Are You Aware of Your Loved One’s Rights in a Nursing Home?

Over 1.3 million Americans reside in nursing homes, relying on these facilities for care and support during their most vulnerable years. However, not all nursing homes operate ethically, and some may engage in practices that are strictly prohibited under federal and state laws. To protect residents’ dignity, safety, and well-being, regulations like the Nursing Home Reform Act of 1987 (OBRA ’87) and guidelines from the Centers for Medicare & Medicaid Services (CMS) set clear boundaries on what nursing homes can and cannot do.

This guide explores things nursing homes are not allowed to do, shedding light on common violations, legal protections, and how families can take action if their loved one’s rights are compromised. By understanding these restrictions, family members and caregivers can ensure their loved ones receive the care they deserve.

Why Understanding Nursing Home Restrictions Matters

Legal Framework Protecting Residents

Federal laws such as OBRA ’87 and state-specific regulations govern the operation of nursing homes to protect residents from harm. These laws ensure that facilities adhere to standards for care, staffing, and resident rights. Violations can lead to penalties, including fines up to $10,000 per day, loss of certification, or facility closure.

Common Misconceptions About Nursing Homes

Many families mistakenly believe that nursing homes have unlimited authority over residents. For example, some assume facilities can evict residents without notice or restrict their access to personal belongings. Understanding what nursing homes are prohibited from doing empowers families to advocate for their loved ones effectively.

Quick Facts: Top Violations

Recent CMS reports highlight common violations, including neglect, improper use of restraints, and failure to provide adequate nutrition. These infractions not only harm residents but also result in legal and financial consequences for facilities.

12 Things Nursing Homes Are Not Allowed to Do

1. Deny Medically Necessary Care or Treatment

Nursing homes are legally required to provide adequate medical care tailored to each resident’s needs. This includes managing chronic conditions, administering medications, and addressing emergencies. Facilities that neglect these responsibilities can face severe penalties.

• Legal Basis: OBRA ’87 mandates that residents receive necessary care to maintain their highest possible level of well-being.
• Example: A resident with diabetes was hospitalized after a nursing home failed to monitor their blood sugar levels consistently. The facility faced fines and lost its CMS certification.

2. Use Physical or Chemical Restraints Without Justification

Restraints, whether physical (e.g., straps) or chemical (e.g., sedatives), can only be used as a last resort and with proper justification. Arbitrary use of restraints is not only unethical but also illegal.

• Legal Basis: CMS guidelines emphasize “least restrictive alternatives” for managing behavioral issues.
• Red Flag: Unexplained marks on wrists or excessive sedation may indicate improper restraint use.

3. Employ Unqualified or Abusive Staff

Nursing homes must conduct thorough background checks and provide adequate training for their staff. Employing unqualified or abusive personnel puts residents at risk.

• Legal Basis: OBRA ’87 requires facilities to verify staff credentials and report abuse allegations.
• Example: A whistleblower revealed that a staff member with a history of abuse was hired without proper vetting. The facility was fined and required to implement stricter hiring protocols.

4. Ignore Resident Rights to Privacy and Dignity

Residents have the right to privacy in their rooms, personal care, and correspondence. Facilities must respect these rights at all times.

• Legal Basis: The Resident Bill of Rights guarantees privacy and dignity for all nursing home residents.
• Red Flag: Unauthorized room entries or staff discussing personal matters in public areas.

5. Commit Financial Exploitation or Demand Illegal Fees

Nursing homes cannot demand residents to pay additional fees or transfer assets to the facility. Financial exploitation is a common violation that often goes unnoticed.

• Legal Basis: Federal law prohibits kickbacks, forced asset transfers, and unauthorized charges.
• Example: A facility was caught charging residents for “priority care” packages, which were not part of their agreed-upon services.

6. Evict Residents Without Due Process

Residents cannot be evicted arbitrarily. Federal law requires facilities to provide a 30-day notice and valid reasons for eviction, such as non-payment or safety concerns.

• Legal Basis: State and federal laws outline specific conditions under which evictions are permissible.
• Red Flag: Sudden eviction notices without explanation or legal documentation.

7. Provide Substandard Food or Nutrition

Nursing homes must ensure residents receive balanced, nutritious meals tailored to their dietary needs. Substandard food can lead to malnutrition and other health issues.

• Legal Basis: CMS dietary guidelines require facilities to provide therapeutic diets and accommodate allergies.
• Red Flag: Complaints of hunger, repetitive meals, or lack of fresh food.

8. Neglect Hygiene, Sanitation, or Infection Control

Hygiene and infection control are critical in nursing homes, especially post-COVID. Facilities must maintain clean environments and prevent outbreaks of illnesses like pneumonia or flu.

• Legal Basis: Federal regulations mandate bed sore prevention, sanitation, and regular hygiene checks.
• Example: A nursing home was fined after an outbreak of infections revealed poor sanitation practices.

9. Discriminate Based on Race, Disability, or Payer Source

Nursing homes cannot deny admission or provide substandard care based on a resident’s race, disability, or payment method (e.g., Medicaid).

• Legal Basis: ADA and Title VI of the Civil Rights Act protect residents against discrimination.
• Red Flag: Families reporting differential treatment based on financial status.

10. Withhold Personal Belongings or Correspondence

Residents have the right to access their mail, visitors, and personal belongings. Nursing homes cannot censor communication or restrict access without valid reasons.

• Legal Basis: Resident Bill of Rights ensures freedom to correspond and retain personal property.
• Example: A facility faced a lawsuit for withholding a resident’s letters and packages.

11. Administer Medications Improperly or Without Consent

Medications must be administered as prescribed and with informed consent. Overmedication or errors in administration are serious violations.

• Legal Basis: Federal law requires oversight for psychotropic drugs and informed consent for all medications.
• Red Flag: Residents appearing overly sedated or confused without clear explanations.

12. Retaliate Against Complaints or Family Advocacy

Residents and their families have the right to file complaints without fear of retaliation. Facilities that intimidate or punish advocates are breaking the law.

• Legal Basis: Federal regulations protect whistleblowers and ensure ombudsman access.
• Example: A family that reported neglect faced threats from facility staff, leading to legal action.

Red Flags and How to Spot Violations

Common Warning Signs

• Unexplained injuries or bruises.
• Frequent staff turnover or shortages.
• Poor hygiene or unsanitary conditions.
• Sudden changes in a resident’s mood or behavior.

Tips for Families

• Conduct unannounced visits at different times of day.
• Review care plans regularly with staff.
• Document any concerns and take photos as evidence.

What to Do If You Suspect Violations

If you believe a nursing home is violating a resident’s rights, follow these steps:

1. Document Everything: Take notes, photos, and videos of concerning incidents.
2. Report to Authorities: Contact your state’s long-term care ombudsman or CMS hotline.
3. Seek Legal Assistance: Involve a lawyer specializing in elder care if necessary.

Resources like LongTermCare.gov and AARP’s nursing home guides can provide additional support.

Conclusion

Understanding the things nursing homes are not allowed to do is essential for protecting your loved ones. From denying care to financial exploitation, these prohibited practices can have serious consequences. By staying informed and vigilant, families can advocate effectively and ensure their loved ones receive the quality care they deserve.