A nursing home is your parent's home, not just a place they receive care. Federal regulations for every nursing home that participates in Medicare or Medicaid set out residents' rights in detail, from choosing a doctor and receiving visitors to seeing records and managing money1. They also limit when and how a home can make a resident leave2. Before move-in, read our guide to the nursing home admission agreement.
This guide explains those rights in plain language, then covers the situations families ask about most: discharge, pressure to sign out, refusing care, room changes and closures. For payment-related situations, including Medicare ending, a Medicaid application pending, and what a discharge notice must say, see our companion guide, when Medicare stops paying for a nursing home.
Core rights every resident has
Federal rules say residents have a right to a dignified existence, self-determination and communication with people inside and outside the home, and that the home must protect and promote those rights1. In practice, that includes:
- Choice in care. To be informed about care and treatment options, take part in care planning, choose among options, and request, refuse or stop treatment1.
- Choosing a doctor. To choose an attending physician, who must be licensed and meet federal requirements1.
- Visitors. To receive visitors of the resident's choosing at the time of their choosing, subject to the resident's own right to refuse visits and reasonable limits that protect other residents. Ombudsman and state representatives must be given immediate access1.
- Records. To see their medical records within 24 hours of asking (excluding weekends and holidays) and get copies within two working days, at a reasonable cost-based charge1.
- Money. To manage their own finances. A home may not require residents to deposit money with it; if they choose to, the home must safeguard and account for it1.
- Privacy and communication. Privacy in care, mail, phone calls and visits, and the right to join resident and family groups1.
- Freedom from abuse and restraints. Freedom from abuse, neglect, exploitation and misappropriation of property, and from physical or chemical restraints used for discipline or staff convenience3.
- Grievances. To voice complaints without fear of retaliation and have the home respond1.
Rights at admission
- No waiver of Medicare or Medicaid rights. A home may not ask a resident to give up rights or promise not to apply for Medicare or Medicaid2.
- No third-party guarantee. A home may not require a family member to personally guarantee payment as a condition of admission or a continued stay2.
- Arbitration is optional. A home may not require a resident or representative to sign a binding arbitration agreement to be admitted or to keep receiving care, must say so explicitly, and must allow the agreement to be rescinded within 30 calendar days of signing4.
Read the admission agreement slowly, ideally before the day of admission, and cross out or ask about anything that conflicts with these rules. Our guide to choosing a nursing home covers questions to ask before you sign. For tips on making visits count, see visiting a parent in a nursing home.
When a nursing home can make a resident leave
A certified nursing home may transfer or discharge a resident, over the resident's objection, only for these reasons2:
- The home cannot meet the resident's needs. The transfer is necessary for the resident's welfare and needs cannot be met in the facility.
- The resident's health has improved. The resident no longer needs the services the facility provides.
- Safety of others is endangered. Because of the resident's clinical or behavioral status.
- Health of others is endangered. The health of individuals in the facility would otherwise be at risk.
- Nonpayment. Under a specific federal definition; see our Medicare and Medicaid guide for how pending Medicaid applications are treated.
- The facility is closing. Covered below.
For the first two reasons, the resident's own physician must document the basis; for the safety and health reasons, a physician must document it. When the home says it cannot meet needs, the record must show the specific needs it cannot meet, what the home tried, and what the receiving setting offers that the home does not2.
The home must give written notice (usually 30 days ahead) and the resident can appeal through the state; during an appeal, the home generally may not discharge the resident25. We cover notice timing, contents and appeal steps in detail in when Medicare stops paying for a nursing home. If your parent has received a notice to leave, our step-by-step guide to nursing home eviction notices and appeals covers the notice, the appeal and refusal to readmit after a hospital stay.
Pressure to sign out or take a parent home
Sometimes no formal notice arrives. Instead, staff suggest the family take a parent home, or ask the resident to sign out against medical advice. CMS tells inspectors to look closely at these situations.
CMS defines a facility-initiated discharge as one the resident objects to, did not request, or that does not match the resident's stated goals and preferences. If evidence shows a resident or representative was forced, pressured or intimidated into leaving against medical advice, CMS treats it as a facility-initiated discharge, which must meet the notice and other discharge requirements6. A general wish to go home someday, or a confused resident wandering out, is not a resident's notice of intent to leave6.
- Do not sign under pressure. Say clearly, in writing if possible, that your parent does not agree to leave.
- Ask for the formal notice. If the home wants your parent to go, ask for the written discharge notice with appeal rights.
- Insist on a safe plan. Any discharge must include planning for care afterward and information sent to the next provider2.
- Call the ombudsman. Ombudsman programs help residents and families push back on unsafe or pressured discharges7.
Refusing care is not a reason to discharge
Residents have the right to refuse treatment, including medicines, therapy or meals of a certain type1. CMS guidance says a resident may not be transferred or discharged for refusing treatment unless the discharge criteria are otherwise met, and that refusal should not be a basis for discharge unless it creates a risk to the resident's or others' health or safety6.
The home's job is to find out why. CMS expects staff to try to learn the reason for a refusal, including whether a resident who cannot explain is refusing because of pain or fear of a particular staff member, and to address it. Any declined services and the risks must be written into the care plan6.
If your parent with dementia resists bathing or medicines, ask for a care plan meeting. Approaches like changing the time, the staff member or the method often help. Our guide to person-centered dementia care has ideas.
Room and roommate changes
Residents have the right to written notice, including the reason, before their room or roommate is changed. They may share a room with a spouse or a roommate of their choice when practicable and both agree1.
A resident may refuse a move to another room in the same building when the purpose is1:
- Moving out of the Medicare-certified skilled nursing unit. For example, moving a resident off the skilled unit once Medicare coverage ends.
- Moving into the skilled unit from the Medicaid nursing facility part. When the move is to a distinct part certified differently.
- Staff convenience. A move made solely for the convenience of staff.
Refusing such a move does not affect the resident's eligibility for Medicare or Medicaid benefits1. A move within the same certified facility is a room change, not a discharge; a move to a bed outside the certified facility is a transfer or discharge with its own protections6.
If the nursing home is closing
A nursing home administrator must give written notice of a planned closure to the state survey agency, the State Long-Term Care Ombudsman, residents and their representatives at least 60 days before the closure date, unless the government terminated the home's participation, in which case the timing is set by the government. The home must stop admitting new residents once notice is given, and the notice must include a state-approved plan to relocate residents to the most appropriate setting, considering each resident's needs, choice and best interests4.
- Put preferences in writing early. Tell the home and the ombudsman which settings and locations your parent prefers.
- Ask for records and medication lists. Make sure the next home or setting receives complete information.
- Consider all options. Some residents may be able to move to assisted living or home with support.
How to enforce these rights
- Raise it with the home. Start with the charge nurse, social worker or director of nursing, then the administrator. Use the home's grievance process and keep notes.
- Ask for a care plan meeting. Many problems are solved by changing the plan and putting agreements in writing. See our guide to nursing home care plan meetings.
- Call the ombudsman. The long-term care ombudsman is a free, confidential advocate for residents7. Our guide to the long-term care ombudsman explains what they do and how consent works when a parent cannot speak for herself.
- File a complaint with the state. The state survey agency investigates complaints about certified nursing homes; Care Compare shows complaint inspection results8.
- Report suspected abuse immediately. Federal rules require homes to report and investigate alleged abuse and neglect3. If someone is in danger, call 911. For money or property that goes missing, see our guide to elder financial abuse.
For veterans in a nursing home, VA social workers and State Veterans Homes are additional resources9. Veterans may also qualify for Aid and Attendance10.
Comparing settings? See memory care vs. nursing home or take the care quiz.
