Medicare/Medicaid Rights of Nursing Home Residents
Federal law gives each resident of a nursing home that participates in the Medicare and/or Medicaid program a right to:
- Choose his or her personal doctor.
- Have full information, in advance, about his or her care and treatment, and participate in planning and making any changes in his or her care and treatment.
- Live and receive services with reasonable allowance by the nursing home for his or her needs and preferences.
- Voice grievances about care or treatment received or not received without being discriminated against, or punished, and receive a prompt response to any grievance from the nursing home.
- Organize and participate in resident groups. (Families may organize family groups as well.)
- Participate in social, religious and community activities as he or she wants.
- Receive medical treatment in private, and have privacy for sleeping, bathing, and using the toilet, and other living activities, personal visits, telephone calls, reading and writing mail, and meetings of resident and family groups.
- Have personal and medical records kept confidential.
- Be free from physical or mental abuse, bodily punishment, involuntary isolation, or restraints used for discipline.
- Be free from restraints used for the convenience of the nursing home, rather than the resident's well-being, and have restraints used only under a doctor's written order for treatment and for the resident's safety and the safety of other residents.
- Be given results of the latest inspection of the nursing home and any plan of correction submitted by the home.
- Be notified in advance of any plans to change his or her room or roommate.
- Be informed of his or her rights at admission and, upon request, be given a written copy of his or her rights.
- Be given written and oral information about how to apply for and use Medicaid and how to receive a refund for previous private payments that Medicaid will pay for retroactively.
- Be given a written list, at admission and during his or her stay, of the services available under the basic rate and any extra charges for other services. Also, if the resident is a Medicaid resident, be given a written list of services covered by Medicaid and those for which there is an extra charge.
- (a) Be permitted immediate visits by his or her personal doctor, people from the ORS (which licenses nursing homes) or a Long-term Care Ombudsman, (b) be permitted immediate visits by his or her relatives, (c) be permitted visits by others under reasonable limits, and (d) be permitted reasonable visits by people or organizations providing health, social, legal, or other services.
- Have a Long-term Care Ombudsman review the resident's medical records with his or her consent.
- Be allowed to remain in the nursing home and not be transferred or discharged unless: (a) the transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met by the facility; (b) the resident no longer needs nursing home care; (c) the health or safety of other residents is in danger; or (d) the resident has not paid an allowable charge for an item or service requested by the resident after the resident has received reasonable notice of the payment due.
- Have 30 days advance, written notice of an involuntary transfer, which gives the reasons for the transfer, the resident's right to appeal the transfer, and the name, address and phone number of the Long-term Care Ombudsman program and other protection and advocacy programs.
- Request that the resident's bed be held, (if the resident is hospitalized, for example) and request information about how many days Medicaid will pay for the bed to be held, the home's policy about holding beds, and the right to return to the next available bed if Medicaid bed-holding coverage ends.
- Not be required to deposit personal funds with the nursing home.
- If the resident chooses to deposit personal funds with the nursing home, (a) have the funds held under a written agreement with the home, (b) have the funds kept in an account separate from the home's account, which bears interest if the funds are over $50, and (c) have the home keep a complete and separate accounting of the funds, with a written record of all transactions, available for review by the resident (and his or her representative).
Important: Also, under federal law, a nursing home may not discriminate against Medicaid patients. In particular, (1) the home must keep the same policies and practices about transfers, discharges and providing Medicaid-required services for all residents no matter who pays their bills; (2) the home cannot require residents to waive their rights to Medicaid; (3) the home cannot require a third party to guarantee payment as a condition of admission or continued stay; and (4) the home cannot charge or accept gifts, money, donations or other "consideration" in order for a Medicaid resident to continue to stay in the home.
Finally, under a federal law called the Patient Self-Determination Act, a new resident is entitled to receive from the nursing home information on his or her right to have a durable power of attorney for health care ("DPAHC") or a living will. A nursing home may not require you to have either a DPAHC or a living will in order to be admitted. Please see the Section on POWERS OF ATTORNEY in this Website for information on DPAHCs and living wills.