The Nursing Home Reform Act of 1987, enacted as part of the Omnibus Budget Reconciliation Act, established a federal floor of rights for residents in any nursing facility that participates in Medicare or Medicaid. Because the vast majority of US nursing homes accept at least one of these programs, the law has broad reach. The corresponding federal regulations — found at 42 CFR Part 483 — spell out a detailed Resident Bill of Rights covering everything from dignity and self-determination to financial protections and discharge procedures.

Assisted living occupies different legal ground. No comparable federal statute governs these facilities, so protections are created entirely by state law. Some states have robust resident rights statutes; others offer minimal statutory guidance. If a loved one is entering assisted living, reviewing the specific state licensing rules is an essential step — not just the admissions contract the facility provides.

For a broader view of how legal protections apply across different senior housing arrangements, see our comparison of rights in rental and senior community settings.

Core Rights Every Nursing Home Resident Holds

Federal regulations organize resident rights into several categories. Understanding each one helps residents and families recognize when a facility may be falling short of its legal obligations.

1.2 million

Certified nursing facility residents in the US

According to the Centers for Medicare & Medicaid Services, approximately 1.2 million people reside in Medicare- and Medicaid-certified nursing facilities on any given day.

800,000+

People living in assisted living communities

The National Center for Assisted Living estimates that more than 800,000 Americans reside in assisted living facilities, a number that has grown steadily with the aging population.

50

Separate state regulatory frameworks for assisted living

Every US state maintains its own licensing laws for assisted living, meaning resident rights protections can differ substantially depending on where a facility is located.

Dignity, Privacy, and Self-Determination

Residents must be treated with respect and dignity at all times. They have the right to make decisions about their own care — including the right to refuse treatment — and to participate in developing their individualized care plan. Privacy rights extend to personal communications, medical records, and visits with family, legal counsel, and the ombudsman.

Financial Protections

Facilities are prohibited from requiring residents to waive their rights to Medicare or Medicaid benefits as a condition of admission. If a facility manages a resident's personal funds, it must maintain a separate account, provide quarterly statements, and return funds promptly upon discharge or death. Residents who pay privately retain the right to know in advance of any rate increases.

Discharge and Transfer Rights

A facility may only discharge or involuntarily transfer a resident for specific permissible reasons: the resident's health needs cannot be met there, the resident no longer needs nursing facility care, the safety or welfare of other residents is endangered, the resident has not paid, or the facility closes. A written notice of at least 30 days is required in most circumstances, and the notice must explain the resident's right to appeal.

Keep a Written Record of Care Concerns

Residents and family members should document care concerns in writing — including dates, the names of staff involved, and the nature of the issue. Written records strengthen any complaint filed with a facility administrator, ombudsman, or state licensing agency. Many ombudsmen recommend submitting concerns in writing even when the facility initially receives them verbally.

The Role of the Long-Term Care Ombudsman

The Older Americans Act requires every state to operate a Long-Term Care Ombudsman Program. Ombudsmen are trained advocates who investigate and work to resolve complaints about nursing homes and assisted living facilities. Their services are free and confidential, and residents cannot face retaliation for contacting them.

“The ombudsman program exists to ensure that residents — not institutions — are at the center of long-term care decision-making. Residents have the right to raise concerns without fear, and the ombudsman's job is to make that possible.”

— Administration for Community Living, Federal agency overseeing the Long-Term Care Ombudsman Program under the Older Americans Act

Certified nursing facilities must post the name and contact information of the local ombudsman in a visible location. Families and friends can also reach ombudsmen on behalf of a resident, though the ombudsman's primary obligation is to the resident's wishes — not the family's preferences. To find your state program, the Administration for Community Living maintains a national directory.

Assisted Living: Know Your State's Rules

Because assisted living regulation is entirely a state function, the gap between states can be wide. Some states require facilities to provide residents with a written rights disclosure at admission, guarantee a minimum notice period before discharge, and mandate an external complaint process. Others impose fewer requirements, placing more weight on the language of the individual residency agreement.

Key questions to ask before or shortly after admission include: What are the permissible grounds for discharge? How much notice is required? Who handles complaints? Is there a state-run ombudsman program that covers this facility type? The state's licensing or health department — not the facility — is the authoritative source for these answers.

Understanding the full range of senior housing law also means recognizing how rights change depending on the type of arrangement. Our overview of senior housing rights from lease signing to move-out provides useful context.

This article is for general informational purposes only and does not constitute legal advice. Residents and families facing specific legal concerns should consult a licensed attorney or contact their state's Long-Term Care Ombudsman Program.