Nursing Home Residents' Rights and the Long-Term Care Ombudsman

Nursing home residents’ rights are written into federal law. Every nursing home certified by Medicare or Medicaid must follow 42 CFR 483.10, which gives each resident the right to “a dignified existence, self-determination,” and contact with people and services inside and outside the home. Those rights apply in full to your parent from the day they move in, whether Medicare, Medicaid, insurance or your parent’s savings pays the bill.

When a right isn’t being respected, the Long-Term Care Ombudsman is the person to call. Ombudsmen are free advocates in every state who work for residents, not for the nursing home or the state agency that inspects it.

This guide sets out the rights that matter most in daily life, money and discharge, then explains how the ombudsman works and how to raise a problem until it’s fixed.

Nursing Home Residents’ Rights Under Federal Law

The rule starts with equality. A home must give equal access to quality care regardless of diagnosis, how severe a condition is or who pays, and it must apply the same transfer, discharge and service policies to every resident regardless of payment source. A resident on Medicaid can’t be treated as second class.

Residents also have the right to use their rights without “interference, coercion, discrimination, or reprisal.” Complaining, refusing a treatment or calling the ombudsman can’t be held against your parent.

If your parent can’t make decisions, the rights pass to a representative: someone your parent named under state law, or a guardian a court appointed. Even then, your parent keeps every right not handed over, their wishes must be considered, and they should take part in care planning as far as they can. The legal and financial planning guide covers how to name a health care agent while your parent still can.

The Core Rights in One Table

Right	What it means for your parent
Dignity and respect	Care that maintains or improves quality of life and recognizes your parent as an individual
Self-determination	Choosing activities, schedules (including when to sleep and wake) and health care
Visitors	Visitors of their choosing at the time of their choosing; family has immediate access
Care planning	Taking part in the care plan, requesting meetings and changes, seeing the plan
Treatment	Being told risks, benefits and alternatives; accepting or refusing any treatment
Physician	Choosing their own attending doctor, if licensed and meeting federal requirements
Freedom from restraints	No physical or chemical restraints for discipline or staff convenience
Privacy	Private calls, unopened mail, private visits and confidential records
Money	Managing their own finances; no charges for items Medicare or Medicaid pays for
Information	Their records within 24 hours; the latest inspection results posted in the home
Complaints	Filing grievances, including anonymously, without reprisal
Discharge protection	Leaving only for limited reasons, with written notice and the right to appeal

Rights in Daily Life: Choices, Visitors and Privacy

Federal rules expect the home to fit around your parent, within reason, not the other way round.

• Daily choices. Your parent can choose when to get up, go to bed and eat, which activities to join, and make other choices that matter to them. Medicare’s guide adds that the home should make a reasonable effort to get specific foods a resident asks for.
• Visitors. Your parent can receive visitors of their choosing at the time of their choosing, and can also refuse a visit. Family, the ombudsman and the resident’s doctor get immediate access. A home may set reasonable clinical and safety limits, but it must put them in a written policy and explain them, and it can’t restrict visits on the basis of race, religion, sex, gender identity, sexual orientation or disability.
• Personal belongings. Residents can keep and use their own furniture, clothing and possessions as space allows, as long as it doesn’t affect others’ safety. The home must take reasonable care to protect belongings from loss or theft.
• Rooms and roommates. Married residents can share a room if both agree. Your parent must get written notice, with the reason, before any room or roommate change.
• Privacy. Staff should knock and ask before entering. Residents have the right to private phone calls, to send and receive unopened mail, to use email and video calls where the home has access, and to keep their records confidential.
• Resident and family councils. Residents can organize and join a resident council, and families can form a family council. The home must provide private space and a staff contact, and act promptly on the group’s concerns. Only 1,811 nursing homes reported a family council in CMS data from August 2026, so ask about it on your tour.
• A homelike place. The home must be safe, clean and comfortable, with clean linens, private closet space and good lighting. Homes first certified after October 1, 1990 must keep the temperature between 71 and 81 degrees.

Rights Over Care and Treatment

Your parent is a partner in their own care, not just the person receiving it.

• Care planning. Each resident gets a person-centered care plan. Your parent can say who should attend, ask for meetings, help set goals, be told in advance about changes, see the plan and sign it after significant changes.
• Informed choices. The doctor or other professional must explain the risks and benefits of proposed care and the alternatives. Your parent can request, refuse or stop any treatment, and can make an advance directive.
• Medicines that affect behavior. Residents have the right to be free from physical or chemical restraints used for discipline or convenience rather than to treat a medical symptom. Medicare’s guide notes that antipsychotic drugs can carry health risks and be unnecessarily sedating, and suggests asking about approaches without medicine first. The antipsychotics guide explains what CMS tracks for each home.
• Being told when things change. The home must immediately tell your parent, consult the doctor and notify the representative after an accident with injury, a significant change in health, a major change in treatment or a decision to transfer or discharge.
• Records. Your parent, or their representative, can see their records within 24 hours of asking (not counting weekends and holidays) and get copies with 2 working days’ notice, for a reasonable cost-based fee.
• Inspection results. The home must post its most recent inspection results where residents and families can see them, and keep 3 years of inspection and complaint reports available on request. The inspection reports guide shows how to read them.

Money Rights: Personal Funds, Charges and the Admission Agreement

Money problems are among the most common sources of conflict, so it helps to know the rules before signing anything.

The admission agreement. Medicare’s guide says a nursing home can’t:

• make a third party, such as you, pay your parent’s bill. It may only ask a family member with legal access to use your parent’s money;
• require your parent to sign a binding arbitration agreement to be admitted or to get care.

The agreement must say what the basic rate covers and what costs extra. You can cross out items you don’t agree with before signing, or have a lawyer review it first.

Personal funds. Your parent has the right to manage their own money and can’t be required to hand it to the home. If they choose to deposit funds:

• the home must keep amounts over $100 (over $50 for Medicaid residents) in a separate interest-bearing account;
• it must keep complete records, provide quarterly statements and carry a surety bond;
• after discharge or death, it must return the funds and a final accounting within 30 days.

Charges. During a Medicare- or Medicaid-covered stay, the home can’t charge your parent for nursing, meals, the activities program or routine personal care items such as soap, toothpaste and incontinence supplies. It can charge for extras your parent asks for, such as a private phone, a private room or a hairdresser, but only after saying what the charge will be. The home must give written notice at least 60 days before changing what it charges for other items and services.

Discharge and Transfer Rights

Discharge or eviction was the most frequent nursing home complaint ombudsmen handled in fiscal 2023, according to ACL. Federal rules let a home transfer or discharge a resident only in limited situations, which Medicare lists as:

• the home can’t meet your parent’s needs, such as an emergency transfer to a hospital;
• your parent’s health has improved enough that they no longer need nursing home care;
• your parent’s condition endangers their own or others’ health or safety;
• the bill hasn’t been paid, after reasonable notice;
• the home is closing.

The home must give written notice, with the reasons, usually at least 30 days in advance, and send a copy to the ombudsman. The notice must explain how to appeal and give the ombudsman’s contact details.

Your parent has the right to appeal. Steps vary by state, but the appeal usually goes to the state, and an administrative law judge holds a hearing where your parent and their representative can speak and submit information. While an appeal is pending, the home can’t discharge your parent unless staying would endanger someone’s health or safety.

Before a hospital transfer, the home must give written notice of its bed-hold policy and must have a written policy on letting residents return. Call the ombudsman the day a discharge notice arrives.

What the Long-Term Care Ombudsman Does

Every state, plus Washington, D.C., Puerto Rico and Guam, has an Office of the State Long-Term Care Ombudsman under the federal Older Americans Act. The program began in 1972. Ombudsmen serve residents of nursing homes, board and care homes, assisted living and other residential care communities.

Under federal law, ombudsman programs must:

• identify, investigate and resolve complaints made by or for residents;
• give residents information about long-term care services;
• make sure residents have regular, timely access to ombudsman services;
• represent residents before government agencies;
• recommend changes to laws that affect residents.

Medicare’s guide adds that an ombudsman can visit and talk with your parent, help with problems including money issues, and tell you how many complaints they’ve received about a specific home, what kind they were and whether they were resolved. That makes the ombudsman worth a call before you choose a home, too.

The program in numbers (ACL, federal fiscal year 2023):

• over 1,500 full-time-equivalent staff and 3,443 volunteers;
• 202,894 complaints worked on, with 71% resolved or partly resolved to the satisfaction of the resident or complainant;
• visits to 60% of all nursing homes at least once a quarter;
• 17,095 resident council meetings and 1,271 family council meetings attended.

The most frequent nursing home complaints were discharge or eviction, response to requests for help, physical abuse, unattended symptoms and medications.

The ombudsman works for your parent. Federal rules require the ombudsman to ask for the resident’s consent before investigating, and in most cases not to report suspected abuse to other agencies without that consent. If you want an official investigation of abuse or neglect, report it to the state survey agency as well. The abuse warning signs guide lists who to call, and 911 comes first in an emergency.

How to Reach Your State’s Ombudsman

Here are examples from several states. Your state page lists the ombudsman for every state, and the Eldercare Locator, 1-800-677-1116, can connect you too.

State	Ombudsman program	Phone
California	Long-Term Care Ombudsman Program	1-800-231-4024
Texas	State Long-Term Care Ombudsman	800-252-2412
Florida	Florida Long-Term Care Ombudsman Program	1-888-831-0404
New York	Office of the State Long Term Care Ombudsman	1-855-582-6769
Georgia	Georgia Long-Term Care Ombudsman Program	1-866-552-4464 (option 5)
North Carolina	Long-Term Care Ombudsman Program	1-800-662-7030
Michigan	Michigan Long Term Care Ombudsman Program	866-485-9393

How to Raise a Problem Until It’s Fixed

Medicare suggests working up from the people closest to the problem. Here’s the order that usually works fastest:

1. Talk to the staff involved. Many problems end here.
2. Ask for a supervisor. That can be the charge nurse, the social worker, the director of nursing, the administrator or your parent’s doctor.
3. File a grievance. Every home must have a Grievance Official. You can raise a concern out loud, in writing or anonymously, and the home must answer in writing with what it investigated, what it found, whether the concern was confirmed and what it will do. The home must keep evidence of grievance results for at least 3 years.
4. Bring in the resident or family council if the home has one.
5. Call the ombudsman. Your parent can contact the ombudsman at any time, and the home can’t discourage it.
6. File a complaint with the state survey agency. It inspects the home and can issue citations. Medicare says to contact your Medicare Regional Office if the state doesn’t address the complaint.

Keep dated notes of each conversation. If a problem involves harm or danger, skip straight to the state survey agency, and call 911 in an emergency.

Rights Don’t Depend on Who Pays

Every right in this guide applies whether the stay is paid by Medicare, Medicaid, the VA, long-term care insurance or private funds. What changes is the bill:

• Medicare covers short skilled nursing stays after a qualifying hospital stay, not long-term custodial care. See does Medicare cover nursing homes.
• Medicaid pays for long-term care for people who meet state income and asset rules. Homes must give Medicaid residents written information about what’s included and what can be charged. See Medicaid nursing home eligibility or try the Medicaid long-term care checker.
• Other sources are compared in how to pay for a nursing home.

When you’re choosing a home, use the how to choose a nursing home checklist, search the nursing home finder and compare up to three homes in the nursing home comparison tool. Assisted living follows state rules rather than these federal ones; the choosing assisted living guide explains what to check. And if caring from a distance is wearing you down, the caregiver support programs guide lists free help.

Frequently Asked Questions

Can a Nursing Home Require Binding Arbitration?

No. Medicare's guide to living in a nursing home says a home can't require you to sign an agreement to settle disputes outside state or federal courts as a condition of admission or care. If an admission agreement includes it, you can cross it out before signing.

Can My Family Be Made to Pay My Parent's Bill?

No. A nursing home can't make a third party, like family, pay the bill. It may only ask a family member with legal access to your parent's funds to use your parent's money to pay.

Does My Parent Have to Let the Nursing Home Hold Their Money?

No. Federal rules say a home can't require residents to deposit personal funds with it. If your parent chooses to, the home must keep the money separate from its own accounts, account for it fully and give quarterly statements.

Can a Resident Choose Their Own Doctor?

Yes. Each resident has the right to choose an attending physician who is licensed and meets federal requirements. If that doctor can't or won't meet them, the home must tell the resident, discuss alternatives and honor the resident's preference among the options.

Does the Ombudsman Help in Assisted Living Too?

Yes. ACL says ombudsman programs serve people living in nursing homes, board and care homes, assisted living and other residential care communities. In fiscal 2023, discharge or eviction was the most frequent complaint in both nursing homes and assisted living settings.

Can My Parent File a Grievance Without Giving Their Name?

Yes. A nursing home's grievance policy must tell residents they can file grievances orally, in writing or anonymously, and the Grievance Official must keep the identity of an anonymous complainant confidential.

More on Choosing a Facility

• Choosing a Nursing HomeRatings, inspections, staffing and the questions to ask on a visit
• Star Ratings ExplainedWhat each Care Compare star rating measures and its limits
• Inspection ReportsDeficiencies, scope and severity, fines and where to find reports
• Staffing and TurnoverNurse staffing hours, turnover and the federal staffing data
• Antipsychotic UseThe FDA warning for dementia, CMS's measure and what to ask
• Abuse Warning SignsWarning signs, CMS's abuse icon and who to call

This guide explains long-term care in plain language from official sources. It isn't medical, legal or financial advice; a doctor, your state Medicaid agency or an elder law attorney can advise on your situation.

Sources

1. eCFR: 42 CFR 483.10, Resident rights
2. eCFR: 42 CFR 483.15, Admission, transfer, and discharge rights
3. Medicare.gov: Your guide to living in a nursing home (CMS Product No. 12217)
4. ACL: Long-Term Care Ombudsman Program
5. eCFR: 45 CFR 1324.19, Duties of the Ombudsman and representatives
6. eCFR: 42 CFR 483.12, Freedom from abuse, neglect, and exploitation