Residents' Rights
Residents of nursing homes have rights under both federal and state
law. Nursing homes are required to inform residents of these rights
and protect and promote their rights. If a resident is incapable of exercising
his or her rights, the person designated by law, such as conservator or
attorney-in-fact, or in most cases, the next of kin, or representative
payee, may exercise these rights.
For a more detailed listing of residents' rights, see CANHR's Fact Sheet, Outline of Nursing Home Residents' Rights.
Topics:
Grievances
The resident has the right to:
- Exercise rights, voice grievances, and recommend changes in policies
and services to facility staff and/or outside representatives of the
resident's choice, free from restraint, interference, coercion, discrimination
or reprisal. (42 C.F.R. §483.10(f)(1))
- Prompt efforts by the facility to resolve grievances the resident
may have, including those having to do with other residents. (42
C.F.R. §483.10(f)(2))
Admission Agreements
The resident has rights about the content of admission agreement contracts,
which are signed at the time the resident enters the nursing home:
- The contract may not require that the resident pay with private funds
(i.e. with funds that are not Medicare or Medi-Cal) for a specified period
of time. (Cal. Health
& Safety Code §1599.69(a))
- The contract may not require, at the time of admission, the resident
to give notice that he or she intends to convert to Medi-Cal status.
(Health & Safety Code §1599.69(b))
- The contract may not require the resident to promise not to apply
for Medicare or Medi-Cal benefits. (42 C.F.R. §483.12(d)(1)(i-ii))
- The contract may not require a third-party guarantee of payment as
a condition of admission or expedited admission.
(42 C.F.R. §483.12(d)(2); Cal. Welfare & Institutions
Code §14110.8(b))
In addition, a resident has the right to have his or her security deposit
returned:
- When the resident converts to Medi-Cal. (Cal. Health
& Safety Code §1599.70(b); Cal. Welfare & Institutions Code
14110.8(d))
Medical Condition and Treatment
The resident has the right to:
- Be fully informed by a physician of his or her total health status
and to be afforded the opportunity to participate on an immediate and
ongoing basis in the total plan of care. (42 C.F.R. §483.10(b)(3)
- Be fully informed in advance about care and treatment and of any changes
in care or treatment that may affect the resident. (42 C.F.R. §483.10(d)(2))
- Participate in planning care and treatment or changes in care or treatment
unless adjudged incompetent or otherwise found to be incapacitated under
State law.
(42 C.F.R. §483.10(d)(3))
- Self-administer medications unless doing so would be dangerous.(42 C.F.R. §483.10(n))
- Choose a personal attending physician. (42 C.F.R. §483.10(d)(1))
- To consent to or refuse any treatment or procedure or participation
in experimental research.(42 C.F.R. §483.10(b)(4))
- To receive all information that is material to his or her decision
concerning whether to accept or refuse any proposed treatment or procedure.
(42 C.F.R. §483.10(b)(8))
Protection of Resident Funds
The resident has the right to:
- Manage his or her financial affairs. The facility may not require
residents to deposit their personal funds with the facility although
a resident can if he or she so desires.(42 C.F.R. §483.10(c)(1))
- Have funds entrusted to the facility held separately from the funds
of the facility and from those of other residents, and have an accurate
accounting of those funds. Funds over $50 must be held in an interest-bearing
account. (42 C.F.R. §483.10(c)(3))
- Be informed when the amount in the resident's account, if managed
by the facility, reaches $200 less than the $2000 Medi-Cal resource limit
and, if increased, may cause the resident to be disqualified from Medi-Cal.
(42 C.F.R. §483.10(c)(5))
Transfer and Discharge
The resident has the right to be transferred or discharged only if:
- He or she has recovered to the point of not needing nursing home care.(42 C.F.R. §483.12(a)(2)(ii))
- It is necessary for the resident's welfare and her/his needs cannot
be met in the facility. (42 C.F.R. §483.12(a)(2)(i))
- The health or safety of others is endangered. (42
C.F.R. §483.12(a)(2)(iii) and (iv))
- He or she has failed to pay for care.(42 C.F.R. §483.12(a)(2)(v))
- The facility ceases to operate. (42 C.F.R. §483.12(a)(2)(vi))
Other rights regarding transfer or discharge from a nursing home:
- A nursing home must give both the resident and a family member or
legal representative advance notice of the transfer or discharge as soon
as practicable or reasonable, or in some cases, at least 30 days in advance.
(42 C.F.R. §483.10(b)(11)(D), §483.12(a)(4),
(5); Title 22, Cal. Code of Regulations §72527(a)(5))
- A nursing home that participates in the Medi-Cal program may not transfer
or seek to evict a resident when he or she changes from private pay or
Medicare to Medi-Cal, or while the Medi-Cal application is pending. (42 C.F.R. §483.12(c)(1); Cal. Welfare &
Institutions Code §14124.7(a))
- The nursing home must provide sufficient preparation and orientation
to residents to ensure safe and orderly transfer or discharge from the
facility. (42 C.F.R. §483.12(a)(7); Cal. Health & Safety
Code §1599.78)
- The nursing home must produce a discharge summary that includes a
post-discharge plan of care that is developed with the participation
of the resident and his or her family, which will assist the resident
to adjust to his or her new living arrangement. (42
C.F.R. §483.20(l)(3))
- The resident has a right to a 7-day bedhold and immediate readmission
when transferred to a general acute care hospital, if he or she continues
to pay for the nursing home bed. (42 C.F.R. §483.12(b); Cal. Health & Safety
Code § 1599.79; Title 22, Cal. Code of Regulations, §72520(a))
- After a hospitalization, the resident has the right to be readmitted
to the nursing home's first available bed, if the nursing home fails
to give written notice of the resident's right to a 7-day bedhold. (Cal. Health & Safety Code §1599.79; Title
22, Cal. Code of Regulations, §72520(c))
- After a hospitalization, a resident who is a Medi-Cal recipient has
the right to the nursing home's first available bed even if he or she
is absent from the nursing home for more than 7 days. (42 C.F.R. 483.12(b)(3))
Chemical & Physical Restraints & Abuse
The resident has the right to:
- Be free from verbal, sexual, physical, and mental abuse, corporal
punishment, and involuntary seclusion. (42 C.F.R.
§483.13(b))
- Be free from any physical or chemical restraints—either psychotherapeutic
or antipsychotic drugs—imposed for purposes of patient discipline
or staff convenience which are not required to treat the resident's medical
symptoms, except in an emergency which threatens to bring immediate injury
to the resident or others.(42 C.F.R. §483.13(a))
- Be given the necessary information to be able to refuse or accept
the use of psychotherapeutic drugs, physical restraints, or the prolonged
use of a device that may lead to the inability to regain use of normal
bodily functions, which will allow the resident to give informed consent
about the use of these methods. (Title
22, Cal. Code of Regulations §72528(c))
Based on a comprehensive assessment of a resident, the facility must
ensure that:
- Residents who have not used antipsychotic drugs are not given these
drugs unless antipsychotic drug therapy is necessary to treat a specific
condition. (42 C.F.R. §483.25(l)(2)(i))
- Residents who use antipsychotic drugs receive gradual dose reductions
or behavioral programming in an effort to discontinue these drugs, unless
clinically contraindicated. (42 C.F.R. §483.25(l)(2)(ii))
- The facility must ensure that each resident's drug regimen is free
from unnecessary drugs. (42 C.F.R. §483.25(l)(1))
Resident Records
The resident has the right to:
- Personal privacy and confidentiality of his or her personal and clinical
records. (42 C.F.R. §483.10(e))
- Review all records pertaining to the resident upon oral or written
request within 24 hours, and to purchase photocopies of these records
with two days advance notice. (42 C.F.R. §483.10(b)(2))
- Approve or refuse release of records to any individual or agency outside
the facility except when transferred or required by law. (42
C.F.R. §483.10(e)(2) and (3))
Dignity and Privacy
The resident has the right to be treated with
consideration, respect and full recognition of dignity and individuality
(42 C.F.R. §483.15(a)).
This includes the right to:
- privacy during treatment and personal care; (42
C.F.R. §483.10(e)(1))
- receive and make phone calls in private; (42 C.F.R. §483.10(k))
- send and receive mail unopened;
(42 C.F.R. §483.10(i)(1))
- associate privately with persons of resident's choice, inside or outside
the facility. (42 C.F.R. §483.15(b)(2))
Free Choice and Participation
The resident has the right to:
- Refuse to perform services for the facility. (42
C.F.R. §483.10(h)(1))
- Choose activities and schedules consistent with his or her interests
and care plan and to receive services with reasonable accommodation of
individual needs and preferences. (42 C.F.R. §483.15(b)(1) and (e)(1))
- Participate in resident groups and in activities of social, religious
and community groups. (42 C.F.R. §483.15(c)(1)
and (d))
- Communicate with persons of one's choice inside or outside of the
facility. (42 C.F.R. §483.10)
- Retain and use personal clothing and possessions as space permits
if it doesn't infringe upon the rights or health and safety of other
residents. (42 C.F.R. §483.10(l))
Access and Visitation
The resident has the right and the facility must provide—subject
to the resident's right to deny or withdraw consent at any time—immediate
access to any resident by:
- Immediate family or other relatives of the resident. (42
C.F.R. §483.10(j)(1)(vii))
- Others who are visiting with the consent of the resident, subject
to reasonable restrictions. (42 C.F.R. §483.10(j)(1)(viii))
- 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. (42 C.F.R. §483.10(j)(2))
- If a resident is married, he or she and their spouse must be assured
privacy and to be able to share a room if both are residents in the facility
and both agree to do so. (42 C.F.R. §483.10(e)(1)
and (m))
Resident & Family Councils
Resident Councils
- A resident has the right to organize and participate in resident
groups in the facility. (42 C.F.R. §483.15(c)(1))
- The facility must provide a resident group with private space. (42
C.F.R. §483.15(c)(3))
- Staff or visitors may attend meetings at the group's invitation.
(42 C.F.R. §483.15(c)(4))
- The facility must provide a designated staff person responsible for
providing assistance and responding to written requests from the resident
council. (42 C.F.R. §483.15(c)(5))
- The nursing home must listen to the views, and act upon the grievances
and recommendations of a resident council, concerning policies affecting
resident care and life in the facility. (42 C.F.R.
§483.15(c)(6))
Family Councils
- A resident's family has the right to meet in the facility with families
of other residents. A nursing home may not prohibit the formation of
a family council. (42 C.F.R. §483.15(c)(2))
- A family council may be made up of family members, friends, or representatives
of residents. (Cal. Health & Safety Code §1418.4(b))
- The family council must be allowed to meet in a common meeting room
of the nursing home at least once a month, and to meet in private without
nursing home staff present. (42 C.F.R. §483.15(c)(3); Cal. Health & Safety
Code §1418.4(a), (c))
- Staff or visitors may attend family council meetings, at the group's
invitation. (42 C.F.R. §483.15(c)(4); Cal. Health & Safety
Code §1418.4(e))
- The nursing home is required to consider the views, and act upon the
grievances and recommendations of a family council, concerning proposed
policy and operational decisions affecting resident care and life in
the facility. (42 C.F.R. §483.15(c)(6); Cal. Health & Safety
Code §1418.4(g))
- The nursing home is required to respond within 10 working days to
written requests or concerns of the family council. (Cal. Health & Safety Code §1418.4(h))
These residents' rights are found under both Federal and State law.
The Federal rights are found in the Code of Federal Regulations ("C.F.R"),
Title 42, which can be accessed online at www.gpoaccess.gov/cfr/index.html.
The State rights are found in the Health & Safety and Welfare &
Institutions Codes, which can be accessed online at www.leginfo.ca.gov/calaw.html,
and in the California Code of Regulations, Title 22, which can be accessed
online at www.calregs.com.
Page Last Modified: April 7, 2009
