When an individual moves into a long-term care setting, such as a nursing home or assisted living facility, they do not surrender their fundamental rights to self-determination and personal choice. Federal and state regulations guarantee residents specific rights regarding Activities of Daily Living (ADLs), which encompass tasks like bathing, dressing, eating, and mobility. These mandates ensure that assistance with personal care protects the resident’s autonomy, individuality, and overall quality of life. The rights framework is designed to transition care from a facility-centered model to a person-centered model. These protections cover initial planning, daily interactions, and the process for addressing concerns.
The Right to Participate in the Care Planning Process
The right to person-centered care requires a resident to be an active collaborator in developing their Individualized Care Plan (ICP). This process begins with a comprehensive assessment of the resident’s physical needs, cognitive status, and personal preferences related to ADLs. The facility must use this information to create a written plan describing the services the resident will receive to maintain or enhance their well-being.
This planning is a partnership where the resident or their designated representative provides input, asks questions, and reviews the final document. The plan must specifically document the resident’s goals for admission, including any desire to return to the community, and the necessary steps to support those outcomes. If a resident’s preferences for receiving ADL care differ from standard facility routines, those preferences must be incorporated into the plan whenever possible. The facility must also inform the resident of any proposed changes to the care plan in advance, allowing them to participate in those decisions.
Maintaining Dignity and Privacy During Assistance
Regulations require that all residents be treated with respect and dignity, and this standard applies directly to the delivery of personal care. Staff must care for each resident in a manner that promotes self-esteem and recognizes their individuality, especially during intimate ADL tasks like bathing or toileting. Privacy must be maintained by closing doors, using screens, or ensuring other residents are not present during personal care procedures.
Respect for personal space extends to the right to retain and use personal possessions and clothing, allowing the resident to dress in their own clothes rather than hospital gowns. The facility must accommodate the resident’s needs and preferences to create a comfortable, homelike environment. Dignified care also involves ensuring staff explain procedures before they are performed and providing assistance in a way that maximizes the resident’s remaining independence.
Resident Control Over Scheduling and Refusal of Care
Two of the most substantial rights afforded to residents are the power to control their daily schedule and the right to refuse care at any time. Residents have the explicit right to choose their activities and schedules, which includes determining their own sleeping and waking times, meal times, and bathing times. The facility must make reasonable accommodations to honor these personal choices, shifting away from rigid, facility-dictated routines. This self-determination is a foundational element of quality of life in a long-term care setting.
The right to refuse care is a fundamental component of patient autonomy. A resident can refuse any specific treatment or service, including ADL assistance, even if it is listed in the care plan. Staff must honor this decision unless the refusal poses an immediate threat to the life or safety of the resident or others. When a resident refuses care, the facility must document the refusal and attempt to find alternative approaches to meet the resident’s needs while respecting their choice. This documentation typically involves discussing the potential consequences of the refusal and exploring whether the care can be delivered in a different manner or at a different time.
Mechanisms for Reporting and Resolving Violations
When a resident’s rights regarding ADL care are violated, resolution begins with the facility’s internal grievance procedures. Every facility must have a process for residents to voice complaints and recommend changes without fear of retaliation. Facilities are required to make prompt efforts to resolve these grievances internally.
For issues that cannot be resolved internally, the Long-Term Care Ombudsman Program is the primary external advocate for residents. Ombudsmen investigate and resolve complaints related to quality of care, dignity, and rights violations. These services are confidential and free, and the Ombudsmen work to resolve issues according to the resident’s expressed wishes. Additionally, residents or family members can file a complaint with the state licensing or survey agency, which inspects facilities and enforces compliance with federal and state regulations.