Overview 

Federal and state law require nursing homes to provide high quality, individualized care for every nursing home resident.  The law protects residents who complain from retaliation by the nursing home and prohibits discrimination based on the source of payment.  When facilities violate these rights, residents can file complaints with a variety of state and federal agencies.  If found in violation of the law, nursing homes, their owners and administrators can be fined, have their licenses suspended or revoked, and lose their right to payments by Medicaid or Medicare.

Rights to Quality Care Generally

A central provision of the law is that every resident is entitled to individualized, high quality care designed to prevent deterioration whenever possible.

Patients’ Bill of Rights.  Connecticut General Statutes § 19a-550 (b) (8) & (10).

Resident rights.  42 Code of Federal Regulations § 483.10.

Quality of life.  42 Code of Federal Regulations § 483.15 (b), (e)  (f), and (h).

Quality of care.  42 Code of Federal Regulations § 483.25 (a), (c), (d), (f) and (g).

Dental services.  42 Code of Federal Regulations § 483.55.

The Right To Be Evaluated and Informed as to Your Medical Condition

Patients’ Bill of Rights.  Connecticut General Statutes § 19a-550 (b) (3), (9) & (10).

Resident rights.  42 Code of Federal Regulations § 483.10 (b) (1), (3) and (11) (i) and (ii).

Resident assessment.  42 Code of Federal Regulations § 483.20 (b) and (d). 

The Right to be Free from Abuse and Restraints

Patients’ Bill of Rights.  Connecticut General Statutes § 19a-550 (b) (5), (8), (10) & (11).

Resident behavior and facility practices.  42 Code of Federal Regulations § 483.13 (a) and (b).

The Right to Complain without Fear of Retaliation

Patients’ Bill of Rights.  Connecticut General Statutes § 19a-550 (b) (5), (6), (8), (17) & (20).

Resident rights.  42 Code of Federal Regulations § 483.10 (f).

The Right to Refuse Treatment

Patients’ Bill of Rights.  Connecticut General Statutes § 19a-550 (b) (3), (5), (8) & (21).

Resident rights.  42 Code of Federal Regulations § 483.10 (b) (4).

The Right to Choose Your Own Doctor

Residents may hire and fire doctors as often as they want to.  Residents also have the right to visits by their own doctors.

Patients’ Bill of Rights.  Connecticut General Statutes § 19a-550 (b) (3), (12) & (18).

Resident rights.  42 Code of Federal Regulations § 483.10 (d) & (j)(iii).

The Right to Privacy

Patients’ Bill of Rights.  Connecticut General Statutes § 19a-550 (b) (9), (12) & (15).

Resident rights.  42 Code of Federal Regulations § 483.10 (e).

The Right to Equal Care

All nursing home residents are entitled to receive the same high quality care, regardless of whether nursing home is paid by Medicaid, Medicare, insurance or savings.

Patients' Bill of Rights.  Connecticut General Statutes § 19a-550 (b) (23). 

Admission, transfer and discharge rights.  42 Code of Federal Regulations § 483.12 (c).

The Right to Form and Participate in Resident and Family Councils

Patients’ Bill of Rights.  Connecticut General Statutes § 19a-550 (b) (12), (13) & (17).

Quality of Life.  42 Code of Federal Regulations § 483.15 (c).

Resident rights.  42 Code of Federal Regulations § 483.10 (e)(1).

Nursing Home Staffing Requirements

Connecticut law only requires that nursing home staffing levels result in 1.90 total nurse and nurse's aide hours per resident per day.  In contrast, the U.S. Dept. of Health and Human Services (HHS) recommends 4.10 total hours per resident day as an optimum level and the National Citizens' Coalition for Nursing Home Reform (NCCNHR) recommends at least 4.13 total hours per resident per day.

While most of Connecticut nursing homes staff above the very low required levels, the state's average nursing-staff-hours-to-resident-day (3.16) still ranks 33rd out of the 50 states, is the second lowest in New England, and falls below both the HHS optimum and NCCNHR recommended minimum levels.

Federal law does require nursing homes to post in a clearly visible place the number of nursing staff (RN's, LPN's, and CNA's) on duty each shift.   Unfortunately, the law does not require spearate postings for each unit and it does not require facilities to post how many residents there are.  As a result, advocates will have to ask for a resident census to conclude if the staffing levels meet the NCCNHR standards.

Nursing Home Staffing Reports

National

The Kaiser Family Foundation published two reports in June 2002:

"Nursing Home Staffing Standards"
This issue paper describes the current federal staffing requirements and how states separately regulate staffing levels in nursing homes.  It also presents data showing that actual staffing levels in over half of this country's nursing homes exceed the levels that states and the federal government require.

"Nursing Home Quality: State Agency Survey Funding and Performance"
This issue paper describes the resources, staffing, and performance of state licensing and certification agencies based on findings from a survey of state survey agency officials.

In 2002, HHS released Phase II of a Congressionally mandated study entitled "Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes."  Sadly, the study found that 9 out of 10 of the nation's nursing homes lack adequate staff to take proper care of their residents.  The HHS study recommended minimum staffing levels of 4.10 total direct care hours per resident per day in the nation's nursing homes because staffing below this level may compromise the quality of care, causing costly, dangerous outcomes such as pressure sores, infections, and avoidable hospitalizations.

Click here for the Executive Summary.  To view all of the volumes of Phase II of this federal study one can visit the National Clearinghouse on the Direct Care Workforce web site.

Connecticut

In late 2000, the Connecticut General Assembly's Legislative Program Review and Investigations Committee published a report entitled "Staffing in Nursing Homes."

Read the Digest of Findings and Recommendations of the Final Report.

Read the Keypoints of the Final Report.

Read the entire "Staffing in Nursing Homes" Final Report.

Nursing Home Staffing Legislation

In the 2008 Connecticut General Assembly legislative session, House Bill 5794 seeks to increase requirements for direct care staffing levels to the NCCNHR standards.

In Congress, The Nursing Home Staffing Act of 2005 (H.R. 4293) was introduced.  The purpose of the bill was to increase nursing home staffing levels to equal the recommended HHS optimum level of 4.10 hours per resident per day. It did not become law.

Nursing Home Staffing Laws

Chronic and convalescent nursing homes and rest homes with nursing supervision.  Regulations of Connecticut State Agencies § 19-13-D8t (m).

Resident behavior and facility practices.  42 Code of Federal Regulations § 483.13 (a) and (b).

Quality of life.  42 Code of Federal Regulations § 483.15 (h).

Nursing services.  42 Code of Federal Regulations § 483.30.

Specialized rehabilitative services.  42 Code of Federal Regulations § 483.45.

Posting of Information on Nursing Facility Staffing.   42 United States Code § 1395i-3 (b)(8) & 42 United States Code 1396r (b)(8); 42 Code of Federal Regulations § 483.30(e).

Addressing Resident and Staffing Needs with Residents who have Challenging Behavior