What are nursing homes not allowed to do? It's an important question. People who reside in nursing homes are in vulnerable positions. Many residents need frequent or constant personal or nursing care. For example, some chronically ill residents need full-time medical assistance, whereas some disabled persons only need help with daily living activities.
Federal and state laws exist to safeguard nursing home residents’ care. However, your ability to protect yourself or your loved one during a nursing home stay depends in part on knowing what these facilities are not allowed to do and what action to take if a violation occurs.
The Rights of Nursing Home Patients
In this article we address some of the nursing home rights and protections that the Centers for Medicare and Medicaid Services (CMS) have set for Medicare and Medicaid facilities, along with some insight from a nursing home expert. These cover rights added in 2016 (some of which did not phase in until 2019), including the rights to sue the nursing care facility, have any visitors at almost any time, and have property safeguarded.
The points in this article apply specifically to skilled nursing facilities—defined by Medicare as a special facility or part of a hospital that provides medically necessary professional services. These services come from nurses, physical and occupational therapists, speech pathologists, and audiologists. The pointers in this work do not apply to assisted living facilities or retirement homes.
- Nursing homes provide skilled nursing care for chronically ill and/or disabled persons.
- The Centers for Medicare and Medicaid Services (CMS) have detailed the rights and protections to which residents at Medicare- and Medicaid-eligible facilities are entitled.
- Residents have many rights, including the right to manage their financial affairs, be a party to their medical treatment, be free from abuse, and enjoy their safeguarded property.
- Nursing home residents have the right to report abuse and register complaints without retribution.
Before Moving In
Federal law prohibits skilled nursing facilities from discriminating against protected classes. In other words, they can’t decide whether people can live there based on their race, color, religion, age, sex, or any other protected characteristic. If you suspect a nursing home has violated this civil rights law, you should report the facility to your local long-term care ombudsman and to the agency that regulates nursing homes in your state. Medicare offers an official complaint form.
A skilled nursing facility must state in writing before a patient moves in which services it will provide and its associated fees. Also, while some types of retirement facilities, such as continuing care communities, require a substantial buy-in fee upfront that guarantees residents access to various levels of care as their needs change, skilled nursing facilities cannot impose such fees.
Upon Entry to a Nursing Home
When a patient first enters a nursing home, they undergo a health assessment, and assessments continue daily for the length of the stay. The patient’s doctor and the nursing home’s staff will evaluate the patient’s physical and mental health, medications, ability to manage daily tasks (e.g., getting dressed, eating, bathing, using the toilet, etc.), and ability to speak and make decisions.
These assessments are used to plan treatment, evaluate progress, and determine ongoing eligibility for Medicare coverage. Nursing home residents are allowed to participate and weigh in on their care plan. If they’re not capable of doing so, someone they trust—such as an adult child or a sibling—can participate on their behalf.
A nursing home cannot force residents to let it manage their money.
While a nursing home may offer to manage a resident’s funds as part of its services, it can’t require a resident to let it manage their money, nor can it serve as a financial custodian without the resident’s written consent. Even if the resident gives consent, the nursing home must provide quarterly financial statements, and it cannot prevent such individuals from accessing their bank accounts, cash, or financial documents. Further, if a resident deposits more than $50 into a managed account, that account must pay interest.
Humane Nursing Home Treatment
Federal law protects nursing home residents’ “right to be treated with dignity and respect,” which includes making decisions, such as what time to go to bed and get up, what time to eat meals, and what activities to do during the day, as long as these decisions don’t conflict with the care plan.
Staff are not allowed to verbally or physically abuse patients, administer medicines that are not part of the treatment plan, physically restrain patients (unless they pose a danger to themselves or others), involuntarily isolate them from others, or take or use a resident’s property (that includes prohibiting other residents or anyone else working at or visiting the facility from taking or using a resident’s property).
Nurses and facilities have wide-ranging discretion as to when physical restraint can be used. The decisions are complex, and it can be difficult to ensure ethical use of restraint. The laws regarding how to report suspected abuse vary by state.
Patients have the right to privacy and personal property, which includes being allowed to open their mail and have private phone conversations. They are permitted to have visitors during reasonable times, and they may forbid people from visiting. Family members must be allowed access at any time (unless the patient desires otherwise). The facility also bears responsibility for patients’ behavior toward other patients. For example, it must step in if it learns that one resident is giving another resident trouble.
Although patients may be in poor health, physical or mental, they have a right to be told what their physical condition is, what ailments they’ve been diagnosed with, and which medications they’ve been prescribed. They have a right to see their medical records.
Patients can continue to see their doctors—they can refuse the services of resident practitioners or practitioners appointed by the nursing home—and they have the same right to refuse treatments and medications that outpatients have. If patients need mental, legal, or financial counseling related to their treatment, the nursing home must provide these services.
Nursing homes do not have to keep track of the Medicare benefits used to care for a patient.
One thing nursing homes are not required to do is to keep track of the Medicare benefits used for a patient’s care. When it comes to facilities, Medicare coverage is somewhat complicated. It covers a stay completely for a certain number of days and then pays a set amount for an additional period—and all this only under certain conditions.
After that patients are responsible for the entire bill, unless they have long-term care insurance or some other form of coverage. The nursing home is not required to notify residents that the benefit days are ending, and it can continue to charge them for their care.
There is one exception. If Original Medicare benefits stop earlier than expected because the care is deemed no longer “medically reasonable and necessary,” the nursing home is required to notify the patient that coverage is ending, when it’s ending, and why. It must also tell these patients that they will be responsible for further costs and how much it estimates those costs will be. However, a facility usually cannot require another family member to pay for a resident’s care.
Leaving the Nursing Home
Nursing homes are required to help with discharge planning. Generally, they can’t discharge patients or transfer them to another facility without their consent, unless they meet one of the following criteria:
- Their health has declined to the point where the facility can no longer meet their needs.
- They have improved to the point where they no longer require the facility’s services.
- They pose a threat to their welfare or that of other residents.
A resident can also be discharged for not paying the facility’s bills, though not if the delinquency is caused by waiting for Medicaid payments to come through.
The right to sue federally funded nursing home facilities was finally afforded to nursing home residents in 2016.
Residents and their advocates have a right to complain about any problem they experience in a nursing home, and nursing homes cannot punish someone for speaking up. “Residents and caregivers should speak to a supervisor or administrator even about a seemingly minor problem,” says Brian Lee, executive director of Families for Better Care, a nonprofit citizen advocacy group based in Austin, Texas.
Lee believes that small issues can snowball into dangerous situations. For example, something as simple as repeatedly placing a resident’s water out of reach at dinner can lead to dehydration, hospitalization, infection, or even death. “Other common violations to look out for include untreated bed sores; medication errors that may result in injury or death; disrespectful, demeaning, or bullying speech; neglecting to follow proper hand-washing or other infection-control practices, which lead to outbreaks; and ill-prepared food,” Lee says. Egregious violations such as sexual assault, physical abuse, and overmedication “are not the norm, but they are more widespread than we even realize."
If the facility’s management can’t or won’t resolve the issue, Lee recommends reporting the problem to the state survey agency, which enforces nursing home laws and regulations, and to the local long-term care ombudsman, who can advocate on the family’s behalf at no cost.
A regulation promulgated in September 2016 gave nursing home residents and their families the ability to sue any nursing home that receives federal funding. Previously, nursing homes could try to force people into arbitration, meaning that many instances of quality of care and safety issues—including abuse, harassment, and wrongful death—could be kept under wraps. Because court proceedings are on the public record while arbitration proceedings are private, nursing homes now have a greater incentive to provide high-quality care, and consumers have more information about which homes to avoid.
Recent regulations now prohibit nursing homes from sending dementia patients to a hospital and then refusing to readmit them.
New regulations that were phased in from November 2016 through 2019 give nursing home residents additional rights. Residents may receive any visitor, not just relatives, at any hour of the day, as long as their visitors don’t disturb fellow residents. Residents who want to live together may do so, and nursing homes have greater responsibility for ensuring that residents’ personal belongings aren’t lost or stolen.
They are required to provide meals and snacks when residents want them, not just at fixed hours. Staff members are receiving greater training in caring for dementia patients and preventing elder abuse, and nursing homes are no longer able to easily kick out residents with dementia by sending them to a hospital and then refusing to readmit them.
The Bottom Line
Essentially, a person’s rights as a nursing home resident mirror the rights they had outside the facility. Patients might have less control over their lives because of their physical or mental condition, but that doesn’t make it acceptable for anyone else to dominate, intimidate, or exert authority beyond the bounds of what’s necessary to help them manage day-to-day life and get better. Neglect, discrimination, abuse, and theft are unacceptable in any setting, and that includes nursing homes.