Rights of Nursing Home Residents

When a person enters a nursing home he still has rights, and these rights should be respected and enforced. For this to happen, residents must be aware of the rights they have. Accordingly, the following is a summary of the rights granted to Louisiana nursing home residents under federal7 and state law. 

Dignity: The federal regulations provide that a "resident has a right to a dignified existence, self determination, and communication with and access to persons and services inside and outside the facility." In addition, a "resident has the right to be free of interference, coercion, discrimination, and reprisal from the facility in exercising his or her rights.  "Under state law, a resident has the "right to be treated courteously, fairly, and with the fullest measure of dignity." A resident also has a right to receive a "prompt response to all reasonable requests and inquiries."'' 

Equality of Treatment: Private pay residents and Medicaid residents must be treated equally regarding transfers, discharges, and the provision of services under Medicaid. 

Civil Rights: Under the federal regulations, a "resident has the right to exercise his or her rights as a resident of the facility and as a citizen or resident of the United States." Louisiana law also guarantees that the resident's civil liberties are protected. 

Religious Liberties: Louisiana law provides that a resident retains his full religious liberties. 

Admissions Policies: A facility cannot require residents or potential residents to give up their rights under Medicare or Medicaid. The facilities also cannot require oral or written assurances that residents or potential residents are not eligible for or will not apply for Medicare or Medicaid benefits. Also, a third party (such as spouse, companion, child, other relative, or friend) cannot be required-to personally guarantee payment to the facility as a condition for a resident or potential resident's admission or continued stay at the nursing home.  If a resident is eligible for Medicaid, the nursing facility may not "charge, solicit, accept, or receive ... any gift, money, donation, or other consideration as a precondition of admission, expedited admission or continued stay in the facility." Information: A nursing home resident has a right to receive a number of types of information. For example, "the facility must inform the resident both orally and in writing in a language that the resident understands of his or her rights and all rules and regulations governing resident conduct and responsibilities during the stay in the facility." For a resident entitled to Medicaid benefits, the facility must inform the resident in writing of the items and services covered by Medicaid and the charges for items and services not covered The facility must also furnish a written description of legal rights, including the manner of protecting personal funds, requirements and procedures for Medicaid, a posting of information on advocacy groups, and information on the right to file complaints with the State. The facility must also post the results of the latest State survey (or inspection) or a notice of their availability for examination by interested residents. 

Self-Determination: The federal regulations make it clear that a resident has the right to "choose activities, schedules, and health care consistent with his or her interests, assessments, and plans of care." This right allows residents to have input into when they arise and go to bed, when and with whom they eat their meals, what they wear, how they choose to bathe, etc. Unless the health or safety of the resident or other residents would be endangered, the resident should receive reasonable accommodation of such needs and preferences. 

Medical Decision making: The federal regulations also specify that "the resident has the right to be fully informed in a language that he or she can understand of his or her total health status, including but not limited to, his or her medical condition." In addition, the resident has the right to be fully informed in advance about his care and treatment and any changes that may affect his well-being. A resident also normally has the right to participate in planning or changing his care and treatment. Louisiana law similarly provides that the resident has the right to be adequately informed of his medical condition and proposed treatment and to participate in the planning of treatment. Under the federal regulations, a "resident has the right to refuse treatment, to refuse to participate in experimental research," and to execute an advance directive, such as a living will or a durable power of attorney for health care. The right to refuse treatment is also guaranteed under Louisiana law. Both federal and state law provide that a resident has the right to choose his own attending physician. State law also provides that a resident has the right to use the pharmacy of his choice. 

Abuse: The federal regulations provide that a "resident has the right to be free from verbal, sexual, physical, and mental abuse, corporal punishment, and voluntary seclusion."

Restraints: Under the federal regulations, a "resident has a right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident's medical Symptoms." As with other types of medical treatments, a resident has the right to refuse the use of restraints.

Access to Records: Under the federal regulations, a resident or his legal representative has the right to access all records pertaining to himself within twenty-four hours of an oral or written request.  The resident or representative also has the right to purchase photocopies of his records upon two working days advance notice to the facility.

Personal Finances: Under the federal regulations, 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." If they so choose, however, residents can authorize the facility to hold, safeguard, manage, and account for their funds. If a resident has over $50 on deposit with the facility, the facility must place the money in an interest-bearing account for the resident. If the resident is on Medicaid, the facility also must warn the resident when his balance is near to endangering his Medicaid eligibility.

Privacy and Confidentiality: The federal regulations provide that a resident shall have personal privacy in "accommodations, medical treatment, written and telephone communications, personal care, visits, and meetings of family and resident groups." This right extends to privacy "with whomever the resident wishes to be private and ... this privacy should include full visual, and, to the extent desired, for visits or other activities, auditory privacy." In addition, the resident normally has the right to "approve or refuse the release of personal and clinical records to any individual outside the facility." These rights are similarly protected under state law. 

Mail: Federal regulations and state law both provide that a resident has the right to privacy in written communications, including the right to send and promptly receive unopened mail.

Telephone: Both federal regulations and state law provide that a resident must have reasonable accesS48 to the use of a telephone where calls can be made without being overheard.

Visitation: Under the federal regulations, any of the following shall have immediate access (without regard to visiting hour limitations) to a resident: specified federal and state authorities, the resident's physician, the state long- term care ombudsman, representatives of the Advocacy Center for the Elderly and Disabled, and (in accordance with the resident's wishes) the resident's immediate family or other relatives. Subject to reasonable restrictions and the resident's wishes, this right also extends to others who desire to visit the resident. In addition, consistent with the resident's wishes, "the facility must provide reasonable access to any resident by any entity or individual that provides health, social, legal, or other services to the resident." Visitation rights are also protected under state law.

Participation in Group Activities: Both residents and their families have the right to organize and participate in groups at the facility. The facility must provide such groups with a private meeting space and designate a staff person to provide assistance and respond to written requests of such groups.

Married couples: Residents who are married and live in the same facility have the right to share an available room if they both consent.

Personal Property. Subject to some limitations, a resident has a right to keep and use personal property such as mementos, furnishings, and clothing.

Work: A resident has the right to refuse to perform any services for the facility. He may, however, perform such services under certain circumstances if he so chooses.

Alcoholic Beverages: A resident generally has a right to consume a reasonable amount of alcoholic beverages at his own expense.

Tobacco: A resident has a "right to use tobacco at his own expense under the home's safety rules and under applicable laws and rules of the state, unless the facility's policies preclude smoking in patient rooms.

Complaints: A resident has the right to make complaints without discrimination or punishment and to have the facility act promptly to resolve the problems.

Room Changes: A resident must receive notice before his room or roommate is changed in the facility. 

Transfers and Discharges: A resident cannot be transferred or discharged from the facility except on certain specified grounds.61 This right is fully discussed in this manual's chapter entitled "Involuntary Transfers and Discharges from Nursing Homes." 

Bed-Hold Policies: If a resident leaves the facility to go to the hospital or on therapeutic leave, the nursing home must inform the resident (and a family member or legal representative) in writing of Medicaid's and the facility's bed-hold policies. If a Medicaid resident's hospitalization or therapeutic leave exceeds the bed-hold period, the facility must still readmit the resident to the first available bed in a semi-private room if he needs the facility's services and is eligible for  Under state law, a private pay resident may reserve his bed Medicaid benefits. for up to thirty days for a single hospitalization if he pays for the bed while away. 

If a nursing home resident needs assistance because his rights are being violated, he should contact the local ombudsman. The ombudsman's services are free and confidential. More information on the ombudsman program (including how to contact the area coordinator) may be obtained by contacting the Office of the State Ombudsman, Post Office Box 80374, Baton Rouge, Louisiana 70898-0374 (telephone: 504-925-3990 in Baton Rouge or 1-800-259- 4990 statewide).