Refuse a transfer to another room, if the purpose of the transfer is to relocate—
- A resident of a skilled nursing facility from the distinct part of the institution facility
- A resident of a nursing facility to skilled nursing facility distinct part
- A resident has the right to voice grievances without discrimination or reprisal
- The facility must promptly work to resolve resident grievances.
A resident has the right to:
- Choose a personal attending physician
- Be fully informed in advance about care and treatment and of any changes in that care or treatment that may affect the resident's well-being
- Participate in planning care and treatment or changes in care and treatment
- A resident has the right to manage his or her financial affairs, and the facility may not require residents to deposit their personal funds with the facility
- The facility must hold, safeguard, manage, and account for the personal funds of the resident deposited with the facility upon consent of the resident
Medicare or Medicaid Included Services
During the course of a covered Medicare or Medicaid stay, facilities may not charge a resident for the following:
- Nursing services
- Dietary services
- An activities program
- Room/bed maintenance services
- Person hygiene products that include, but are not limited to:
- Comb and brush
- Soap
- Razor and shaving cream
- Toothbrush, toothpaste and dental floss
- Denture adhesive and cleaner
- Moisturizing lotion
- Tissue
- Cotton balls and cotton swabs
- Deodorant
- Incontinence care and supplies
- Napkins
- Towels and washcloths
- Hospital gowns
- Over the counter medicine
- Hair and nail services
- Bathing
- Personal laundry
The following are items and services the facility may charge the resident:
- Phone
- Television or radio for personal use
- Cigarettes and other smoking materials
- Cosmetic products that exceed those covered by Medicare and Medicaid
- Personal clothing
- Books, magazines, and other reading material
- Gifts
- Flowers and plants
- Social events and entertainment offered outside of the facility’s designated activity program
- Private duty care
- Private room, except when medically required
- Specially prepared food not offered on the facility’s menu
A facility must immediately inform the resident (and resident’s legal representative) and consult with the resident’s physician of:
- An accident involving the resident which results in injury and has the potential for requiring physician intervention
- A significant change in the resident's physical, mental, or psychosocial status
- A need to alter treatment significantly
- A decision to transfer or discharge the resident from the facility
A facility must also promptly notify the resident (and the resident's legal representative or interested family member) when there is:
- A change in room or roommate assignment
- A change in resident rights
A facility must record and periodically update the address and phone number of the resident's legal representative or interested family member
Notification of Rights and Services
A resident has the right to:
- Be fully informed orally and in writing of all rights, rules and regulations governing resident conduct and responsibilities during the stay in the facility in a language that the resident understands
- Access and review all individual records within 24 hours upon oral or written request
- Purchase and receive copies of records (at a cost that does not exceed a community standard) within two working days advance notice to the facility
- Be fully informed of his or her health status in a language the resident understands
- Refuse treatment and to refuse to participate in experimental research
- Formulate an advance directive
A resident has the right to:
- Personal privacy and confidentiality of personal and medical records.
- Private written and telephone communications
- Send and receive (unopened) mail
- Participate in resident groups
- Release, or refuse release, personal and medical records, except when transferred to another health care institution or the release is required by law
Requests for Items and Services
- The facility must not charge a resident (or legal representative) for any item or service not requested by the resident.
- The facility must not require a resident (or legal representative) to request any item or service as a condition of admission or continued stay.
- The facility must inform the resident (or legal representative) requesting an additional service and what the charge will be for the service.
- The resident has the right to work for the facility and receive a competitive wage at, or above, the prevailing rate.
