Nursing home residents keep their rights when they move in, and nurse aides are the staff who protect them hour by hour. Federal rules for nursing facilities set those rights out in 42 CFR 483.10 and 483.12.
Dignity and respect
Each resident has a right to a dignified existence, self-determination, and communication with people and services inside and outside the facility (42 CFR 483.10(a)). Staff must treat every resident with respect and dignity and recognize the resident's individuality (42 CFR 483.10(a)(1)). Equal access to quality care applies regardless of diagnosis, severity of condition or payment source (42 CFR 483.10(a)(2)).
Respect shows up in small daily acts. Residents may keep and use personal possessions, including furnishings and clothing, as space permits (42 CFR 483.10(e)(2)). They may receive written notice, with the reason, before a room or roommate changes (42 CFR 483.10(e)(6)). They may refuse a room transfer that is solely for staff convenience (42 CFR 483.10(e)(7)).
Choice and self-determination
Residents choose activities, schedules (including sleeping and waking times), health care and providers, consistent with their assessments and care plan (42 CFR 483.10(f)(1)). They may receive visitors of their choosing at the time of their choosing, and may deny or withdraw consent to a visitor at any time (42 CFR 483.10(f)(4)). Visitation may not be restricted on the basis of race, color, national origin, religion, sex, gender identity, sexual orientation or disability (42 CFR 483.10(f)(4)(vi)(C)).
Residents also have a right to take part in their own care. They can be informed of their condition in language they understand, take part in the care plan, and request, refuse or discontinue treatment (42 CFR 483.10(c)(1), (c)(2), (c)(6)). A resident who refuses care is exercising a right. The aide's job is to report the refusal to the nurse, not to argue or force the task. A resident is also not required to work for the facility, and may choose whether to do so (42 CFR 483.10(f)(9)), and is not required to deposit personal funds with it (42 CFR 483.10(f)(10)(i)).
Privacy and confidentiality
A resident has a right to personal privacy and to confidentiality of personal and medical records (42 CFR 483.10(h)). Privacy covers accommodations, medical treatment, written and telephone communications, personal care, visits and meetings, though it does not require a private room (42 CFR 483.10(h)(1)). In practice, aides close curtains and doors during personal care and keep resident information to those who need it for care.
Residents may send and receive mail promptly and unopened (42 CFR 483.10(h)(2)). They have reasonable access to a telephone in a place where calls cannot be overheard (42 CFR 483.10(g)(6)), and reasonable access to and privacy in email and video communications (42 CFR 483.10(g)(9)).
Grievances without reprisal
Residents may voice grievances to the facility or an outside agency, without discrimination or fear of reprisal. Grievances can cover care that was or was not provided, staff and resident behavior, and other concerns about the stay (42 CFR 483.10(j)(1)). The facility must work promptly to resolve them and must make information on how to file available (42 CFR 483.10(j)(2)-(3)). Its grievance policy must allow oral or written grievances and anonymous ones, and name a grievance official (42 CFR 483.10(j)(4)). Evidence of grievance results is kept at least 3 years (42 CFR 483.10(j)(4)(vii)). If a resident tells you they are unhappy, do not discourage them or treat them differently; pass it on through the facility's process.
Freedom from abuse, neglect and restraint
Residents are free from abuse, neglect, misappropriation of property and exploitation, including corporal punishment and involuntary seclusion (42 CFR 483.12). Facilities may not use verbal, mental, sexual or physical abuse (42 CFR 483.12(a)(1)). Exploitation means taking advantage of a resident for personal gain through manipulation, intimidation, threats or coercion, and misappropriation means deliberately misplacing or wrongly using a resident's belongings or money without consent (42 CFR 483.5).
Residents are also free from physical or chemical restraints imposed for discipline or convenience and not required to treat medical symptoms (42 CFR 483.10(e)(1); 483.12(a)(2)). When a restraint is indicated, the least restrictive alternative must be used for the least amount of time, with ongoing re-evaluation of the need documented (42 CFR 483.12(a)(2)). An aide never decides to restrain a resident alone.
Your reporting duties
Covered individuals must report any reasonable suspicion of a crime against a resident to the State agency and local law enforcement. The deadline is immediately, and no later than 2 hours, if the events result in serious bodily injury, or no later than 24 hours if they do not (42 CFR 483.12(b)(5)(i)). Alleged violations involving abuse or serious bodily injury, including injuries of unknown source, are reported to the administrator and other officials immediately and no later than 2 hours. Other alleged violations are reported within 24 hours (42 CFR 483.12(c)(1)). The facility must investigate thoroughly, protect residents during the investigation, and report results within 5 working days (42 CFR 483.12(c)(2)-(4)).
The facility must also prevent retaliation against people who report (42 CFR 483.12(b)(5)(iii)). The practical rule for an aide: report what you see or hear at once, to your supervisor and through the facility's process, and do not wait to gather proof or decide whether it is serious enough.
Practice CNA written exam questions with explanations and timed mock exams.