Nursing home residents have a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility, including those specified in this section. A facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident’s individuality. The facility must protect and promote the rights of the resident. The facility must provide equal access to quality care regardless of diagnosis, severity of condition, or payment source. A facility must establish and maintain identical policies and practices regarding transfer, discharge, and the provision of services under the State plan for all residents regardless of payment source. See 42 C.F.R. § 483.10(a).

In addition, 42 C.F.R. § 483.10(e) provides that the resident has a right to be treated with respect and dignity, including:

(1) The right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident’s medical symptoms, consistent with § 483.12(a)(2).

(2) The right to retain and use personal possessions, including furnishings, and clothing, as space permits, unless to do so would infringe upon the rights or health and safety of other residents.

(3) The right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences except when to do so would endanger the health or safety of the resident or other residents.

(4) The right to share a room with his or her spouse when married residents live in the same facility and both spouses consent to the arrangement.

(5) The right to share a room with his or her roommate of choice when practicable, when both residents live in the same facility and both residents consent to the arrangement.

(6) The right to receive written notice, including the reason for the change, before the resident’s room or roommate in the facility is changed.

(7) The right to refuse to transfer to another room in the facility, if the purpose of the transfer is:

(i) To relocate a resident of a SNF from the distinct part of the institution that is a SNF to a part of the institution that is not a SNF, or

(ii) to relocate a resident of a NF from the distinct part of the institution that is a NF to a distinct part of the institution that is a SNF.

(iii) solely for the convenience of staff.

(8) A resident’s exercise of the right to refuse transfer does not affect the resident’s eligibility or entitlement to Medicare or Medicaid benefits.

Appendix PP states that the intent of this regulation is that “All residents have rights guaranteed to them under Federal and State laws and regulations. This regulation is intended to lay the foundation for the resident rights requirements in long-term care facilities. Each resident has the right to be treated with dignity and respect. All activities and interactions with residents by any staff, temporary agency staff or volunteers must focus on assisting the resident in maintaining and enhancing his or her self-esteem and self-worth and incorporating the resident’s, goals, preferences, and choices. When providing care and services, staff must respect each resident’s individuality, as well as honor and value their input.”

Examples of treating residents with dignity and respect include, but are not limited to:

• • Encouraging and assisting residents to dress in their own clothes, rather than hospitaltype gowns, and appropriate footwear for the time of day and individual preferences;
  • Placing labels on each resident’s clothing in a way that is inconspicuous and respects his or her dignity (for example, placing labeling on the inside of shoes and clothing or using a color coding system);
  • Promoting resident independence and dignity while dining, such as avoiding:
    • Daily use of disposable cutlery and dishware;
    • Bibs or clothing protectors instead of napkins (except by resident choice);
    • Staff standing over residents while assisting them to eat;
    • Staff interacting/conversing only with each other rather than with residents while assisting with meals;
  • Protecting and valuing residents’ private space (for example, knocking on doors and requesting permission before entering, closing doors as requested by the resident);
  • Staff should address residents with the name or pronoun of the resident’s choice, avoiding the use of labels for residents such as “feeders” or “walkers.” Residents should not be excluded from conversations during activities or when care is being provided, nor should staff discuss residents in settings where others can overhear private or protected information or document in charts/electronic health records where others can see a resident’s information;
  • Refraining from practices demeaning to residents such as leaving urinary catheter bags uncovered, refusing to comply with a resident’s request for bathroom assistance during meal times, and restricting residents from use of common areas open to the general public such as lobbies and restrooms, unless they are on transmission-based isolation precautions or are restricted according to their care planned needs.

Consider the resident’s life style and personal choices identified through their assessment processes to obtain a picture of his or her individual needs and preferences.

Staff and volunteers must interact with residents in a manner that takes into account the physical limitations of the resident, assures communication, and maintains respect. For example, getting down to eye level with a resident who is sitting, maintaining eye contact when speaking with a resident with limited hearing, or utilizing a hearing amplification device when needed by a resident.

Pay close attention to resident or staff interactions that may represent deliberate actions to limit a resident’s autonomy or choice. These actions may indicate abuse. See F600, Free from Abuse, for guidance.