Resident Rights FAQs

ADLs are personal care tasks that people perform daily. ADLs include bathing, dressing, toileting, transferring (for example moving from bed to chair), and eating. Assessments measure someone’s ability to perform these tasks and indicate the level of assistance that is needed in these areas so that the appropriate level of care can be arranged.

IADLs are certain tasks that may not be necessary every day, but are essential to living independently. IADLs include meal preparation, housekeeping, laundry, money management, transportation, shopping, using the telephone and performing basic home maintenance.

Carefully read the entire agreement before signing. If you’re not in an emergency situation, ask a lawyer or a trusted person to review it with you. If there are parts of the contract you’re uncomfortable with—such as a responsible party guarantee, arbitration agreement, or negotiated risk clause—you can refuse to sign them or cross them out and initial the changes.

No. Nursing homes cannot legally require a third-party guarantee of payment as a condition for admission or continued stay. If someone (like a family member) has legal access to your finances (e.g., power of attorney), the facility can ask them to agree to use your funds to pay. However, they cannot be held personally responsible unless they misuse your money.

Read it carefully. If it appears to make someone personally responsible for your bills (beyond just using your funds), they should consider not signing or crossing it out and initialing it. Politely explain that you believe the clause is illegal and unenforceable. If the facility later tries to collect or sue based on that clause, speak with a lawyer familiar with nursing home law.

An arbitration agreement means that any future disputes will be handled by a private arbitrator rather than in court. These agreements often favor the facility and can be more expensive. Courts also tend to be more sympathetic to residents.

If possible, do not sign the arbitration agreement. You can tell the facility you’d rather decide on arbitration if a dispute ever comes up. If you’ve already signed one and the facility tries to force arbitration, talk to an attorney to see if the agreement can be challenged.

This clause says the facility isn’t liable for injuries if the resident didn’t hire extra private nursing care. Do not sign this clause if you can avoid it. Nursing homes are legally required to provide enough staff to meet a resident’s needs. You shouldn’t have to pay for private nurses just to get adequate care. If this clause is in the contract, consider crossing it out and initialing it.

No. A nursing home cannot require donations, gifts, or promises to pay privately for a certain time period in exchange for admission or faster admission. They also cannot require you to waive your right to apply for Medicaid or Medicare. These practices are illegal under federal law.

No. By law, nursing homes must treat all residents the same, regardless of whether they pay privately or through Medicaid. This includes equal access to services, care quality, and transfer/discharge policies.

No. Federal law only allows eviction (called a “transfer” or “discharge”) for six specific reasons:

1. The resident’s needs can’t be met at the facility.

2. The resident’s health has improved and no longer needs care.

3. The resident poses a safety risk to others.

4. The resident’s presence endangers the health of others.

5. The resident hasn’t paid after receiving proper notice.

6. The facility is closing.

Complaints or minor rule violations are not valid reasons for eviction.

No. A facility must:

• Have a valid legal reason to discharge or transfer a resident.

• Provide written notice to the resident and a family member or representative.

• Usually give at least 30 days’ notice, unless it’s an emergency.

The notice must include:

• The reason and date of discharge/transfer.

• The new location.

• How to appeal the decision.

• Contact info for the Long-Term Care Ombudsman and advocacy agencies.

Take action immediately:

1. Contact your local Long-Term Care Ombudsman – they can often resolve issues quickly.

2. File an appeal with DMAS (Department of Medical Assistance Services) before the scheduled discharge date.

If your nursing home accepts Medicaid—even if you’re paying privately—you still have the right to appeal.

Appealing pauses the discharge until a decision is made. A hearing will be scheduled, usually at the nursing home. It’s best to have a lawyer or legal advocate help you prepare.

You can learn more and find forms here: dmas.virginia.gov/appeals

To appeal in writing, send your letter to:

Department of Medical Assistance Services
Division of Client Appeals
600 E. Broad Street, Suite 1300
Richmond, VA 23219
Phone: (804) 371-8488
Fax: (804) 452-5454

Include:

• A statement that you’re appealing.

• The resident and facility names.

• A copy of the discharge notice.

• Your contact info.

It depends:

• Roommate or room changes: No right to appeal.

• Move to a different unit with separate Medicaid/Medicare certification: Yes, you have the same rights as for a full discharge or transfer.

The facility must consult the resident’s doctor and get their approval.
The doctor must document:

• Why the transfer/discharge is necessary.

• How the resident’s needs will be met.

• The impact of the move.

If the facility doesn’t do this properly, the discharge can be challenged.

No. Discharging a resident without a safe, appropriate plan is illegal.

The nursing home must make sure the new setting can meet the resident’s care needs. For example, sending a quadriplegic patient home without home care would be improper and challengeable.

Effective arguments include:

• The discharge notice is incomplete or inaccurate.

• Required documentation is missing.

• The new placement is not appropriate.

• The facility doesn’t have valid legal grounds.

Make all valid arguments, not just one—you don’t know what the hearing officer will find persuasive.

The hearing officer may:

• Approve the discharge. The facility can proceed but must give a new notice.

• Reverse the discharge. The resident stays.

• Send the case back to the facility to fix issues before proceeding.

If the decision goes against the resident, speak to a lawyer immediately. There may still be appeal options, but time is critical.

Yes, absolutely. These hearings are complex. A legal advocate can:

• Build a strong case.

• Help gather and review evidence.

• Protect your appeal rights.

Low-income residents may qualify for free legal help. Contact legal aid as soon as possible—and reach out to the ombudsman immediately when a discharge notice is received.

Yes, if the resident is eligible for Medicaid and still needs nursing home care, they have the right to return to the same facility when a suitable bed is available. This applies even if the resident owes money or the facility has concerns, but the facility can start discharge procedures if necessary.

No, Virginia Medicaid does not pay to hold a bed during hospital stays. The bed may be given to someone else unless the resident or family pays to hold it. However, residents still have the right to return to the next available bed. For therapeutic leave, Medicaid pays for up to 18 days a year if it’s in the care plan.

Federal law gives residents of any nursing home that accepts Medicare and/or Medicaid the right to organize and meet privately on a regular basis as a “resident council.” The law also requires the nursing home to provide a meeting space, cooperate with the council’s activities, and respond to the group’s concerns. Nursing homes must appoint a staff adviser or liaison to the resident council, however, staff and administrators have access to resident council meetings only by invitation from the resident council.

Federal law states:

• A resident has the right to organize and participate in resident groups in the facility.
• The facility must provide a resident group, if one exists, with private meeting space.
• Staff or visitors may attend meetings at the group’s invitation.
• The facility must provide a designated staff person responsible for providing assistance and responding to written requests that result from group meetings.
• When a resident group exists, the facility must listen to the views and act upon the grievances and recommendations of residents and families concerning proposed policy and operational decisions affecting resident care and life in the facility.

42 CFR sec.483.15(c)

More information can be found here.

Virginia state law requires assisted living facilities to allow and to encourage the formation of resident councils. Assisted living facilities must assist residents in establishing a resident council, if one does not already exist. The law states that the purposes of the resident council are as follows:

• Work with the administration in improving the quality of life for all residents;
• Discuss the services offered by the facility and make recommendations for resolution of identified problems or concerns; and
• Perform other functions as determined by the council.

Virginia law also gives resident councils in assisted living facilities the right to extend membership to family members, advocates, friends, and others as they wish. Further more, it also provides the right of resident councils to hold at least part of each meeting in private without the presence of any facility personnel in order to promote a free exchange of ideas.

In addition, the law specifies how a facility must assist residents in maintaining a resident council, including, but not limited to the following:

• Scheduling regular meetings;
• Providing space for meetings;
• Posting notice for meetings;
• Providing assistance in attending meetings for those residents who request it; and
• Preparing written reports of meetings for dissemination to all residents.

Other requirements set in state law include:

• Facilities must encourage residents to attend meetings, but may not require attendance; and
• If no resident councils exists, the facility must explain to residents the general purpose of a resident council and remind them yearly that they may establish a resident council and that the facility will assist in its formation and maintenance.

Standards of Licensed Assisted Living Facilities
22 VAC 40-72-810. Resident Councils

Federal law gives family members of nursing homes that accept Medicare and Medicaid the right to form as a group (a “family council”) and hold regular private meetings. Further more, the nursing home must provide a meeting space, cooperate with the council’s activities, and respond to the group’s concerns. Nursing homes must appoint a staff advisor or liaison to the family council, but staff and administrators have access to council meetings only by invitation. While the federal law specifically references “families” of residents, close friends of residents can and should be encouraged to play an active role in family councils, too.

Federal law states:

• A resident’s family has the right to meet in the facility with the families of other residents in the facility.
• The facility must provide a family group, if one exists, with private space.
• Staff or visitors may attend meetings at the group’s invitation.
• The facility must provide a designated staff person responsible for providing assistance and responding to written requests that result from group meetings.
• When a family group exists, the facility must listen to the views and act upon the grievances and recommendations of residents and families concerning proposed policy and operational decisions affecting resident care and life in the facility.

42 CFR sec.483.15(c)

Many assisted living facilities encourage the establishment of family councils as a way to involve family members of residents and to preemptively problem solve. Virginia law does not provide specific rights to family councils in assisted living facilities. It does say a resident council may extend its membership to family members, advocates, friends, and others. If your loved one’s assisted living facility does not have a family council, talk to the facility administrator about starting one. Some of the materials for family councils in nursing homes may be helpful to consider for ideas for family councils in assisted living facilities.