Know rights, protections in a nursing home
Nursing homes, now more commonly known as Skilled Nursing Facilities (SNFs), serve as licensed healthcare residences for individuals who require a higher level of medical care than can be provided in an assisted living facility or at home. Residents in a Medicare and/or Medicaid-certified nursing home have certain rights and protections under federal and state law. These rights and protections help make sure you get the care and services you need. You have the right to be informed, make your own decisions, and have your personal information kept private.
The nursing home must tell you about these rights and explain them in writing in a language you understand. They must also explain in writing:
• How you should act while you’re in the nursing home
• What you’re responsible for while you’re in the nursing home
This must be done before or at the time you’re admitted, as well as during your stay. You must acknowledge in writing that you received this information.
At a minimum, federal law states that a nursing home must protect and promote the rights of each resident. You have guaranteed rights and protections as a person with Medicare. These Medicare rights include:
Be treated with dignity and respect at all times; Be protected from discrimination; Have your personal and health information kept private; Get information in a way you understand from Medicare, health care providers, and, under certain circumstances, contractors.
Get understandable information about Medicare to help you make health care decisions, including: What’s covered, What Medicare pays; How much you have to pay and What to do if you want to file a complaint or appeal. You have the right to have your questions about Medicare answered; Have access to doctors, specialists, and hospitals; Learn about your treatment choices in clear language that you can understand, and participate in treatment decisions; Get health care services in a language you understand and in a culturallysensitive way; Get Medicare-covered services in an emergency; Get a decision about health care payment, coverage of services, or prescription drug coverage.
When a claim is filed, you get a notice letting you know what will and won’t be covered. The notice may come from Medicare, your Medicare Advantage Plan (Part C), your other Medicare health plan or your Medicare Prescription Drug Plan (Part D). If you disagree with the decision of your claim, you have the right to file an appeal; Request a review (appeal) of certain decisions about health care payment, coverage of services, or prescription drug coverage. If you disagree with a decision about your claims or services, you have the right to appeal and file complaints (sometimes called “grievances”), including complaints about the quality of your care.
In addition, your rights as a nursing home resident include the right to:
Be free from discrimination; Be free from abuse and neglect; Exercise your rights as a U.S. citizen; Have your personal representative notified; Get proper medical care; Be treated with respect; Be free from restraints; Have protections against involuntary transfer or discharge; Participate in activities; Spend time with visitors; Form or participate in resident groups; Manage your money; Get information on services and fees; Get proper privacy, property, and living arrangements; Make complaints.
Mike Zimmer is president of Bay State Insurance Agency Ltd. in Centreville. He is available to answer your questions or speak to your groups regarding Medicare, Medicare Advantage, Medicare Supplements, Medicare Part D (Prescription Plans) and Home Health Care Indemnity Plans. He may be reached at 410-758-1680.