Residents’ Rights in Long-Term Care: Assisted Living, Nursing Homes & Group Homes

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What are Residents’ Rights?

Residents’ rights ensure that someone living in a nursing facility will enjoy the same rights as someone living in the larger community. Further, through the Nursing Home Reform Act of 1987, Long-term care facilities accepting Medicare / Medicaid are required to provide the following rights to residents:

  • Planning and implementing of care
  • Choice of attending physician
  • Respect and dignity 
  • Self-determination 
  • Information and communication
  • Privacy and confidentiality
  • Ability to file grievances
  • Contact with external entities

Additionally, the Nursing Home Reform Act of 1987 instituted requirements for facilities around:

  • Freedom from abuse, neglect, and exploitation
  • Comprehensive person-centered care planning
  • Quality of life
  • Quality of care
  • Food and nutrition services
  • Specialized rehabilitative services
  • Infection control
  • Physical environment
  • Training requirements

Read on to get a better understanding of residents’ rights in long-term care facilities. 

Table of Contents

Origins of Residents’ Rights

In the mid-1980s, the quality of care in too many U.S. nursing homes was poor. In addition, few systems existed to monitor resident care, making it even harder to enforce existing laws. The solution was for Congress to pass the 1987 Nursing Home Reform Act as part of that year’s Omnibus Budget Reconciliation Act.

The Act’s reforms were the most meaningful changes since Medicaid and Medicare had started covering care in nursing homes. But they were just the start. Years of fine-tuning have helped define a clear set of rights that residents can count on in every aspect of their nursing home stay. 

Who do Residents’ Rights Apply to?

Residents’ rights apply to people living in skilled nursing facilities, where they receive 24-hour nursing care. The federal regulations that make up the Nursing Home Reform Act govern the operation of certified nursing homes that accept Medicare payments. Ensuring compliance with these regulations means residents are treated fairly, with dignity, choice and self-determination.

And one tool used to communicate that protection is some form of a Residents’ Bill of Rights.

Residents’ Rights – Federal Laws vs. State Laws

Legislation has been enacted at federal and state levels to combat psychological and physical abuse in long-term care facilities. However, it is applied differently depending on the type of long-term care facility.

Skilled nursing home facilities that receive funds from Medicare or Medicaid must comply at a minimum with the federal regulations of the Nursing Home Reform Act. However, some states have enacted stricter laws to extend residents’ protections.

On the other hand, assisted living facilities and adult group homes – where care is primarily custodial and not skilled nursing – are not governed by federal law. Instead, they are regulated at the state level, and each state has its own laws, regulations and licensing standards.

Related: Assisted Living Facilities vs Skilled Nursing Facilities

As a U.S. citizen or resident, certain civil and religious rights will not be infringed, whether someone lives at home or in some form of long-term care facility.

Beyond that, a review of state laws will show that many reflect the basic protections of the Nursing Home Reform Law, but with varying degrees of effectiveness.

Before entering assisted living or an adult group home, it is critical to obtain a copy of the relevant state’s law and the facility’s Residents’ Bill of Rights. An internet search of “residents’ rights” plus the state’s name will provide a specific state’s regulations (or you can jump down here where we’ve already done this research).

Federal Residents’ Rights Laws for Long-Term Care Facilities

Residents’ rights under federal law – as defined in the Nursing Home Reform Act of 1987 – can be described as follows:

 Exercise of rights

 A person does not lose personal and legal rights when moving to a nursing home. The “exercise of rights” guarantees a resident’s ability to exercise their rights as a facility resident and as a U.S. citizen or resident. The facility cannot use interference, threats, coercion, discrimination or reprisal against a resident.

A resident can designate a legal representative to exercise those rights. The state court will appoint a resident representative if the resident is adjudged incompetent by the appropriate authorities.

Planning and implementing care

Residents can stay involved in the planning and implementation of medical care. A resident has the right to be informed in understandable language about their complete health status and medical condition. In addition to participating in developing and implementing treatment plans, a resident can participate in establishing goals and outcomes.

A resident also has the right to know of any plan changes, the risks and benefits of proposed care, and care alternatives. In addition, specific medically necessary treatments can be requested, refused or discontinued.

Choice of attending physician

A resident can choose a personal attending physician. However, that resident’s physician must be licensed to practice and, if not, may be replaced by an alternate physician selected by the facility. If the resident chooses a different qualified attending physician, the facility will honor that selection.

The name, specialty and contact information of any physician will be provided to the resident.

Respect and dignity 

A resident has the right to be treated with respect and dignity. This includes the freedom from physical and chemical restraints (such as antipsychotic drugs) and the right to use personal possessions.

Residents are protected against relocation from one room to another without reason and have the right to written notice justifying the change. Refusing to transfer rooms does not mean a resident loses entitlement or eligibility for Medicare or Medicaid benefits.

Married residents in the same facility may choose to share a room, and residents can choose roommates from among other facility residents based on mutual agreement.

Self-determination 

A resident has the right to self-determination, which includes making choices about significant aspects of their life in the facility. This ranges from deciding on daily schedules, health care and health care providers – to participating in social, religious and community activities of their choice.

A resident can interact with community members inside and outside the facility, receive visitors at will, and organize and participate in resident groups or groups of family members.

Residents can manage their own financial affairs, and the facility can only charge their personal funds for services not covered by Medicare or Medicaid or that exceed their standard coverage.

Information and communication

A resident has the right to know all rights, rules and regulations that govern that resident’s conduct and responsibilities. All personal and medical records must be made available. Oral and written notices must be in an understandable format and language. Names, addresses and telephone numbers of all state agencies and advocacy groups must be posted.

Residents will have reasonable access to a telephone to communicate with individuals and entities inside and outside the facility and access to and privacy in electronic communications. In addition, residents can send and receive letters, packages and other materials.

Residents will have the right to access survey results by federal or state surveyors – also information on the facility’s policies on advance directives and applicable state law. Benefits and possible charges related to Medicare and Medicaid will be explained, as will the nursing facility services available under the state’s Medicaid plan.

Privacy and confidentiality

Residents have the right to personal privacy and the confidentiality of their personal and medical records. This privacy extends to accommodations, medical treatment, personal care, written and oral communications, visits and meetings.

Grievances

A facility resident can present grievances to that facility, appropriate agencies or other entities without fear of discrimination or reprisal. Grievances can cover care and treatment that have or have not been received, staff member behavior, resident behavior and other concerns at the facility.

The facility must advise residents of its grievance process and move promptly to remedy the grievance following its readily accessible grievance policy.

Contact with external entities

Residents must be free to communicate with federal, state and local entities, as well as with representatives of the state’s Office of the Long-Term Care Ombudsman or other agencies responsible for protecting individuals with a mental disorder.

State Specific Residents’ Rights

In addition to federal laws protecting the rights of each resident, many states have enacted their own residents’ rights laws to provide additional protections to residents of a long-term care facility. Below is a list of residents’ rights for individual states. Additionally, if you have concerns about your, or a family member’s rights, you may want to search for a local Long-Term Care Ombudsman Program.

Other Requirements for Long-Term Care Facilities From the Nursing Home Reform Act of 1987

The Nursing Home Reform Act of 1987 defines other requirements, including:

Freedom from abuse, neglect, and exploitation 

Residents have the right to protection from all forms of abuse, neglect, exploitation and loss of personal property. According to its written policies and procedures, the facility is responsible for supplying such protection (including vetting its hires). That includes reporting violations, conducting investigations and reporting investigation results to the appropriate authorities.

Comprehensive person-centered care planning

The facility is responsible for creating a baseline care plan, a comprehensive care plan, and a discharge plan for each resident. Each element includes instructions on what is needed to provide person-centered care that reaches quality standards of care.

The baseline care plan covers the minimum health care information, such as physician and dietary orders and therapy and social services. The comprehensive plan provides measurable objectives and timeframes to meet a resident’s medical, nursing, mental and psychosocial needs.

The discharge plan follows the facility’s planning process to help departing residents transition successfully to post-discharge care with minimum readmissions. Residents will receive a discharge summary of the diagnoses, treatments and testing results. 

Quality of life

The facility’s goal is to provide the care and services needed for a resident to reach the highest possible physical, mental and psychosocial well-being – in keeping with that resident’s assessment and plan of care.

A facility strives to prevent a decline in the resident’s self-care abilities as measured by the Activities of Daily Living (ADLs). The ADLs include hygiene, mobility, toileting, eating and communicating.

Quality of care

Quality of care measures the treatment and care received by residents in keeping with their comprehensive assessment and professional standards of practice. The measurement factors in the resident’s preferences and dozens of aspects ranging from mobility to incontinence and from assisted nutrition to pain management.

Food and nutrition services 

The facility is responsible for providing nourishing, tasty and well-balanced meals to meet a resident’s nutritional and special dietary needs and preferences. To do so, the facility must employ enough staff with the skills to fulfill all those needs.

Specialized rehabilitative services

The facility must provide specialized rehabilitative services as required by the resident’s comprehensive plan of care, implemented by qualified personnel based on a physician’s written prescription. For example, services could include physical, speech, occupational or respiratory therapies or rehabilitative services for mental disorders or intellectual disabilities.

Infection control

Programs to prevent and control Infection are part of a facility’s responsibilities. It must provide a sanitary, comfortable environment where the development and transmission of communicable diseases and infections are kept to a minimum. The more common targets are influenza, pneumococcal disease and Covid-19.

The program extends to all residents, staff, volunteers and visitors through the facility’s written standards, policies and procedures. It requires one or more specialists in infection prevention.

Physical environment

A facility is required to design, build, equip and maintain a physical environment that protects the safety and health of its residents, staff and the public.

Besides resident rooms and shared facilities, requirements extend to fire and building safety, emergency power, resident call systems and environmental conditions.

Training requirements

Facilities must develop, implement and maintain training programs for existing staff, new staff, contractors, volunteers and others who make up the facility’s staffing. Training topics cover compliance and ethics, communication, residents’ rights, and facility responsibility to avoid abuse, neglect, and exploitation.

FAQs 

What are ombudsman groups?

Ombudsman groups consist of government officials who advocate for residents of long-term care facilities such as nursing homes, assisted living facilities or adult family care homes. They are familiar with the laws and regulations that govern those types of facilities. They regularly visit local facilities and look into complaints as neutral, informal and confidential resources. [Source: Federal Register. “State Long-Term Care Ombudsman Programs.” Accessed March 18, 2022.

What are examples of Resident Rights?

Examples of residents’ rights include the right to:

  • be treated with respect,
  • be free from discrimination, abuse and neglect,
  • get proper medical care,
  • spend time with visitors, and
  • get information on services and fees.

What does the resident have the right to refuse?

A resident has the right to refuse to:

  • participate in a specific treatment, including experimental,
  • release personal and medical records, and
  • be transferred to another room in a facility or to another facility against his or her will.
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