Residents' Rights

General Policy Statement

It is the policy of [PROVIDER] that all residents have the right to a dignified existence, self-determination, and communication with and access to people and services inside and outside the facility.

Note: Many states have adopted specific lists of residents’ rights. Providers should check state law and modify this section to ensure compliance.

Suggested Elements

To protect and promote the rights of each resident, provider may wish to include the following suggested elements as part of their corporate compliance policy.

A resident has the right:

• To exercise his or her rights as a resident of the facility and a citizen or resident of the U.S. and be free of interference, coercion, discrimination, or reprisal by [PROVIDER] or its employees for the exercise of such rights;
• To be fully informed of his or her rights and all rules and regulations governing resident conduct and responsibilities during the stay in the facility;
• To access personal records within 24 hours of request;
• To purchase copies of records with two working days’ advance notice to the facility;
• To be fully informed of his or her health status and medical conditions;
• To refuse treatment;
• To be informed of the items and services paid for by Medicaid and for which Medicaid-covered residents may not be charged, and to be informed of items and services for which the resident may be charged and the amount of such charges;
• To be informed of his or her legal rights, including the manner of protecting personal funds, a description of the requirements and procedures for qualifying for Medicaid, a posting of the names, addresses, and telephone numbers of all pertinent state client advocacy groups, and at statement that the resident may file complaints with the state survey and certification agency;
• To be advised of the name, specialty, and manner of contacting the physician for his or her care;
• To receive information on how to apply for and use Medicaid and Medicare benefits;
• To be notified, and have his or her physician and legal representative or family member notified, of accidents resulting in injury or requiring the intervention of a physician, of significant changes in condition, of a need to significantly alter treatment, or of a decision to be transferred;
• To be notified of a change in room or roommate or a change in residents’ rights under state or federal law;
• To manage his or her financial affairs;
• To have the facility hold and manage his or her personal funds;
• To have a full and complete accounting of personal funds managed by the facility;
• Not to have any charge made against personal funds for items paid by Medicaid or Medicare;
• To choose a personal physician, to be informed in advance about care and treatment and any changes in care or treatment that may affect his or her well-being, and to participate in planning care or treatment unless adjusted incompetent or incapacitated under state law;
• To personal privacy and confidentiality or personal and clinical records;
• To file grievances without discrimination or reprisal;
• To examine facility survey results;
• To visitation by people of the resident’s choosing, including family members, state representatives, the ombudsman, and others, subject to reasonable restrictions;
• Not to be transferred except in the situations and according to the procedure described at 42 C.F.R. Part 483.12.
• To be free from physical or chemical restraints imposed for the purpose of discipline or convenience and not required to treat medical symptoms;
• To be free from verbal, sexual, physical and mental abuse, corporal punishment, and involuntary seclusion; and
• To receive services in a facility environment that is safe, clean, and comfortable with adequate space for all activities.

Discrimination Against Residents And Payment Provisions

Policy Statement

It is the policy of [PROVIDER] to maintain identical policies and practices for all individuals regarding transfer and discharge, regardless of payment source, and to comply with all applicable law with respect to admissions decisions, as well as the provision of services under the state Medicaid plan.

Suggested Elements

Providers may wish to include the following suggested elements as part of their corporate compliance policy:

• [PROVIDER] will not require residents or potential residents to waive their rights under Medicaid or Medicare, nor require oral or written assurances that residents or potential residents are not eligible or will not apply for Medicaid or Medicare benefits;
• [PROVIDER] will not require a third-party guarantee of payment as a condition of admission, expedited admission, or continued stay at the facility.[PROVIDER] may require a person who has legal access to and/or control over a resident’s income or resources to pay for facility care or sign a contract to provide payment for the resident’s services, without requiring the person to assume personal financial liability for such care;
• For Medicaid eligible residents, [PROVIDER] will not charge, solicit, accept, nor receive for services covered by Medicaid any gift, money, donation, or other consideration, in addition to any amount required to be paid under the state Medicaid plan, as a precondition of admission, expedited admission, or continued stay at the facility;
• [PROVIDER] may charge residents amounts above and beyond payment received by Medicaid for items and services requested by the resident and not included in the Medicaid package of ‘nursing facility services’ as long as the facility gives proper notice of the availability and cost of such services or items and does not condition the resident’s admission and continued stay on the purchase of such items or services; and
• [PROVIDER] may solicit, accept, or receive charitable, religious, or philanthropic contributions from an organization or a person unrelated to a Medicaid resident as long as such contribution is not a condition or a resident’s admission or continued stay. All offers for the donation of such contributions shall be reported to the [facility administrator, corporate compliance officer, other person designated by the provider] for a determination that such contribution is allowed under applicable law.