Nursing Home Regulations

In order to be Medicare or Medicaid approved, nursing homes must meet certain standards.

Note: If a court finds a nursing home resident to be incompetent, any legal-surrogate may exercise the care recipient’s rights within the limit of state law.

According to federal regulations, nursing home residents have the right to:

  • Access all personal records, including current clinical records, as well as the ability to copy these records for the average community price
  • Be free of interference, coercion, discrimination, and reprisal from the facility in exercising their rights
  • Be fully informed of their health status
  • Oral and written information on all rules and regulations concerning residents’ conduct and responsibilities. Such information should be given prior to or upon admission.
  • Refuse treatment and participation in experimental research
  • Create an advanced directive
  • Be informed in writing of any items or services included in facility payment that the resident doesn’t have to pay for, as well as any changes made to costs, items, and services
  • A written description of residents’ legal rights
  • The name, specialty, and contact information of doctors
  • Be immediately informed, as well as to have personal doctors and legal representatives informed, if the resident is in an accident resulting in the need for a doctor; experiences a deterioration in health, mental, or psychosocial status; needs a significant change in treatment; or if a decision is being made to transfer the resident.
  • Manage their own financial affairs and to choose whether or not to deposit personal funds with the facility
  • Be given information regarding how deposited funds will be treated and protected.

If your loved one’s nursing facility stay is covered by Medicare or Medicaid, the nursing facility cannot charge him or her for:

  • Activities programming
  • Any service not requested by the resident
  • Nursing services
  • Dietary services
  • Room/bed maintenance
  • Routine personal hygiene items and services that include but are not limited to: bathing, disinfecting soaps or cleansing agents (bath soap), moisturizing lotion, deodorant, razor, shaving cream, hair hygiene supplies (comb, brush), nail hygiene services, dental hygiene supplies (denture adhesive, denture cleanser, dental floss, toothbrush, toothpaste), incontinence care and supplies, sanitary napkins and related supplies, tissues, cotton balls, cotton swabs, towels, washcloths, hospital gowns, over-the-counter drugs, and personal laundry services.
    Social services that are medically related

In contrast, your loved one can be charged for:

  • Telephone
  • Personal use of a television or radio
  • Personal comfort items, including smoking materials, notions and novelties, and
  • onfections
  • Excess cosmetic and grooming items and services (more than what is covered by Medicare or Medicaid)
  • Personal clothingPersonal reading materials
  • Gifts purchased at the care recipient’s request
  • Flowers and plants
  • Social events or entertainment that are not part of the social programming
  • Special care services not covered by Medicare or Medicaid
  • A private room, except when therapeutically required (e.g., for infection control)
  • Specially prepared or alternative food that is personally requested to replace facility food

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