Regulations for Skilled Nursing Facilities

U.S. Department of Health, Education and Welfare


The following list of patients' rights forms part of the regulations approved for the Social Security Administration of the U.S. Department of Health, Education and Welfare, effective 2 December 1974, for skilled nursing facilities which participate in Medicare and Medicaid health insurance programs for the aged and disabled. These regulations are significant because they have the force of law in all fifty states of the United States.

These regulations were extended, with appropriate changes, to institutions for the mentally retarded or for per­sons with related conditions (intermediate care facilities), effective 23 June 1976. Because of objections raised against the 1974 regulations, the italicized phrases were omitted from the regulations for intermediate care facilities.

Patients' Rights. The governing body of the facility establishes written policies regarding the rights and respon­sibilities of patients and, through the administrator, is responsible for development of, and adherence to, procedures implementing such policies. These policies and procedures are made available to patients, to any guardians, next of kin, sponsoring agency(ies), or representative payees..., and to the public. The staff of the facility is trained and in­volved in the implementation of these policies and procedures. These patients' rights policies and procedures ensure that, at least, each patient admitted to the facility:

(1)    Is fully informed, as evidenced by the patient's written acknowledgment, prior to or at the time of admission and during stay, of these rights and of all rules and regulations governing patient conduct and responsibilities; 

(2)    Is fully informed. prior to or at the time of admission and during stay, of services available in the facility, and of related charges including any charges for services not covered [by] the Social Security Act, or not cov­ered by the facility's basic per diem rate;

(3)     Is fully informed, by a physician, of his medical condition unless medically contraindicated (as documented, by a physician, in his medical record), and is afforded the opportunity to participate in the planning of his medical treatment and to refuse to participate in experimental research 

(4)    Is transferred or discharged only for medical reasons, or for his welfare or that of other patients, or for non-payment of his stay (except as prohibited by titles XVIII or XIX of the Social Security Act), and is given reasonable advance notice to ensure orderly transfer or discharge, and such actions are documented in his med­ical record; 

(5)    Is encouraged and assisted, throughout his period of stay, to exercise his rights as a patient and as a citizen, and to this end may voice grievances and recommend changes in policies and services to facility staff and/or to outside representatives of his choice, free from restraint, interference, coercion, discrimination, or reprisal; 

(6)    May manage his personal financial affairs, or is given at least a quarterly accounting of financial transactions made on his behalf should the facility accept his written delegation of this responsibility to the facility for any period of time in conformance with State law;

(7)    Is free from mental and physical abuse, and free from chemical and (except in emergencies) physical restraints except as authorized in writing by a physician for a specified and limited period of time, or when necessary to protect the patient from injury to himself or to others; 

(8)    Is assured confidential treatment of his personal and medical records, and may approve or refuse their release to any individual outside the facility, except, in case of his transfer to another health care institution, or as required by law or third-party payment contract; 

(9)    Is treated with consideration, respect, and full recognition of his dignity and individuality, including privacy in treatment and in care for his personal needs; 

(10)    Is not required to perform services for the facility that are not included for therapeutic purposes in his plan of care;

(11)    May associate and communicate privately with persons of his choice. and send and receive his personal mail unopened, unless medically contraindicated (as documented by his physician in his medical record); 

(12)    May meet with, and participate in activities of, social, religious, and community groups at his discretion, unless medically contraindicated (as documented by his physician in his medical record); 

(13)    May retain and use his personal clothing and possessions as space permits, unless to do so would infringe upon rights of other patients, and unless medically contraindicated (as documented by his physician in his medical record); and 

(14)    If married, is assured privacy for visits by his/her spouse; if both are inpatients in the facility, they are per­mitted to share a room, unless medically contraindicated (as documented by the attending physician in the medical record).

All rights and responsibilities specified in paragraphs...(l) through (4) of this section—as they pertain to (a) a patient adjudicated incompetent in accordance with State law, (b) a patient who is found, by his physician, to be medically incapable of understanding these rights, or (c) a patient who exhibits a communication barrier-devolve to such patient's guardian, next of kin, sponsoring agency(ies), or representative payee (except when the facility itself is representative payee) selected pursuant to section 205 (j) of the Social Security Act and Subpart Q of Part 404 of this chapter.

[Federal Register, vol. 39, no. 193, part II (3 October 1974), pp. 35775-35776, and Federal Register, vol. 41, no. 61 (29 March 1976), pp. 12884-12885.]