Despite the fact that nursing home residents have a federally protected right to be free from abuse, it is estimated that 1 in 10 older adults experience some form of abuse or neglect. Abuse and neglect can come in many forms including sexual abuse, financial exploitation, privacy issues, resident-to-resident mistreatment, and issues related to surveillance/electronic monitoring.

Arbitration agreements take away your right to hold your nursing home accountable in court, for any and all potential negligence or wrongdoing. Residents, when entering a nursing home, may be presented with a pre-dispute arbitration agreement. You have the right to refuse to sign.

• Don’t Sign – Say No to Arbitration
• Final Rule on Arbitration Agreements
• Consumer Voice Issue Brief on Pre-Dispute Arbitration
• Advocates Letter to House of Representatives Supporting the Fairness in Nursing Home Arbitration Act

Bed rails are metal or plastic bars positioned along the side of a bed, also commonly known as side rails. Bed rails are frequently used in homes or long-term care facilities because they are believed to keep people safe. In reality, bed rails can be extremely harmful and considered a physical restraint.

Too many residents, particularly those living with dementia, are being given off-label antipsychotic drugs to control their behavior instead of person-centered care that meets their individual needs. These drugs can have serious, life threatening side effects for older people. Antipsychotic drugs are meant to treat patients with specific mental disorder diagnoses such as Schizophrenia. These drugs are not appropriate treatment for dementia. When used for sedation, these drugs are a form of chemical restraint. You have the right to question the use of these drugs and raise concerns.

Studies show disparities exist in access and quality of health services for racial and ethnic minorities, individuals who identify as LGBTQ+, and others. These disparities persist for individuals seeking long-term care services.

Long-term care residents or their family members might consider installing a surveillance camera in a resident’s room to help determine that the resident is receiving appropriate care and being treated with dignity and respect, or to be a deterrent to abuse. While surveillance cameras and other devices can offer information about the type of care provided and how a resident is being treated by nursing home staff, other residents, and visitors, they can be invasive and may violate the resident’s or their roommate’s right to privacy.

A nursing home, assisted living, or other long-term care facility should have a comprehensive emergency plan in place, so that residents can be protected and supported in times of crisis. A nursing home, by federal law, is required to have evacuation plans in the event of a natural or man-made disaster.

• Questions Consumers Should Ask
• Resources for Long-Term Care Ombudsman Programs

Resources from CMS

• Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers
• CMS Emergency Preparedness Rule
• CMS Emergency Preparedness Rule: Resources at Your Fingertips
• Emergency Preparedness for Every Emergency

Checklists for:

• People living in long-term care facilities, their families and ombudsmen
• People with medical needs living at home
• Survey and Certification Emergency Preparedness Checklist Revision

Many older adults want to age in place – to receive
necessary services without moving into a nursing facility or other health care institution. The Medicaid program provides this type of assistance through home and community-based services (HCBS) programs. These programs are designed to help people remain in their communities.

Resources about the HCBS Rule

• • Medicaid’s New Rule to Promote Independence and Choice for Persons Receiving HCBS
  • Applying the New Federal HCBS Rules to Adult Day Centers
  • Understanding and Advocating for Effective Implementation of the Home and Community-Based Services Settings Rule

Consumer Resources

• • Consumer to Consumer: Tips for a Successful Nursing Home Transition (Large Print)
  • Steps to Getting Quality Home Care from an Agency or from a Home Care Worker You Hired
  • How to Address Concerns with a Home Health or Home Care Agency or with the Home Care Worker You Hired
  • What is Quality Home Care?

Individuals in long-term care settings are especially vulnerable to viruses, infections, and other health issues. These infections can have negative emotional, financial, and medical effects on long-term care residents. Our resources include a wide range of information on flu prevention, best practices around COVID-19, and healthcare-associated infections such as catheter-associated urinary tract infections.

Individuals receiving long-term care may experience challenges and adjustments regarding their mental health. Good mental health enables a person to face changes to their environment and daily routine and adapt to them.

• Taking Care of You: Tips for Residents of Long-Term Care Facilities
• Working With Individuals With Mental Health Conditions – Reference Guide for Long-Term Care Ombudsman Programs

Nursing home closings can have serious negative effects on residents. When closures are inevitable, better policies and practices can be implemented to minimize the negative impact, including transfer trauma, on residents.

Residents’ Rights are guaranteed by the federal 1987 Nursing Home Reform Law. The law requires nursing homes to “promote and protect the rights of each resident” and places a strong emphasis on individual dignity and self-determination. Nursing homes must meet federal residents’ rights requirements if they participate in Medicare or Medicaid. Some states have residents’ rights in state law or regulation for nursing homes, licensed assisted living, adult care homes, and other board and care facilities.

Chronic understaffing has been a serious problem in nursing homes for decades and has been exacerbated by the COVID-19 pandemic. While there are numerous factors contributing to this problem, one major cause has been the lack of adequate minimum staffing standards at both the state and federal levels. Minimum standards ensure that staffing will not fall to a level that would be harmful to residents.

The threat of transfer or discharge from a nursing home can be both frightening and stressful for residents and their families. Too often, a facility may respond to a resident’s difficulties or increasing need for care, or repeated questions or complaints from family members, by attempting to transfer or discharge a resident. Residents have rights regarding transfer and discharge.

Each year nursing homes funnel billions of dollars through private equity firms and related party companies (companies they own) with little to no oversight by the Centers for Medicare & Medicaid Services (CMS). Increased transparency and oversight of nursing home finances and ownership is critical to protecting both resident care and the integrity of public reimbursement.

Trauma-informed care involves understanding, recognizing, and responding to the effects of all types of trauma. Trauma-informed care also emphasizes physical, psychological, and emotional safety for both consumers and providers, and helps survivors rebuild a sense of control and empowerment. It’s essential that long-term care consumers receive culturally competent, trauma-informed care. A person’s experience of an event determines whether it is traumatic and everyone’s experience is unique. This means it is important that every resident has a comprehensive assessment and individualized care plan.

Trauma-Informed Care: Nursing Home Requirements and Ombudsman Program Advocacy – Reference Guide for Long-Term Care Ombudsman Programs

Individuals receiving long-term services and supports retain their voting rights, no matter where they live or what type of care they receive. However, residents of long-term care facilities may have a harder time voting due to mobility, health, and other issues that inhibit their access.