Nursing Home Residents’ Rights

The biggest concern most people have when they place their elderly parent or spouse in a nursing home is the quality of care their loved one will receive. In 1987, the federal government passed the Nursing Home Reform Act (OBRA), which requires certain services to be provided to each resident and establishes a Residents’ Bill of Rights (see below). Only if Nursing Homes are in compliance with the requirements of this law will they be certified by the state to receive Medicaid and Medicare payments for the long-term care of residents.

Required services as specified in the Act include: periodic assessments for each resident, individual comprehensive care plans, nursing services, social, rehabilitation, pharmaceutical and dietary services, and, if the facility has more than 120 beds, the services of a full-time social worker.

To monitor whether nursing homes meet the requirements, the law established a certification process that requires states to conduct unannounced surveys, including resident interviews, at least once every 15 months. The surveys generally focus on residents' rights, quality of care, quality of life and the services provided. More targeted surveys may be carried out in response to specific complaints. If the survey reveals that a nursing home is out of compliance, the severity of the remedy depends on whether the deficiency puts a resident in immediate jeopardy, and whether it is an isolated incident or widespread throughout the facility. For some violations, nursing homes have an opportunity to correct the deficiency before remedies may be enforced.

Under the law, any or all of the following sanctions may be imposed to enforce compliance with the law:

• Directed in-service training of staff
• Directed plan of correction
• State monitoring
• Civil monetary penalties
• Denial of payment for all new Medicare or Medicaid admissions
• Denial of payment for all Medicaid or Medicare patients
• Temporary management
• Termination of the provider agreement

The Residents’ Bill of Rights

In addition to the service requirements, The Nursing Home Reform Act also established the following Bill of Rights for nursing home residents:

• The right to freedom from abuse, mistreatment, and neglect;
• The right to freedom from physical restraints;
• The right to privacy;
• The right to accommodation of medical, physical, psychological, and social needs;
• The right to participate in resident and family groups;
• The right to be treated with dignity;
• The right to exercise self-determination;
• The right to communicate freely;
• The right to participate in the review of one's care plan, and to be fully informed in advance about any changes in care, treatment, or change of status in the facility; and
• The right to voice grievances without discrimination or reprisal.

The Bad News

The extent to which the law has been successful in improving nursing homes varies tremendously from state to state, and even from nursing home to nursing home. There have been some significant improvements overall, but despite federal regulation, major problems are still fairly widespread today. The issue has mainly been enforcement of the law. State surveyors have been terribly inconsistent in how they conduct inspections and there have been serious deficiencies. The law has not deterred some nursing homes from repeatedly mistreating its residents. In 2006, almost one in five nursing homes nationwide was cited for serious deficiencies—those that caused actual harm or placed residents in immediate jeopardy.

What to Do if you have a Loved One in a Nursing Home

The best answer is do your homework. Be thorough in investigating whether or not any complaints have been made against the home, and what was done to correct the situation. Visit often. Establish a relationship with the administrators of the home and let it be known that you will be there regularly. Don’t let even small problems be ignored. Any issue effecting the comfort or care of your relative should be brought to the attention of the administrators immediately.

Then watch for modifications and improvements. If none is made, don’t be afraid to take the matter further and contact the Ombudsman’s office in your state. There are also attorneys who specialize in elder law and will be able to give you advice in this area. Don’t give up until the problem is corrected. Of course, if your loved one is being neglected or abused in any way, moving him or her to a different home is the best option while you still work through the system with the offending nursing home.

Read an article on Nursing Home Myths.