Families trust nursing homes to provide safe, dignified care for their elderly loved ones. Understanding things nursing homes are not allowed to do helps families recognize when a facility crosses legal boundaries and harms the people they’re supposed to protect.
Federal regulations exist as protections that apply to all nursing homes receiving Medicare or Medicaid funding.
Learn about the specific prohibitions that govern nursing home operations, explain the legal foundations of resident rights, and outline how families can respond when facilities break the law.
Federal Protections for Nursing Home Residents
The Nursing Home Reform Act and Resident Rights
The Nursing Home Reform Act of 1987, passed as part of the Omnibus Budget Reconciliation Act, transformed how nursing homes operate across the country. This landmark legislation established minimum standards of care that facilities must meet to receive Medicare and Medicaid funding.
The Nursing Home Bill of Rights
Every nursing home must provide services and activities that help residents maintain their highest possible level of physical, mental, and social well-being. The law created a comprehensive nursing home bill of rights that protects residents from mistreatment and ensures they receive dignified care.
Individualized Care Plans and Assessments
Federal nursing home regulations require facilities to conduct thorough assessments of each resident’s needs and develop individualized care plans. These plans must address medical, psychological, and social needs while respecting the resident’s preferences and goals.
Medicare and Medicaid Compliance Requirements
Medicare and Medicaid funding represents a significant portion of payments for nursing home care. Facilities that fail to comply with federal law risk losing this essential funding, creating a powerful incentive for compliance.
10 Things Nursing Homes Are Not Allowed to Do
1. Restrict Access to Visitors Without Valid Reason
Federal regulations protect the right of nursing home residents to receive visitors at reasonable times. The law prohibits a nursing home from blocking family members, friends, or advocates from visiting without legitimate cause.
Facilities cannot isolate residents from visitors as punishment or retaliation. The only acceptable reasons for limiting visits involve genuine health or safety concerns, such as:
- During disease outbreaks
- When a specific visitor poses a documented threat
Nursing homes often claim visitation policies during family disputes, but residents have the final say about who they want to see. Staff must respect these choices unless a court order states otherwise.
2. Use Physical or Chemical Restraints for Staff Convenience
Nursing homes use restraints only when medically necessary and ordered by a physician for a specific therapeutic purpose. Common types of restraints include:
Physical restraints (devices that restrict movement):
- Vest restraints
- Bed rails that are used improperly
- Chair belts
Chemical restraints:
- Medications given primarily to control behavior rather than treat a medical condition
Using restraints to make staffing easier constitutes nursing home abuse. Common violations include:
- Sedating residents to reduce the need for supervision
- Using bed rails to prevent residents from getting up, rather than for safety
- Restraining residents who wander instead of providing appropriate supervision
- Administering antipsychotic drugs without proper medical justification
The resident or their representative must consent, and the facility must document the medical need clearly.
3. Deny Residents the Right to Manage Their Own Finances
Residents paying privately for care maintain the right to control their own money. A nursing home cannot force residents to hand over financial control as a condition of admission or continued residency.
If a resident chooses to allow the facility to manage personal funds, federal law requires detailed accounting. The nursing home must provide quarterly statements showing all transactions. Any interest earned on these funds belongs to the resident.
Families should watch for unexplained withdrawals, missing personal items, or pressure to sign over financial authority.
4. Transfer or Discharge Residents Without Proper Notice and Reason
Federal law protects residents from arbitrary eviction or transfer. Nursing homes receive strict guidelines about when and how they can move or discharge residents against their will.
Valid reasons for involuntary discharge or transfer include:
- The resident’s medical needs exceed what the facility can provide
- The resident’s health has improved enough that nursing care is no longer necessary
- The resident poses a danger to others in the facility
- The resident has failed to pay after receiving reasonable notice
- The facility is closing or losing its certification
The nursing home must give at least 30 days written notice before any involuntary transfer or discharge. This notice must include the specific reason, the proposed move date, and information about appeal rights.
Many nursing home residents successfully challenge improper discharge attempts through the appeals process.
5. Discriminate Based on Payment Source
Care facilities cannot treat residents differently based on whether they pay privately, through Medicare, or through Medicaid. Federal law requires identical policies and practices for all residents regardless of how they pay.
This protection ensures that the care that residents receive meets consistent quality standards. Prohibited discrimination includes:
- Refusing to admit Medicaid applicants when beds are available
- Providing fewer services or amenities to Medicare and Medicaid residents
- Attempting to discharge residents when they transition from private pay to Medicaid
- Assigning Medicaid residents to less desirable rooms
6. Interfere with Medical Care Choices
A resident has the right to choose their own physician, though getting doctors to make nursing home visits can be challenging. The facility cannot require residents to use specific healthcare providers as a condition of admission.
Resident may choose to participate in or refuse treatment, including:
- Medications
- Procedures
- Therapies
This right includes informed consent, meaning staff must explain proposed treatments in language the resident understands. Nursing home staff must respect advance directives and healthcare proxies.
Moreover, if a resident has designated someone to make medical decisions when they cannot, the facility must honor that authority.
Important: The nursing home is required to promptly inform residents about changes in their medical condition.
7. Neglect Basic Care Needs
Abuse and neglect remain serious problems in care facilities nationwide. Common nursing home violations include:
- Failing to provide adequate assistance with daily activities
- Bathing
- Dressing
- Eating
- Using the bathroom
Federal nursing home regulations mandate that residents receive the care described in their individualized care plan. This includes:
- Assistance with mobility and preventing falls
- Regular repositioning to prevent bedsores
- Proper nutrition and hydration
- Timely medication administration
- Personal hygiene and grooming assistance
Nursing home abuse and neglect can manifest as pressure ulcers, unexplained weight loss, dehydration, poor hygiene, or untreated medical conditions.
The director of nursing bears responsibility for ensuring adequate staffing and proper care delivery.
8. Retaliate Against Residents Who File Complaints
Residents’ rights include voicing grievances without fear of punishment. The law prohibits nursing homes from retaliating against residents or family members who report concerns to:
- Facility management
- State agencies
- The Long-Term Care Ombudsman.
Protected activities include:
- Filing formal complaints with the facility
- Contacting state licensing agencies
- Speaking with nursing home inspection surveyors
- Reporting suspected abuse to law enforcement
- Participating in family or resident councils
Nursing home staff may want to discourage complaints, but any attempt to punish, isolate, or threaten residents for exercising their rights violates federal law.
Residents and families should document all interactions if they suspect retaliation.
9. Deny Privacy and Confidentiality Rights
The resident’s medical records must remain confidential. Nursing home employees cannot share health information without proper authorization, except as required by law.
Privacy rights extend beyond medical records. Residents deserve:
- Privacy during personal care activities such as bathing and dressing
- Confidential communication with family, friends, and attorneys
- Private space for visits with loved ones
- Unopened personal mail
- Confidential telephone conversations
Staff member access to rooms should respect residents’ privacy. Nursing home staff must knock before entering and cannot enter without permission except in emergencies.
10. Require Residents to Waive Legal Rights
A nursing home cannot pressure or require residents to sign pre-dispute arbitration agreements as a condition of admission. Federal regulations prohibit Medicare and Medicaid certified facilities from mandating arbitration.
If a facility presents arbitration agreements, participation must be completely voluntary. Resident must be given clear information about what signing means and cannot face consequences for refusing.
What Quality Care in Nursing Homes Should Look Like
Skilled nursing facilities must meet several essential standards:
Staffing and Care Planning:
- Maintain adequate staffing levels to meet residents’ needs
- Develop individualized care plans that guide daily activities and medical interventions
Quality of Life Focus:
- Support resident dignity and independence
- Provide opportunities for participation in activities that residents enjoy
- Balance medical care with personal preferences
Regular Oversight:
- State survey agencies conduct nursing home inspections at least every 15 months
- Surveys include conversations with residents and families about their experiences
- Facilities must demonstrate ongoing compliance with federal standards
Skilled nursing means more than just medical care. It means supporting the whole person.
Common Nursing Home Violations and Red Flags
Despite regulations for nursing homes, violations still occur in nursing homes across the country. Families should watch for these concerning signs:
- Unexplained bruises, cuts, or injuries
- Sudden changes in mood or behavior
- Fearfulness around certain staff members
- Poor facility cleanliness or odors
- Inadequate staffing during visits
- Residents left unattended for long periods
Nursing home residents are protected by law, but they depend on family members and advocates to help enforce these protections.
Regular visits at different times of day provide the best picture of actual care conditions.
Reporting Violations and Protecting Residents
Document and Report Concerns
Write down dates, times, and specific details about concerning incidents. Take photographs of injuries or facility conditions when possible.
Report concerns to the facility administrator in writing and request a written response. If problems continue, escalate to:
- The state Long-Term Care Ombudsman program
- The state nursing home licensing agency
- Local law enforcement (for suspected criminal abuse)
- Adult Protective Services
Nursing home violations demand prompt response. Residents deserve immediate protection when their safety or well-being is at risk.
Legal Recourse for Serious Violations
Serious violations may warrant consultation with a nursing home abuse lawyer. Legal help for nursing home abuse becomes necessary when:
- The resident has suffered significant harm
- The facility refuses to address dangerous conditions
- Financial exploitation has occurred
- The violation involves a pattern of misconduct
Residents without strong advocates are particularly vulnerable. Support from the Commonwealth Fund and other organizations has documented that effective oversight requires both regulatory enforcement and vigilant family involvement.
Federal Law Protects Nursing Home Residents
The federal nursing home reform law created strong protections, but enforcement depends on residents and families speaking up. Regular communication with another nursing home resident or participating in resident councils can help identify widespread problems.
If you need guidance protecting a loved one from nursing home abuse or neglect, consider reaching out to attorneys who focus on elder care rights. The Higgins Firm has helped families hold facilities accountable and secure the care their loved ones deserve.
Residents deserve dignified care that honors their preferences and protects their well-being.
When nursing homes aren’t providing that care, families have both moral and legal grounds to demand better.
