The following information is based on federal regulations that apply to all nursing homes receiving Medicare or Medicaid funding. This is for informational purposes only and should not be taken as legal advice. If you feel your rights or the rights of your loved one in long-term care have been violated seek professional legal advice on how to proceed.

While federal regulations are public domain, this comprehensive interpretation, organization, and family-friendly presentation is © 2025 NursingHomeFamilyCouncil.com. All rights reserved. Distribution and linking permitted with attribution intact.

Your Loved One’s Rights in Long-Term Care

Medical Care & Treatment Standards

Quality medical care is the foundation of nursing home life. Federal law requires facilities to assess your loved one’s needs, create personalized care plans, and provide professional medical services. This guide explains the healthcare standards your loved one deserves and how to ensure they receive proper medical attention

How Your Loved One’s Needs Must Be Assessed

Comprehensive Assessment Timeline

The facility must complete:

Initial assessment – within 14 days of admission
Comprehensive assessment – within 14 days, updated annually
Quarterly reviews – every 3 months minimum
Significant change assessment – when condition changes

What Must Be Assessed

Each assessment must evaluate:

Physical health – medical conditions, medications, pain levels
Mental health – mood, behavior, cognitive abilities
Functional abilities – mobility, daily living skills, communication
Social needs – relationships, activities, cultural preferences
Nutritional status – eating habits, weight, special dietary needs
Risk factors – falls, infections, pressure sores

Your Family’s Role in Assessment

You have the right to:

Participate in assessments – provide input about your loved one’s needs
Review assessment results – understand what was found
Request updates – ask for new assessment if condition changes
Question findings – challenge inaccurate or incomplete assessments

Important: Accurate assessments are crucial – they determine the care plan and services your loved one receives. Speak up if you notice the assessment missed important information.

Federal Authority: 42 CFR §483.20 – Resident Assessment
→ Violation Remedies if assessment requirements are being violated

Creating Your Loved One’s Personalized Care Plan

Care Plan Requirements

Every resident must have a care plan that:

Reflects personal goals – what your loved one wants to achieve
Addresses all assessed needs – medical, social, emotional, spiritual
Includes specific interventions – exactly what staff will do
Sets measurable goals – clear targets for improvement or maintenance
Lists responsible staff – who will provide each service

Care Plan Development Process

The facility must:

Include your loved one – resident participates in planning
Involve family – invite your input and preferences
Use interdisciplinary team – doctors, nurses, therapists, social workers
Consider personal preferences – lifestyle, cultural, religious needs
Update regularly – revise when conditions change

Care Plan Meetings

You have the right to:

Attend care conferences – usually held every 3 months
Request special meetings – when you have concerns
Receive advance notice – time to prepare questions
Get meeting summaries – written record of decisions made
Suggest changes – recommend plan modifications

What to Ask During Care Planning

How does this plan address my loved one’s specific goals?
What happens if the current plan isn’t working?
How often will progress be reviewed?
Which staff members are responsible for each part of care?
How will you measure success?

Remember: The care plan should be about what your loved one wants and needs, not what’s convenient for the facility. Advocate for a truly personalized approach.

Federal Authority: 42 CFR §483.21 – Comprehensive Person-Centered Care Planning
→ Violation Remedies if care planning rights are being violated

Medical Care Quality Your Loved One Deserves

Basic Quality Standards

Every resident must receive:

Professional medical care – appropriate for their condition
Nursing services – 24-hour availability of licensed nurses
Medication management – safe storage, administration, monitoring
Therapy services – physical, occupational, speech as needed
Nutritional support – proper diet and hydration
Infection control – prevention and treatment of infections

Prevention Requirements

Facilities must actively prevent:

Pressure sores – regular turning, proper mattresses, skin care
Falls – safe environment, mobility aids, staff supervision
Infections – proper hygiene, isolation when needed
Medication errors – accurate dosing, timing, documentation
Dehydration and malnutrition – monitoring intake, assistance eating
Mental health decline – social interaction, meaningful activities

Treatment Standards

When medical issues arise, the facility must:

Provide prompt treatment – don’t delay necessary care
Follow physician orders – implement prescribed treatments accurately
Monitor progress – track response to treatments
Communicate changes – notify doctors and families of problems
Document everything – maintain detailed medical records

Signs of Quality Care

Look for:

Staff knows your loved one – understands their preferences and needs
Consistent caregivers – same staff providing regular care
Prompt response – staff answers call lights quickly
Clean, comfortable environment – proper hygiene and maintenance
Active treatment – ongoing efforts to improve or maintain health

Quality care means more than just meeting basic needs – your loved one deserves attentive, professional medical care that helps them live their best possible life.

Federal Authority: 42 CFR §483.25 – Quality of Care
→ Violation Remedies if quality of care standards are being violated

Doctor and Nurse Requirements

Physician Service Requirements

Your loved one has the right to:

Choose their doctor – select personal physician or facility medical director
Regular medical visits – at least every 30 days for first 90 days, then every 60 days
Emergency access – doctor available 24/7 for urgent situations
Specialist referrals – access to specialized medical care when needed
Medical orders – written instructions for all treatments and medications

What Physician Visits Must Include

During each visit, the doctor must:

Review medical condition – assess current health status
Update care plan – revise treatment as needed
Check medications – review prescriptions for effectiveness and safety
Order tests – laboratory work, x-rays, other diagnostics as needed
Document findings – maintain detailed medical records

Nursing Service Standards

The facility must provide:

Licensed nurse – RN or LPN on duty 24 hours a day
Registered nurse – RN on duty at least 8 hours every day
Director of nursing – full-time RN responsible for nursing services
Adequate staffing – enough nurses to meet residents’ needs
Trained aides – certified nursing assistants with proper training

Nursing Care Responsibilities

Nursing staff must:

Administer medications – safely and on schedule
Monitor vital signs – blood pressure, temperature, pulse, respiration
Provide personal care – bathing, dressing, toileting assistance
Implement care plans – follow prescribed treatments and interventions
Report changes – notify doctors of health status changes

Important: If you’re concerned about staffing levels or nursing care quality, ask to speak with the Director of Nursing and request information about nurse-to-resident ratios.

Federal Authority: 42 CFR §483.30 (Physician Services)
→ Violation Remedies if physician or nursing service requirements are being violated

Safe Medication Practices

Medication Safety Requirements

The facility must ensure:

Licensed pharmacist – reviews all medications monthly
Proper storage – secure, climate-controlled medication areas
Accurate administration – right patient, right drug, right dose, right time
Documentation – complete records of all medications given
Error reporting – immediate notification of medication mistakes

Medication Review Process

Each month, the pharmacist must:

Review all medications – check for appropriateness and interactions
Identify problems – unnecessary drugs, incorrect dosing, adverse reactions
Recommend changes – suggest medication adjustments to doctors
Monitor outcomes – track effectiveness and side effects
Report findings – provide written recommendations

Your Medication Rights

You and your loved one have the right to:

Know all medications – names, purposes, side effects
Refuse medications – except in emergency situations
Request information – ask questions about any prescribed drugs
Choose pharmacy – use preferred pharmacy when possible
Participate in decisions – be involved in medication choices

Medication Safety Red Flags

Contact the facility immediately if you notice:

Unexplained drowsiness – sudden changes in alertness
New behaviors – agitation, confusion, mood changes
Physical symptoms – nausea, dizziness, unusual movements
Missed doses – medications not given on schedule
Wrong medications – drugs that don’t match medical records

Questions to Ask About Medications

What is this medication for and how does it help?
What are the possible side effects?
How often is the medication list reviewed?
Who can I talk to if I have concerns about side effects?
Are there non-drug alternatives for this condition?

Medication management is critical for safety and quality of life. Don’t hesitate to ask questions or raise concerns about your loved one’s drug therapy.

Federal Authority: 42 CFR §483.45 – Pharmacy Services
→ Violation Remedies if pharmacy service requirements are being violated

Medical Records Access & Warning Signs

Your Medical Record Rights

You have the right to:

Access medical records – review your loved one’s complete medical file
Request copies – obtain copies of records within 24 hours
Reasonable costs only – facility can charge copying fees but not excessive amounts
Explanation of records – ask staff to explain medical terminology
Correct errors – request amendments to inaccurate information

What Medical Records Should Include

Complete records must contain:

Assessment results – all evaluations and reassessments
Care plans – current and previous plans of care
Medical orders – doctor’s instructions and prescriptions
Progress notes – daily nursing and therapy documentation
Medication records – complete drug administration history
Incident reports – falls, injuries, behavior issues

Medical Care Red Flags

Seek help immediately if you notice:

Unexplained injuries – bruises, cuts, fractures without clear cause
Rapid health decline – sudden worsening without medical explanation
Medication problems – missed doses, wrong drugs, adverse reactions
Poor hygiene – unwashed, unchanged clothing, dental problems
Pressure sores – bedsores, especially on back, hips, heels
Weight loss – significant unplanned weight reduction
Dehydration signs – dry mouth, confusion, dizziness

When to Take Immediate Action

Contact authorities if the facility:

Refuses medical record access – won’t let you review records
Delays necessary care – doesn’t provide urgent medical attention
Ignores doctor’s orders – fails to follow prescribed treatments
Hides medical problems – doesn’t inform you of health changes
Provides inadequate staffing – not enough nurses for safe care

Getting Help

Contact these resources for medical care concerns:

Facility Medical Director – responsible for medical services
State Health Department – investigate quality of care violations
State Long-Term Care Ombudsman – advocate for residents
Medicare/Medicaid – report quality concerns for investigation

Trust your instincts about your loved one’s medical care. If something seems wrong, speak up immediately. Early intervention can prevent serious medical complications.

Connect with other families navigating medical care challenges: Join our community to share experiences and get support from families who understand your concerns.

Federal Authority: 42 CFR §483.12 – Medical Records & Multiple Quality Standards
→ Violation Remedies for comprehensive guidance on medical care violations