Residents' Rights, and What to Do When They Are Broken

Every resident of a Medicare or Medicaid certified nursing home has rights set out in federal law. They are not aspirations in a brochure, they are enforceable requirements, and inspectors cite homes for breaking them.

The core rights

• To be treated with dignity and respect, and to be free from abuse, neglect, exploitation and misappropriation of property.
• To be free from physical or chemical restraints imposed for discipline or staff convenience. Sedating a resident because they are difficult is not a treatment; it is a restraint.
• To participate in their own care plan, to be told about changes in treatment, and to refuse treatment.
• To privacy in treatment, personal care, medical records, visits, phone calls and mail.
• To visitors of their choosing at the times they choose, subject only to reasonable clinical or safety restrictions.
• To manage their own money, or to have any funds the home holds accounted for properly.
• To complain without retaliation, including complaints to the state survey agency or the ombudsman.
• To advance notice and a safe discharge plan before any transfer or discharge, with the right to appeal it.

Discharge: the right people most often need

Involuntary discharge is among the most common complaints ombudsmen receive. A home cannot simply put a resident out. There are limited permitted reasons, a written notice requirement with a notice period, and a right to appeal to the state, and filing an appeal generally pauses the discharge while it is heard.

If you are told a resident must leave because their Medicare coverage ended, or because they became "too difficult", get the reason in writing and call the ombudsman the same day. Both of those situations are frequently improper.

When something is wrong: the escalation ladder

1. Raise it in the building, in writing. Start with the charge nurse, then the director of nursing, then the administrator. Keep a dated log of what you reported, to whom, and what they said. That log matters later.
2. Use the care plan meeting. Residents and families have the right to attend and to have concerns recorded in the plan. A written care plan is a commitment you can hold the home to.
3. Call the Long-Term Care Ombudsman. Every state has one, the service is free and confidential, and advocating for residents is their entire job. They can often resolve problems that a family alone cannot.
4. File a complaint with the state survey agency. This triggers an investigation. Complaint investigations are how a large share of the most serious citations get made, including many that never would have surfaced in a routine annual survey.
5. For immediate danger, call emergency services and Adult Protective Services. Do not wait on a process if someone is at risk right now.

Retaliation

Retaliating against a resident for complaining is prohibited. Families still hesitate, understandably, out of fear that care will suffer. Two things help: put concerns in writing so there is a record, and involve the ombudsman early, homes behave differently when an independent advocate is already in the conversation.

About arbitration clauses

Many admission agreements include an arbitration clause, which gives up the right to take a dispute to court. In most circumstances a home cannot require you to sign one as a condition of admission. You can decline it, and you should read the agreement at home rather than at the desk on admission day.