Nursing home residents' rights
Encyclopedia
Nursing home residents' rights are the legal and moral rights of the residents of a nursing home
. Legislation exists in various jurisdictions to protect such rights. An early example of a statute protecting such rights is Florida statute 400.022, enacted in 1980, and commonly known as the Residents' Rights Act.
Specific rights protected vary greatly by jurisdiction. Types of rights protected include: dignity
, medical privacy
, pecuniary, dietary and visitation rights. Process rights, such as right of complaint, are also sometimes protected.
(IoM) report, the US federal government moved to address these concerns by enacting more resident-focused regulations, and among these were a number of new quality-of-life rights for residents of nursing homes. Similar concerns over quality of care motivated people in other countries to advocate for residents' rights.
, for instance, the Long Term Care Homes Act 2007 contains a "Residents' Bill of Rights", including, inter alia, the rights to be treated with courtesy and respect; to privacy in treatment; to be informed of one's medical condition and treatment; to consent to or refuse treatment; to confidentiality of medical records
and treatment; to receive visitors; and, when near death, to have family members present 24 hours a day.
level. In England
, for instance, the Care Quality Commission
, the health and social care regulator for England, describes national minimum standards under the Care Standards Act 2000 for services in care homes, including dignity
and privacy rights, dietary and pecuniary rights, and the right to complain if one is unhappy with the care provided.
level.
was passed to protect the civil rights of, amongst others, residents of nursing homes and similar facilities.
In 1987, amendments known collectively as the Federal Nursing Home Reform Act, including a robust section on nursing home residents' rights, were attached to an Omnibus Budget Reconciliation Act of 1987
(OBRA '87) which was then enacted into law and codified at section 483 of Volume 42 of the Code of Federal Regulations
and related United States Code
sections. These required nursing homes to provides facilities to ensure that residents had a high quality of life, good physical and mental activities and were able to participate in the administration of the home. Appeals to an ombudsman
in case of dispute were to be facilitated. However, the act's protections may or may not not apply to some nursing home residents whose nursing homes receive only state funds, and do not participate in Medicare
or Medicaid
.
Some rights provided by federal law as of 2010 include rights to dignity, privacy, freedom from discrimination
, freedom from restraint, to be informed of medical care and treatment, pecuniary rights, visitation, rights of complaint and protection against transfer and unfair discharge. Specific rights include: choice of physician and involvement in treatment options; a right to be admitted without a third-party guarantee as a condition of admission; freedom from improper physical or chemical restraints; freedom from abuse; right to be treated with dignity; right to reasonable accommodation; right to participate in planning care and treatment and any changes in care and treatment; right to informed consent in language patient can understand; right to refuse treatment; right of family and Ombudsman to immediately access resident and have reasonable access to facility; right to privacy, confidentiality, and visitors; a right to not be transferred unless necessary to meet residents' needs, resident no longer requires care, safety of others is endangered, resident has failed to make own payments, or facility no longer operates; right to readmission; right to appeal hearings; right to have necessary care and services for highest practicable well-being; right to have adequate number of personnel; and, various rights respecting the residents' financial matters and need for proper notice and information.
, for instance, additional rights are protected. As of 2010, these include: a contract will not require the resident to provide advance notice of voluntary discharge; arbitration agreements may not be required as a condition of admission; an arbitration agreement may be rescinded by the resident or his or her agent within 30 days of signing it; a third party guaranty of payment may not be a condition of admission; Facility may not transfer or discharge resident for switching to Medi-Cal
, or while qualification for Medi-Cal is still being determined; resident has a right to be notified in writing about discharges and transfers; resident has a right to appeal discharge and transfer decisions; resident has a right to return to a facility after a temporary stay in a hospital—to the first available bed, with Medi-Cal paying for the first seven days; resident has the right to visitors, and to privacy; and, that there shall be an adequate number of personnel on staff.
There are still other protections for California residents, in part, because California incorporates federal law with respect to nursing home protections.
Nursing home
A nursing home, convalescent home, skilled nursing unit , care home, rest home, or old people's home provides a type of care of residents: it is a place of residence for people who require constant nursing care and have significant deficiencies with activities of daily living...
. Legislation exists in various jurisdictions to protect such rights. An early example of a statute protecting such rights is Florida statute 400.022, enacted in 1980, and commonly known as the Residents' Rights Act.
Specific rights protected vary greatly by jurisdiction. Types of rights protected include: dignity
Dignity
Dignity is a term used in moral, ethical, and political discussions to signify that a being has an innate right to respect and ethical treatment. It is an extension of the Enlightenment-era concepts of inherent, inalienable rights...
, medical privacy
Medical privacy
The main subject of medical privacy or health privacy is the 'medical record' which historically has been a paper file of the entire medical history of the patient. Various electronic forms of medical records have existed in western countries, but mostly in an unintegrated fashion. This lack of...
, pecuniary, dietary and visitation rights. Process rights, such as right of complaint, are also sometimes protected.
Motivations for residents' rights
In the United States, concerns about poor quality care and ineffective regulation of nursing homes date back to the 1970s. Early regulation focused on the ability of nursing homes to provide care, rather than on the quality of the care provided or the experience of the individuals receiving care. In the 1980s, particularly in response to an influential Institute of MedicineInstitute of Medicine
The Institute of Medicine is a not-for-profit, non-governmental American organization founded in 1970, under the congressional charter of the National Academy of Sciences...
(IoM) report, the US federal government moved to address these concerns by enacting more resident-focused regulations, and among these were a number of new quality-of-life rights for residents of nursing homes. Similar concerns over quality of care motivated people in other countries to advocate for residents' rights.
Australia
Advocates for residents' rights in Australia have established a Charter of Residents' Rights and Responsibilities and the Department of Health and Ageing provides an official unit to deal with complaints. In 1987, the government introduced substantial reform and regulation which included a program to monitor standards.Canada
Nursing home residents' rights in Canada appear to have been primarily legislated at the provincial level. In OntarioOntario
Ontario is a province of Canada, located in east-central Canada. It is Canada's most populous province and second largest in total area. It is home to the nation's most populous city, Toronto, and the nation's capital, Ottawa....
, for instance, the Long Term Care Homes Act 2007 contains a "Residents' Bill of Rights", including, inter alia, the rights to be treated with courtesy and respect; to privacy in treatment; to be informed of one's medical condition and treatment; to consent to or refuse treatment; to confidentiality of medical records
Medical privacy
The main subject of medical privacy or health privacy is the 'medical record' which historically has been a paper file of the entire medical history of the patient. Various electronic forms of medical records have existed in western countries, but mostly in an unintegrated fashion. This lack of...
and treatment; to receive visitors; and, when near death, to have family members present 24 hours a day.
New Zealand
Since 1996, New Zealand has protected residents rights' (and rights of the disabled more broadly) under the Health and Disability Commissioner's Act, including rights to respect, freedom from discrimination and coercion, dignity, communication in a language the resident can understand, information and informed consent, and right of complaint.United Kingdom
Residents' rights in the UK appear to have been primarily legislated at the countryCountries of the United Kingdom
Countries of the United Kingdom is a term used to describe England, Northern Ireland, Scotland and Wales. These four countries together form the sovereign state of the United Kingdom of Great Britain and Northern Ireland, which is also described as a country. The alternative terms, constituent...
level. In England
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
, for instance, the Care Quality Commission
Care Quality Commission
The Care Quality Commission is a non-departmental public body of the United Kingdom government established in 2009 to regulate and inspect health and social care services in England. This includes services provided by the NHS, local authorities, private companies and voluntary organisations -...
, the health and social care regulator for England, describes national minimum standards under the Care Standards Act 2000 for services in care homes, including dignity
Dignity
Dignity is a term used in moral, ethical, and political discussions to signify that a being has an innate right to respect and ethical treatment. It is an extension of the Enlightenment-era concepts of inherent, inalienable rights...
and privacy rights, dietary and pecuniary rights, and the right to complain if one is unhappy with the care provided.
United States
Residents' rights in the US are protected at both the federal and stateU.S. state
A U.S. state is any one of the 50 federated states of the United States of America that share sovereignty with the federal government. Because of this shared sovereignty, an American is a citizen both of the federal entity and of his or her state of domicile. Four states use the official title of...
level.
Federal law
In 1980 the Civil Rights of Institutionalized Persons ActCivil Rights of Institutionalized Persons Act
The Civil Rights of Institutionalized Persons Act of 1980 is a United States federal law intended to protect the rights of people in state or local correctional facilities, nursing homes, mental health facilities and institutions for people with intellectual and developmental disabilities.CRIPA is...
was passed to protect the civil rights of, amongst others, residents of nursing homes and similar facilities.
In 1987, amendments known collectively as the Federal Nursing Home Reform Act, including a robust section on nursing home residents' rights, were attached to an Omnibus Budget Reconciliation Act of 1987
Omnibus Budget Reconciliation Act of 1987
The Omnibus Budget Reconciliation Act of 1987 was federal law that was enacted by the 100th United States Congress and signed into law by President Ronald Reagan.-Title I: Agriculture and Related Programs:...
(OBRA '87) which was then enacted into law and codified at section 483 of Volume 42 of the Code of Federal Regulations
Code of Federal Regulations
The Code of Federal Regulations is the codification of the general and permanent rules and regulations published in the Federal Register by the executive departments and agencies of the Federal Government of the United States.The CFR is published by the Office of the Federal Register, an agency...
and related United States Code
United States Code
The Code of Laws of the United States of America is a compilation and codification of the general and permanent federal laws of the United States...
sections. These required nursing homes to provides facilities to ensure that residents had a high quality of life, good physical and mental activities and were able to participate in the administration of the home. Appeals to an ombudsman
Ombudsman
An ombudsman is a person who acts as a trusted intermediary between an organization and some internal or external constituency while representing not only but mostly the broad scope of constituent interests...
in case of dispute were to be facilitated. However, the act's protections may or may not not apply to some nursing home residents whose nursing homes receive only state funds, and do not participate in Medicare
Medicare (United States)
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...
or Medicaid
Medicaid
Medicaid is the United States health program for certain people and families with low incomes and resources. It is a means-tested program that is jointly funded by the state and federal governments, and is managed by the states. People served by Medicaid are U.S. citizens or legal permanent...
.
Some rights provided by federal law as of 2010 include rights to dignity, privacy, freedom from discrimination
Discrimination
Discrimination is the prejudicial treatment of an individual based on their membership in a certain group or category. It involves the actual behaviors towards groups such as excluding or restricting members of one group from opportunities that are available to another group. The term began to be...
, freedom from restraint, to be informed of medical care and treatment, pecuniary rights, visitation, rights of complaint and protection against transfer and unfair discharge. Specific rights include: choice of physician and involvement in treatment options; a right to be admitted without a third-party guarantee as a condition of admission; freedom from improper physical or chemical restraints; freedom from abuse; right to be treated with dignity; right to reasonable accommodation; right to participate in planning care and treatment and any changes in care and treatment; right to informed consent in language patient can understand; right to refuse treatment; right of family and Ombudsman to immediately access resident and have reasonable access to facility; right to privacy, confidentiality, and visitors; a right to not be transferred unless necessary to meet residents' needs, resident no longer requires care, safety of others is endangered, resident has failed to make own payments, or facility no longer operates; right to readmission; right to appeal hearings; right to have necessary care and services for highest practicable well-being; right to have adequate number of personnel; and, various rights respecting the residents' financial matters and need for proper notice and information.
State law
In CaliforniaCalifornia
California is a state located on the West Coast of the United States. It is by far the most populous U.S. state, and the third-largest by land area...
, for instance, additional rights are protected. As of 2010, these include: a contract will not require the resident to provide advance notice of voluntary discharge; arbitration agreements may not be required as a condition of admission; an arbitration agreement may be rescinded by the resident or his or her agent within 30 days of signing it; a third party guaranty of payment may not be a condition of admission; Facility may not transfer or discharge resident for switching to Medi-Cal
Medi-Cal
The California Medical Assistance Program is the name of the California Medicaid program serving low-income families, seniors, persons with disabilities, children in foster care, pregnant women, and certain low-income adults...
, or while qualification for Medi-Cal is still being determined; resident has a right to be notified in writing about discharges and transfers; resident has a right to appeal discharge and transfer decisions; resident has a right to return to a facility after a temporary stay in a hospital—to the first available bed, with Medi-Cal paying for the first seven days; resident has the right to visitors, and to privacy; and, that there shall be an adequate number of personnel on staff.
There are still other protections for California residents, in part, because California incorporates federal law with respect to nursing home protections.