What Nursing Homes Can’t Do

Moving a loved one into a nursing home is an act of trust that they will be cared for with dignity and respect. Much of that trust is built on the laws that are in place to protect nursing home residents from abuse, neglect, fraud, and other forms of mistreatment.

If you are considering nursing home care for a loved one, take time to familiarize yourself with what nursing homes are and aren’t allowed to do. This will help ensure that the residence you choose meets all legal and care standards.

Laws Protecting Nursing Home Residents

In the United States, the Nursing Home Reform Act (NHRA) of 1987 established a foundation of rights for nursing home residents. The goal of the legislation was to ensure that residents of nursing homes receive care to promote their physical and mental well-being.

The NHRA created new legal provisions for nursing homes that receive Medicare and Medicaid funding. It guaranteed that nursing home residents have the right to:

• Protection from abuse and neglect
• Privacy and dignity
• Make their own financial and care decisions

The new law also included requirements for how nursing homes function. Under the NHRA, nursing homes must:

• Develop and follow individualized care plans for residents
• Maintain accurate records
• Ensure proper training for staff

Further regulations passed throughout the 1990s and 2000s built on this legal framework by:

• Creating systems for enforcement
• Requiring background checks for staff members
• Promoting standards for facility safety, such as smoke detector installation

In 2024, the U.S. Department of Health and Human Services (HHS) and the U.S. Centers for Medicare & Medicaid Services (CMS) under the Biden administration announced further nursing home regulations, including establishing minimum staffing levels.

State laws also establish regulations for nursing homes that provide additional protections to residents. For example, the Code of Virginia establishes continuing education requirements that applicants must complete to renew a nursing home administrator license.

Prohibition of Abuse and Neglect

Neglect and abuse in nursing homes is both unethical and illegal. Abuse can take multiple forms:

• Physical abuse, such as hitting or improper restraint
• Verbal abuse, such as insults or intimidation
• Sexual abuse
• Financial abuse

Neglect is the failure to provide necessary care, which can result in either harm or the risk of harm. This could be failing to assist residents with daily hygiene, provide adequate food or water, or provide for medical needs.

Federal law prohibits the abuse and neglect of nursing home residents, including their involuntary seclusion. Facilities are required to report all abuse allegations and investigate them thoroughly within five working days. Unfortunately, many instances of abuse and neglect go unreported or uninvestigated.

If a facility is found guilty of abuse or neglect, it can face fines and the loss of federal funding. Staff and administrators may face criminal charges as well or be terminated from their positions.

Right to Proper Medical Care

Nursing home residents have the right to timely and appropriate medical care. Nursing home facilities must create a personalized care plan for each resident based on an assessment of their health, and the plan must ensure that they receive necessary medications and other treatment. Failing to provide proper medical care, which can range from neglecting to treat injuries like bedsores to failing to administer appropriate medication, is both a violation of federal law and a breach of contract.

Nursing home residents also have the right not just to receive care but to be informed about their conditions and treatment options. They have the right to accept or refuse treatment. They also have the right to access their medical records at any point.

Privacy and Autonomy of Residents

Living in a nursing home facility does not negate residents’ basic rights. They retain their privacy in medical and personal matters. They have the right to private visits and conversations, as well as to confidential health records.

Residents also retain their autonomy after moving into a nursing home. They retain the legal ability to make their own care decisions, such as participating in the development of a medical care plan and choosing physicians. They retain the right to manage their daily schedule and activities.

Staff members are required to respect residents’ autonomy and privacy. They may not force residents into decisions, medical or otherwise. They may not ignore residents’ preferences or invade their privacy without consent. Facilities, administrators, and staff members who violate these rights are violating federal law and may face professional and legal repercussions.

Complaint and Grievance Process

Residents, as well as their families and other caregivers, have the right to voice concerns about nursing home care and actions. This helps facilities maintain standards of care and avoid instances of abuse and neglect. The NHRA requires that nursing home facilities have an established grievance procedure that allows residents and families to file complaints without being worried about retaliation. The facility must also ensure a timely response and, if necessary, investigation.

Residents or families can also report grievances to the state Long-Term Care Ombudsman Program, which advocates for nursing home residents. Ombudsmen work to improve conditions and nursing home facilities by investigating complaints and mediating disputes.

Rules Regarding Facility Closure

If a nursing home closes, it can significantly impact the well-being of the residents who live there and rely on its facilities and staff for their care. To protect residents, nursing homes are required by law to give them at least 60 days’ written notice before closing.

This notice must be provided in a language the residents understand and include a relocation plan and assistance to help residents transition smoothly to new accommodations. The staff must also discuss the relocation plan with residents (or their families/legal representatives) to ensure that they understand the situation and their rights during the closure and relocation.

The nursing home must coordinate with the residents’ other healthcare providers and family members to ensure that medical and other care is not interrupted during the closure. Some states also require that health authorities approve every nursing home closure to ensure that safety and transfer protocols are properly conducted.

Hiring Practices and Staff Conduct

The Elder Justice Act was passed as part of the Affordable Care Act in 2010. It included provisions to improve hiring practices at nursing homes. These stricter hiring practices were intended to further protect residents from abuse, fraud, and other forms of malpractice.

Nursing home facilities must conduct background checks and are prohibited from hiring staff who have been listed on abuse registries or previously found guilty of abuse. Any abuse of older individuals at care facilities must be immediately reported to law enforcement. Nursing homes are also expected to maintain sufficient staffing levels and properly train all staff members to care for vulnerable and elderly individuals.

Visitation Rights

Federal law guarantees that nursing home residents have the right to receive visitors of their choice. These can include family members, friends, legal representatives, and spiritual advisors such as clergy. Isolating residents from visitors, especially as a form of coercion, control, or punishment, is considered emotional abuse and strictly prohibited.

Residents have the right to private communications with people of their choice, whether by phone, mail, email, or other forms of communication. They also have the right to participate in activities of their choice, including community, social, and religious activities.

Financial Autonomy of Residents

Residents of nursing homes retain control of their personal finances and financial decisions unless they have voluntarily designated a representative or have been legally declared incapable. It is illegal for care facilities to require that residents turn over control of their finances or allow staff and administrators to access their personal funds in order to be admitted or continue to receive care.

Nursing home residents must be allowed to manage their own finances and bank accounts, make purchases, and access their financial information.

It is possible that a facility can manage a portion of a resident’s funds if the resident has been legally declared in need of such assistance. If this is the case, the facility must provide quarterly statements and ensure funds are held in appropriate accounts, including interest-bearing accounts.

The Bottom Line

Because of their living situation, nursing home residents can be vulnerable to abuse, neglect, and exploitation. There are legal protections in place at multiple levels to protect them, but these protections are only effective if residents, families, and care providers know their rights and take action when those rights are violated.

If you or a loved one is considering nursing home care, familiarize yourself with the protections against abuse and neglect, as well as guarantees of medical care, privacy, and independence. And if you suspect any instances of elder abuse at a care facility, register your complaint as soon as possible with the facility or even with local and state authorities.