The decision to move to a nursing home is often fraught with worry and stress. Even if you know that you or your family member would benefit from nursing home care, you want to make sure the facility will provide kind, person-centered and effective care. But it’s not just what services a nursing home will provide. If you are considering a nursing home, you are likely also wondering what things nursing homes are not allowed to do.
For example, you want to make sure the nursing home will not be making important decisions without your approval, that they won’t be discriminatory or abusive and that they won’t terminate care without your consent. Thankfully, there is quite a bit of oversight when it comes to nursing home care. “Nursing homes must follow federal and state laws that protect residents’ rights, including respectful treatment, involvement in care planning and privacy,” says Dr. Brittany Ferri, an occupational therapist with the National Council on Aging.
This knowledge can offer you some comfort as you navigate the process of transitioning to a nursing home. Read on for more insights and information about what nursing home care looks like and what nursing homes are not allowed to do.
Who is a nursing home the right fit for?
First, it’s helpful to understand what a nursing home is and who might be a good candidate for one. Nursing homes are not the same assisted living facilities. While assisted living facilities can help residents with some of the activities of daily living (ADLs) such as cleaning, cooking and dressing, they don’t generally provide medical assistance and monitoring for residents like nursing homes do.
“Nursing homes are most known for their long-term care with 24-hour availability of medical assistance for those who need constant care or supervision but do not need to be hospitalized,” explains Christopher Norman, a geriatric nurse practitioner with the National Council on Aging.
Nursing homes usually offer a range of services, including:
- Personal care (bathing, grooming, getting dressed, feeding).
- Rehabilitation services after an injury or surgery.
- Care for chronic medical conditions.
“A nursing home is typically a good fit for those who can’t get good enough care at home due to the complexity of their health needs or the short-term need for intensive rehabilitation or nursing care after a surgery,” Norman describes.
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Your nursing home rights
There are federal rules and regulations in place to protect patients while they reside in a nursing home. These are laid out by the Center for Medicare and Medicaid Services (CMS), which is a federal organization that provides healthcare for individuals enrolled in government funded health insurance, including Medicare and Medicaid.
CMS publishes a document called “Your Rights and Protections as a Nursing Home Resident” that can be helpful to keep on hand if you are navigating the world of nursing home care. Some highlights of this document include:
- You have the right to make your own decisions.
- Your personal information needs to be kept private.
- Any nursing home you reside in must keep you informed of your rights.
- The facility needs to inform you of any rules and regulations they have that you must adhere to; this should be explained before you are admitted to the facility.
Things nursing homes are not allowed to do
In addition to alerting you to any rules or regulations you must follow as a resident in a nursing home, nursing homes themselves are subject to rules and regulations. Let’s take a closer look at some of the things nursing homes aren’t allowed to do.
Make care decisions
Nursing homes can’t make care decisions for residents without consent. You (or a family member who is legally allowed to participate in your care) will help develop your nursing home care plan, and will be allowed access to all your nursing home-related clinical records and reports.
Nursing home residents can actively participate in making decisions, Ferri says. “They can choose their treatment options and voice any concerns,” she says. “Their families or guardians can also help make decisions to make sure the care fits with the resident’s needs and preferences.”
Manage complex medical conditions and treatments
Although nursing homes are set-up to handle many chronic conditions, including diabetes management, Alzheimer’s or Parkinson’s disease, heart failure, post-stroke recovery and post-surgery recovery, there are some medical situations that they don’t cater to.
If specialist care is required, nursing homes will help make or coordinate these appointments and may provide transportation to and from the nursing home.”
— Christopher Norman, geriatric nurse practitioner
Nursing homes do not handle complex medical procedures that require hospital-level care, says Norman. “During emergencies and severe issues, a hospital is still often needed. If specialist care is required, nursing homes will help make or coordinate these appointments and may provide transportation to and from the nursing home.”
Control patient finances
Nursing homes will not manage your money for you. You have the right to manage your own finances. If you need help or are not cognitively capable of doing so, a legal guardian or power of attorney can help.
Sometimes, nursing homes have a designated “banker” who oversees finances that are paid directly to a nursing home on a person’s behalf, Norman explains. “Unless there are restrictions on the amount that can be withdrawn that are put in place by a family member, appointed fiduciary or legal guardian, a nursing home resident can access their funds like any other bank,” he says.
Overall, nursing homes have strict regulations in place to ensure that financial exploitation is avoided, Norman stresses.
Participate in unfair treatment and discrimination
Nursing homes are not allowed to be prejudiced or intolerant. There are federal laws in place that serve to protect you from these types of mistreatment. These laws make it clear that nursing homes can’t discriminate against residents based on race, disability, age, religion or national origin. They also protect from abuse and neglect.
Typically, nursing homes have a patient advocate to make sure these rights are upheld, Norman says. These advocates provide resources for nursing home residents and families who have concerns or complaints. If an advocate is not available on-site, you can reach out to an ombudsman, which is a U.S. public health official who works to resolve resident issues in nursing homes, Norman advises. “Every state in the U.S. has an Office of the State Long-Term Care Ombudsman,” he explains.
Unexpectedly terminate care
A nursing home can’t evict you or terminate your care without due cause. “Discharge from a nursing home can happen if a resident’s health improves enough to require less care, if there’s an agreement to get care elsewhere or if their care needs become too intensive for the facility,” Ferri notes.
Legal reasons may also result in termination. For example, not paying your nursing home bills may lead to discharge, but that’s usually only if there was an appropriate notice of late payment and you still didn’t pay, Ferri says.
“Decisions should be made with the patient’s best interests in mind, giving them enough notice and planning.”
— Christopher Norman
Most of the time, termination is something both parties agree to. “Disposition from nursing home care is frequently a mutual decision-making process between the nursing home staff, resident, and family caregivers,” Norman explains. “Retention efforts (individualized care plans, family meetings, etc.) should be well-documented before it ever gets to this point.”
Ideally, “decisions should be made with the patient’s best interests in mind, giving them enough notice and planning,” says Norman.
Nursing home red flags
Many people wonder how to know if they or their loved one may have been mistreated in a nursing home. Ferri and Norman shared some red flag signs of neglect or abuse:
- Poor hygiene
- Unaddressed weight loss
- Noticeable decline in mood or engagement
- Frequent staff shortage
- Unsanitary conditions
Complaints from other residents
What should you do if you notice any of these signs? “If you notice any problems, it’s important to discuss them with the home’s management, a local ombudsman, or state regulatory agencies to make sure the issues are addressed and residents are protected,” Ferri advises.
You should always feel empowered to report any red flags to the facility. In fact, “the reporting structure for concerns should be clearly visible within the nursing home,” Norman says. “If not, this is also a red flag.”
The bottom line
While nursing homes aren’t for everyone, they are a good match for people who need a higher level of medical and personal care than can be safely provided at home or at an assisted living facility. Most nursing homes provide good care for their residents, and all nursing homes must adhere to a set of rules that honor a person’s right to privacy, respect and competent care.
If you are considering nursing home care or caring for someone who may need this care, it can be helpful to be armed with information about what to expect at a nursing home, including what nursing homes can and cannot do.
Above all, remember that you can — and should — alert the nursing home staff or other regulatory agencies of any problems. “If you suspect a nursing home is not following rules, it’s important to report your concerns,” Norman emphasizes.
