Nursing Home Rights: What Every Family Should Know Before Admission

The Nursing Home Reform Act: Federal Foundation

The Nursing Home Reform Act (OBRA-87) applies to every nursing home that participates in Medicare or Medicaid — which is the vast majority of nursing homes in the United States. The law requires facilities to provide care that maintains each resident's highest practicable level of physical, mental, and psychosocial well-being. It also establishes specific rights that every resident is entitled to exercise.

The Act is enforced through state survey agencies, which conduct regular inspections, and through the federal Centers for Medicare & Medicaid Services (CMS), which oversees the survey process and can impose penalties — including fines and decertification — on facilities that violate the law.

Admission Rights: What the Facility Cannot Require

The admission process is where many families encounter the first — and most consequential — legal issue. Federal law explicitly prohibits nursing homes from requiring a third-party guarantee of payment as a condition of admission, continued stay, or receipt of services (42 U.S.C. section 1396r(c)(5)(A)(ii)).

In plain language: a nursing home cannot require a family member to sign a document making them personally responsible for the resident's bills. If a daughter brings her mother to a nursing home and the admissions coordinator asks the daughter to sign as the "responsible party," the daughter should understand that she is not legally required to do so — and that signing may create personal financial liability for bills that could exceed $10,000 per month.

A family member who holds power of attorney can sign the admission agreement in a representative capacity — on behalf of the resident — without assuming personal liability. The signature line should read something like: "Jane Smith, as agent for Mary Smith under Power of Attorney." This is an important distinction. Signing as an agent is not the same as signing as a personal guarantor.

If a facility refuses to admit a resident unless a family member signs as a personal guarantor, the family should report this to the state ombudsman and the state survey agency. It is a violation of federal law.

Resident Rights Under Federal Law

Once admitted, every nursing home resident has the following rights under federal law:

Dignity and respect. The right to be treated with dignity, to be addressed by their preferred name, and to make personal choices about daily life — including what to wear, when to eat, and how to spend their time.

Freedom from abuse and neglect. The right to be free from verbal, sexual, physical, and mental abuse, corporal punishment, involuntary seclusion, and any form of neglect or exploitation.

Freedom from restraints. The right to be free from physical and chemical restraints imposed for discipline or convenience. Restraints may only be used to treat a medical condition and only under a physician's written order, with regular reassessment.

Privacy. The right to privacy in medical treatment, personal care, communications, visits, and meetings with family and other residents.

Participation in care. The right to participate in planning their own care, to be informed about their medical condition and treatment, and to refuse treatment.

Financial management. The right to manage their own financial affairs or to have an accounting of any funds the facility holds on their behalf.

Grievances. The right to voice grievances about care or conditions without fear of retaliation, and to have those grievances addressed promptly.

Visitors. The right to receive visitors, including family, friends, the ombudsman, and legal counsel.

Discharge Protections

A nursing home cannot discharge or transfer a resident for any reason it chooses. Under federal law, involuntary discharge is permitted only for six specific reasons:

1. The resident's health has improved sufficiently that nursing home care is no longer needed. 2. The resident's condition requires services the facility cannot provide. 3. The safety or health of other residents is endangered. 4. The resident has failed to pay after reasonable and appropriate notice. 5. The facility is closing. 6. The resident was admitted for a specific purpose (such as rehabilitation) that has been completed.

For any involuntary discharge, the facility must provide 30 days written notice that includes the reason for the discharge, the effective date, the location the resident will be transferred to, and information about how to appeal the decision. The resident has the right to appeal the discharge to the state, and in many cases, the discharge is stayed (paused) during the appeal process.

The Ombudsman Program

Every state has a Long-Term Care Ombudsman Program, mandated by the Older Americans Act. Ombudsmen are advocates for nursing home residents. They investigate complaints, mediate disputes between residents and facilities, provide information about long-term care options and residents' rights, and advocate for policy changes at the state and federal level.

Residents, family members, and anyone concerned about the care or treatment of a nursing home resident can contact the ombudsman for help. The ombudsman has the legal authority to enter any nursing home, speak with any resident (with the resident's consent), and access the resident's records. The service is free and confidential.

To find the local ombudsman program, families can call the Eldercare Locator at 1-800-677-1116 or visit the Administration for Community Living's website.

What to Do Before Admission

Read the admission agreement carefully. Do not sign anything under pressure. Take the agreement home, review it with a family member or attorney, and understand every provision — particularly any language about personal financial liability, arbitration clauses, and discharge policies.

Do not sign as a personal guarantor. Sign only in a representative capacity if you hold power of attorney. If the facility insists on a personal guarantee, report it.

Check the facility's record. Review the facility's inspection reports on Medicare's Care Compare website (medicare.gov/care-compare). Look for complaints, deficiencies, and staffing levels. Check the state ombudsman's records for complaint history.

Ensure advance directives are in place. Make sure the resident has a healthcare power of attorney, living will, and POLST or MOLST form (if applicable in the state) before admission. Provide copies to the facility.

The Bottom Line

Nursing home residents have comprehensive federal rights that protect their dignity, safety, and autonomy. Families have the right to refuse personal financial liability during the admission process. Discharge can occur only for legally defined reasons with proper notice and appeal rights. And every resident has access to a state ombudsman who can investigate complaints and advocate on their behalf. Knowing these rights before admission — not after a crisis — is the most effective way to ensure that a loved one receives the care and respect they are entitled to under the law.