Nursing facilities are required to meet a number of requirements relating to provision of services, residents' rights and administration.
In general, to the extent needed to fulfill all plans of care, a nursing facility must provide, or arrange for the provision of:
- nursing and related services and specialized rehabilitative services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident;
- medically-related social services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident;
- pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing and administering of all drugs and biologicals) to meet the needs of each resident;
- dietary services that assure that the meals meet the daily nutritional and special dietary needs of each resident;
- an on-going program, directed by a qualified professional, of activities designed to meet the interests and the physical, mental, and psychosocial well-being of each resident;
- routine dental services (to the extent covered under the State plan) and emergency dental services to meet the needs of each resident; and
- treatment and services required by mentally ill and mentally retarded residents not otherwise provided or arranged for (or required to be provided or arranged for) by the State.
Resident rights. Each nursing facility resident has a right to a dignified existence, self-determination and communication with and access to persons and services inside and outside the facility. A facility must protect the rights of each resident. The resident has the right to exercise his or her rights as a resident of the facility and as a citizen or resident of the United States.
- The resident has the right to be free of interference, coercion, discrimination, and reprisal from the facility in exercising his/her rights.
- In the case of a resident who has been adjudged incompetent by a court, the rights of the resident are exercised by a person appointed to act on the person's behalf.
- In the case of a resident who has not been adjudged incompetent by the court, any legal-surrogate designated in accordance with State law may exercise the resident's rights to the extent provided by State law.
- The facility must inform the resident both orally and in writing, in a language that the resident understands, of his/her rights and all rules and regulations concerning resident conduct and responsibilities during his/her stay in the facility. This notice must be made prior to or upon admission and during the person's stay. Receipt of the information must be acknowledged in writing.
- The resident has the right to access all records pertaining to himself or herself, including current clinical records within 24 hours (excluding weekend and holidays). At the cost of the community standard, the individual has a right to a copy of the records or any portion of the records.
- The resident has the right to be fully informed, in language that he/she can understand, of his/her total health status.
- The resident has the right to refuse treatment; to refuse to participate in experimental research; and to formulate an advance directive.
- The right to refuse medication and treatment.
- The right to refuse chemical and physical restraints.
- The right to make independent personal decisions, such as what to wear and how to spend free time.
- The right to participate in community activities, both inside and outside the nursing home.
- The right to organize and participate in a Resident Council.
- The right to assistance if they have a sensory impairment.
- The right to be informed of the address and telephone number of the State Ombudsman, State licensure office, and other advocacy groups.
- The right to present grievances to the staff of the nursing home, or to any other person, without fear of reprisal and the right to prompt efforts by the nursing home to resolve grievances.
- The right to file a complaint with the State survey and certification agency for abuse, neglect, or misappropriation of their property if the nursing home is handling their financial affairs.
- The right to see the State survey reports of the nursing home and the home's plan of correction.
- The right to be notified in advance of any plans to change their room or roommate.
- The right to remain in the nursing facility unless a transfer or discharge: is necessary to meet the resident's welfare; is appropriate because the resident's health has improved and the resident no longer requires nursing home care; is needed to protect the health and safety of other residents or staff; is required because the resident has failed, after reasonable notice, to pay the facility charge for an item or service provided at the resident's request.
- The right to receive notice of transfer or discharge. A thirty-day notice is required. The notice must include the reason for transfer or discharge, the effective date, the location to which the resident is transferred or discharged, a statement of the right to appeal, and the name, address, and telephone number of the state long-term care ombudsman.
- The right to a safe transfer or discharge through sufficient preparation by the nursing home.
- The Right to Privacy and Confidentiality, including: The right to private and unrestricted communication with any person of their choice, The right to privacy in treatment and in the care of their personal needs, The right to confidentiality regarding their medical, personal, or financial affairs.
- The Right to Dignity, Respect, and Freedom, including: The right to be treated with the fullest measure of consideration, respect, and dignity, The right to be free from mental and physical abuse, corporal punishment, involuntary seclusion, and physical and chemical restraints, The right to self-determination.
- The facility must inform each Medicaid resident, in writing: The items and services that are included in the facility payment for which the resident may not be charged and Those other items and services that the facility offers, for which the resident may be charged, and the cost for those services. The resident must be informed when changes are made to the items, services, and costs.
- The facility must furnish a written description of legal rights.
- The facility must inform each resident of the name, specialty, and way of contacting the physician responsible for his/her care.
- The facility must prominently display, in the facility, written information and provide applicants for admission, oral and written information about how to apply for and use Medicare and Medicaid benefits, and how to receive refunds for previous payments covered by such benefits.
- A facility must immediately inform the resident; consult with the resident's physician; and, if known, notify the resident's legal representative or an interested family member when there is:
- an accident involving the resident which results in injury and has the potential for requiring physician intervention;
- a deterioration in health, mental, or psychosocial status in either life-threatening conditions or clinical complications;
- a need to change treatment significantly; or
- a decision to transfer or discharge the resident from the facility.
The resident has the right to manage his or her financial affairs, and the facility may not require residents to deposit their personal funds with the facility. If a resident does deposit funds with the facility, regulations specify how those moneys will be treated and protected.
Services included in the Medicare and Medicaid payment.
During the course of a covered Medicare or Medicaid stay, facilities may not charge a resident for the following categories of items and services:
- Nursing services.
- Dietary services.
- An activities program.
- Room/bed maintenance services.
- Routine personal hygiene items and services, as required, to meet the needs of residents, including, but not limited to: hair hygiene supplies, comb., brush, bath soap, disinfecting soaps or specialized cleansing agents, when indicated to treat special skin problems or to fight infection, razor, shaving cream, toothbrush, toothpaste, denture adhesive, denture cleaner, dental floss, moisturizing lotion, tissues, cotton balls, cotton swabs, deodorant, incontinence care and supplies, sanitary napkins, and related supplies, towels, washcloths, hospital gowns, over the counter drugs, hair and nail hygiene services, bathing, and basic personal laundry.
- Medically related social services.
Items and services that may be charged to residents' funds.
General categories and examples of items and services that the facility may charge to residents' funds if they are requested by a resident, if the facility informs the resident that there will be a charge and if payment is not made by Medicaid or Medicare:
- Television/radio for personal use.
- Personal comfort items, including smoking materials, notions and novelties, and confections.
- Cosmetic and grooming items and services in excess of those for which payment is made under Medicaid or Medicare.
- Personal clothing.
- Personal reading materials.
- Gifts purchased on behalf of a resident.
- Flowers and plants. Social events and entertainment offered that are not part of the activities program.
- Non-covered special care services, such as privately hired nurses or aides.
- Private room, except when therapeutically required (for example, isolation for infection control).
- Specially prepared or alternative food requested instead of the food generally prepared by the facility.
The facility must not charge a resident (or his/her representative) for any item or service not requested by the resident.