Nursing HOme Residents’ Rights
The rights of nursing home residents are codified in both federal and state statutes with the intent of further protecting each resident’s civil, religious, and human rights while they reside in a nursing facility.
1. To be treated with consideration, respect, and full recognition of personal dignity.
Staff must respect individual choices such as sleeping patterns, food preferences, religious practices, clothing choices, friendships, etc.
Staff should speak courteously with the residents at all times. Staff should call residents by their preferred name and avoid terms such as “sweetie,” “baby,” etc. The exception would be when the resident has given their permission to be called something else or if the resident only responds to a particular nickname.
Staff should always knock before entering a resident's room, and if the resident is able to respond, wait for a response.
Privacy should always be ensured. When care is being given, the door should be shut, the privacy curtain closed, etc.
2. To receive care, treatment, and services which are adequate, and in compliance with relevant federal and state statutes and rules.
The facility must have the capability to provide the type of care that the resident needs. For example, a facility that does not have the capability to care for someone who is ventilator dependent should not accept a resident with a ventilator. Similarly, a resident who requires physical therapy should not be admitted to a facility where there are no physical therapy services available.
Staff should be properly licensed to provide the treatment needed.
Failure to provide adequate and appropriate care is a violation of the law. It is expected that a prudent administrator will, through effective management, monitor staff’s performance to assure that no resident’s health, safety, or welfare is endangered. There should also be enough staff on duty to provide this care.
3. To receive at the time of admission and during the stay a written statement of the services provided by the facility, including those required to be offered on an as-needed basis, and of related charges. Charges for services not covered under Medicare or Medicaid must be specified. The resident should sign as evidence that this information has been given.
The facility must inform the resident of charges not included in the facility’s basic daily rate. This may include such items as beautician services, cosmetics, some personal care items, etc. Items covered under Medicaid should be identified, as well as items charged directly to the resident.
Residents must be informed in advance of any changes in the cost or availability of services.
4. To have on file in the patient’s record the orders of the attending physician with the proposed schedule of medical treatment. Written evidence of informed consent to participate in research must also be evident if the resident is participating in a research project.
Each resident’s diagnosis must be in the medical chart along with an individualized plan of care for the resident. Residents and the residents’ legal representatives must be invited to be involved in the care planning process.
The Federal Patients’ Rights require that each resident be informed of his medical condition and also provide for a resident to refuse treatments. These Federal rights apply to nursing facilities that participate in the Medicare/Medicaid program.
5. To receive respect and privacy in the patient’s medical care program. Case discussion, consultation, and treatment shall remain confidential and shall be conducted discreetly. Personal and medical records shall be confidential, and written consent of the patient shall be obtained for their release to any individual, other than family members, except as needed in case of the patient’s transfer to another health care institution or as required by law or third party payment contract.
Generally, most facilities require written consent before the release of confidential information such as would be found in a resident’s records. Access should be allowed to staff and consultants involved in the resident’s direct care on a “need to know” basis.
Residents have a right to access their own medical, social, and financial records. Under federal nursing home requirements, facilities have up to 24 hours to make records available to residents or legal representatives. Records can be photocopied upon request of the resident or legal representative. However, the prevailing community rate may be charged by the facility for the photocopies.
6. To be free from mental and physical abuse and, except in emergencies, to be free from chemical and physical restraints unless authorized for a specified period of time by a physician according to clear and indicated medical need.
Residents should always be treated courteously and professionally by facility staff. Acts of humiliation, harassment, threats or deprivation are examples of mental abuse.
Chemical and physical restraints are not to be used to control or limit residents’ mobility for the convenience of staff or as a substitute for staff supervision. Likewise, restraints should not replace development of individualized care plans for dealing with specific difficult behaviors. The use of either type of restraint should be the last alternative after all other methods of dealing with the problem have been exhausted.
A physician may write orders for restraints to be used in an emergency situation; however, blanket standing orders for “restraints PRN”(to restrain as needed) are not permitted.
7. To receive from the administrator of the facility a reasonable response to all requests.
Facilities should not arbitrarily dismiss or ignore resident requests which are not excessive and which would improve the quality of the resident’s life. On the other hand, residents should not expect that every request will or can be granted without consideration of practicality or potential harm to a resident’s health or safety.
In all cases of denial, facilities must explain to the resident why a particular request cannot be granted. Facilities should document the denial of a request if a particular resident becomes upset.
8. To associate and communicate privately and without restriction with persons and groups of the patient’s choice on the patient’s initiative or that of the persons or groups at any reasonable hour; to send and receive mail promptly and unopened, unless the patient is unable to open and read personal mail; to have access at any reasonable hour to a telephone where the patient may speak privately; and to have access to writing instruments, stationery, and postage.
Provisions should be made for residents to visit privately with visitors, particularly when the resident shares a semi-private room. Reasonable hours are considered to be the normal waking hours of the day. The facility must allow a visitor to see a resident at the resident’s request, even during odd times, should unusual circumstances warrant such flexibility, for example, an emergency visit from out of town relatives, or a need to relay important information to the resident.
Facilities have the right to restrict visitors when (a) the resident does not wish to see the visitor; (b) the attending physician documents medical records that visits would be harmful to the resident’s health, or (c) the visitor would be disruptive of the facility’s proper function.
Mail containing checks or negotiable instruments may not be opened or withheld by the facility without written authorization from the resident or his legal representative. Upon request, staff should assist residents who require help in reading or sending mail.
Telephone privacy must be provided to residents. This may sometimes necessitate use of a private office phone within the facility.
9. To manage the patient’s financial affairs unless authority has been delegated to another pursuant to a power of attorney, or written agreement, or some other person or agency has been appointed for this purpose pursuant to law. Nothing shall prevent the patient and facility from entering a written agreement for the facility to manage the patient’s financial affairs. In the event that the facility manages the patient’s financial affairs, it shall have an accounting available for inspection and shall furnish the patient with a quarterly statement of the patient’s account. The patient shall have reasonable access to this account at reasonable hours; the patient or facility may terminate the agreement for the facility to manage the patient’s financial affairs at any time upon five days notice.
10. To enjoy privacy in visits by the patient’s spouse and, if both are residents of the facility, they shall be afforded the opportunity, where feasible, to share a room.
The basic intent of this Right is to assure that there is a method of arranging for privacy as may be necessary for visits between spouses. In the case of semi-private rooms or wards, other special arrangements may have to be made. There should be provisions to assure conjugal visits and that complete privacy can be maintained at all times.
A husband and wife should be allowed to share a room unless in the judgment of the attending physician to do so would be adverse to the health of one or both residents, or one of the residents refuses this situation.
11. To enjoy privacy in the patient’s room.
Residents should expect the greatest degree of privacy that is possible under institutional circumstances and as his condition allows. A partially closed door or drawn curtain allows privacy from the staff and visitors as they pass in the hallways. Resident rooms should not be used for ingress or egress to other areas of the building. Likewise, resident telephones and private bathrooms should not be used by unauthorized persons.
Provisions should be made to allow residents to be alone at times when they wish to do so and when it does not interfere with other residents or proper medical care.
A resident’s personal items or belongings should not be searched through without reasonable justifiable cause. Residents should be present whenever staff find it is necessary to move belongings for cleaning purposes.
12. To present grievances and recommend changes in policies and services, personally or through other persons or in combination with others, on the patient’s behalf or that of others to the facility’s staff, the community advisory committee, the administrator, the Department, or other persons or groups without fear of reprisal, restraint, interference, coercion, or discrimination.
Each facility should have procedures in place for receiving resident recommendations for changes within the facility.
Likewise, facilities should have grievance procedures established which residents may use when they have complaints. It is important that all concerns and complaints be addressed and appropriate follow up action be taken, which would include following up with the complaining party as to outcome of the process.
There should also be policy and procedure to assure that each and every resident has the privilege of contacting any outside person, agency, or group, without restraint or interference from the facility. Most facilities post a listing of outside agencies which residents/families may contact for advocacy or complaints.
13. To not be required to perform services for the facility without personal consent and the written approval of the attending physician.
14. To retain, to secure storage for, and to use personal clothing and possessions, where reasonable.
Prior to admission, the facility should clearly specify in writing any limitations on the amount and type of personal property or clothing that will be allowed. Within reason, each resident should be able to decorate their living space with personal pictures, small sentimental items, and possibly a small personal chair if space permits without interfering with another resident’s space, proper nursing care, or with proper cleaning of the room.
Each resident is to be allowed to have his own personal clothing within the storage limits of the facility. It is reasonable that each resident would have adequate clothing to be properly dressed at all times, even when other clothing is being cleaned or laundered.
15. To not be transferred or discharged from a facility except for medical reasons, the patient’s own or other patient’s welfare, nonpayment for the stay, or when the transfer or discharge is mandated under Title XVIII (Medicare) or Title XIX (Medicaid) of the Social Security Act. The patient shall be given at least five days’ advance notice to ensure orderly transfer or discharge, unless the attending physician orders immediate transfer, and these actions and the reasons for them shall be documented in the patient’s medical record. (1977, c. 897,s.1; 1983, c. 775, s.1)
Since 1990, if a nursing facility plans to discharge or transfer a resident, it must follow federal regulations pertaining to Transfer/Discharge of residents. These federal rules are also known as Nursing Home Reform Law and O.B.R.A. Except in cases of emergency or where a resident has been in the facility less that 30 days, the nursing facility may only discharge a resident for the following reasons: 1) nonpayment for stay, 2) medical reasons(needs to go to hospital) 3) is a danger to others in facility 4) is a danger to himself, 5) at own request, or 6) the facility closes.
All residents have the right to receive 30 days’ advance written notice of intent to discharge or transfer them (unless it is an emergency discharge as outlined in federal discharge regulations). Included with the written advance notice must be information advising the resident of his right to appeal the intended discharge and a copy of the Hearing Request Form.
16. To be notified within 10 days after the facility has been issued a provisional license because of violation of the licensure regulations or received notice of revocation of license by the North Carolina Department of Human Resources and the basis on which the provisional license or notice or revocation of license was issued. The patient’s responsible family member or guardian shall also be notified.
Other Helpful Resources
Webinar: Advocating for Justice: Understanding the Legal Rights of Nursing Home Residents (June 2023)