Did you know that over 20% of U.S. nursing homes face violations each year, according to the Centers for Medicare & Medicaid Services (CMS)? For families with loved ones in nursing homes, understanding what facilities cannot do is essential to ensuring safety, dignity, and proper care. Knowing the things nursing homes are not allowed to do empowers families to advocate effectively and protect their loved ones from abuse, neglect, and mistreatment. This guide explores 15 prohibited practices, grouped into four key categories: abuse and neglect, care and medical violations, rights and dignity violations, and staffing and facility standards. You will also learn how to spot and report violations and tips for choosing and monitoring nursing homes.
Why Understanding Nursing Home Regulations Matters
The Nursing Home Reform Act of 1987, part of the Omnibus Budget Reconciliation Act (OBRA), establishes federal standards ensuring nursing home residents receive proper care and their rights are protected. Along with CMS guidelines and state laws, these regulations prevent illegal practices in nursing homes. Recent data shows over 15,000 deficiencies cited across nursing homes in 2025 alone, with issues like inadequate staffing and medication errors on the rise, particularly after the pandemic. Understanding these rules helps families recognize red flags, advocate for loved ones, and take action if necessary.
Common myths include the false idea that nursing homes can use restraints freely, or that residents can be evicted without notice. These misconceptions can put residents at risk, so knowing the truth is vital.
Abuse and Neglect Prohibitions
Physical Abuse or Restraints Without Cause
Nursing homes cannot use physical or chemical restraints unless medically necessary and authorized. Unjustified bedrails or sedatives used as convenience measures are illegal. Signs of abuse include unexplained bruises and fearfulness. For example, a 2022 case involved a Florida nursing home penalized for improper restraint use.
Emotional or Psychological Abuse
Verbal threats, humiliation, social isolation, and intimidation are strictly prohibited. Emotional abuse can severely harm mental health and well-being, with nearly 1 in 10 older Americans affected by elder abuse, according to the National Council on Aging.
Sexual Abuse or Exploitation
Sexual abuse is met with zero tolerance. Nursing homes must follow strict reporting requirements, and families should remain vigilant by visiting regularly and encouraging open dialogue.
Financial Exploitation
Unauthorized use of residents’ funds or property is banned. Power of attorney protections exist to prevent misuse, and families should monitor accounts for suspicious activity.
Care and Medical Neglect Bans
Medical Neglect or Delayed Treatment
CMS mandates timely and adequate medical care. Nursing homes cannot delay medications or pain relief, and must respond promptly to health changes.
Failure to Prevent Bedsores or Infections
Proper hygiene and preventive care are required to avoid pressure ulcers and infections. Neglect in this area can lead to serious penalties.
Inadequate Nutrition and Hydration
Residents must receive sufficient, customized nutrition and hydration. Signs of dehydration or malnutrition require immediate attention.
Improper Medication Management
Overmedication, errors, or failure to administer medicine correctly are prohibited. Families should review medication plans and communicate with healthcare providers.
Rights and Dignity Violations
Denying Resident Autonomy and Choice
Residents have the right to make decisions about visitors, activities, and daily schedules. Nursing homes cannot impose rigid routines or restrict freedoms unjustly.
Forced Evictions or Improper Discharges
Facilities must provide a 30-day written notice for discharge, with valid reasons and appeal options. Unlawful evictions are illegal.
Privacy Invasions
Unauthorized room searches or camera installations violate privacy laws and resident rights.
Discrimination Based on Race, Disability, or Paying Status
Nursing homes must comply with the Americans with Disabilities Act and other civil rights laws, ensuring equal treatment regardless of race, disability, or payment method.
Staffing and Facility Standards
Understaffing Leading to Harm
Adequate staffing is required to meet residents’ needs. CMS mandates a minimum of 3.5 hours of direct nursing care per resident daily. Understaffing risks neglect and harm.
Unsafe or Unsanitary Conditions
Facilities must maintain clean, safe environments free of hazards, pests, and fire risks.
False Advertising or Misrepresentation
Nursing homes cannot promise services they do not provide. Transparency is crucial during admissions and marketing.
How to Spot and Report Violations
Watch for red flags such as unexplained injuries, poor hygiene, and behavioral changes. To report violations: contact your State Long-Term Care Ombudsman, call the CMS hotline at 1-800-MEDICARE, or file complaints online via Medicare.gov. Advocacy includes documenting concerns and staying involved in your loved one’s care.
Preventing Issues: Tips for Choosing and Monitoring a Nursing Home
Before selecting a nursing home, review CMS’s Nursing Home Compare ratings, inspect facilities in person, and talk to residents and families. Use technology like video calls or health-monitoring devices to stay connected.
Conclusion
Being aware of the things nursing homes are not allowed to do is fundamental to protecting your loved ones. From preventing abuse to ensuring proper medical care and respecting resident rights, your vigilance and knowledge can make all the difference. Share this information to help others and empower families to advocate for safe, dignified care.
Frequently Asked Questions About Nursing Home Violations
Are nursing homes allowed to use restraints without consent?
No. Restraints require medical justification and consent.
What should I do if I suspect abuse?
Report immediately to your state ombudsman or CMS.
Can nursing homes discharge residents without notice?
No. A 30-day notice and valid reasons are required.
How to find a safe nursing home?
Use Medicare’s Nursing Home Compare and visit facilities personally.
What rights do residents have?
Rights include dignity, privacy, autonomy, and proper care.