The Vermont Statutes Online

Title 33: Human Services

Chapter 073: Nursing Home Residents' Bill of Rights

• § 7301. Nursing Home Residents’ Bill of Rights

  The General Assembly hereby adopts the Nursing Home Residents’ Bill of Rights as follows:

  (1) The governing body of the facility shall establish written policies regarding the rights and responsibilities of residents and, through the administrator, is responsible for development of, and adherence to, procedures implementing such policies. These policies and procedures shall be made available to residents; to any guardians, next of kin, sponsoring agency, or representative payees selected pursuant to subsection 205(j) of the Social Security Act and 20 C.F.R. Part 404, Subpart U; and to the public.

  (2) The staff of the facility shall ensure that, at a minimum, each individual admitted to the facility:

  (A) Is fully informed, as evidenced by the resident’s written acknowledgment, prior to or at the time of admission and during the stay, of these rights and of all rules and regulations governing resident conduct and responsibilities. Reasonable accommodation shall be made to communicate the Residents’ Bill of Rights to residents with communication impairments and residents who speak a language other than English.

  (B) Is fully informed, prior to or at the time of admission and during the stay, of services available in the facility and of related charges, including any charges for services not covered under Title XVIII or XIX of the Social Security Act, or not covered by the facility’s basic per diem rate, including the facility’s policy on providing toiletries, adult briefs, wheelchairs, and all personal care and medical items. The facility shall inform residents in writing about Medicaid and Medicare eligibility and what is covered under those programs, including information on resource limits and allowable uses of the resident’s income for items and services not covered by Medicaid and Medicare. The facility shall inform residents or their guardians or agents in writing about eligibility for hospice services and the circumstances under which hospice services may be available.

  (C) Is fully informed, by a physician, of the medical condition, and is afforded the opportunity to participate in the planning of the medical treatment and to refuse to participate in experimental research.

  (D) Is transferred or discharged only for medical reasons, or for the resident’s welfare or that of other residents, or for nonpayment of the resident’s stay (except as prohibited by Title 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 the resident’s medical record. Residents shall be notified in writing of the proposed transfer or discharge and reasons for it at least 72 hours before a transfer within the facility and 30 days before a discharge from the facility. In cases in which the health or safety of individuals would be endangered, or an immediate transfer or discharge is required by the resident’s urgent medical needs, notice shall be made as soon as practicable before transfer or discharge. Notice shall explain the resident’s right to appeal the proposed action under the facility’s grievance procedure and shall include the address and phone number of the area ombudsman. The resident informed of this right may choose to relocate before the notice period ends. The facility shall make reasonable efforts to accommodate new residents without disrupting room assignments.

  (E) Is encouraged and assisted, throughout the resident’s period of stay, to exercise the individual’s rights as a resident and as a citizen, and to this end may voice grievances and recommend changes in policies and services to facility staff or to outside representatives of the resident’s choice, free from restraint, interference, coercion, discrimination, or reprisal.

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

  (G) 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 resident from self-injury or injury to others. The facility shall inform residents of its restraint policy and appeal rights under the facility’s grievance procedure. The policy must include the release of the restraints no less than every two hours for 10 minutes for exercise or repositioning. The resident has the right to be free from any physical restraints imposed or psychoactive drugs administered for purposes of discipline or convenience.

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

  (I) Is treated with consideration, respect, and full recognition of the resident’s dignity and individuality, including privacy in treatment and in care for the resident’s personal needs.

  (J) Is not required to perform services for the facility that are not included for therapeutic purposes in the resident’s plan of care.

  (K) May associate and communicate privately with persons of the resident’s choice, and send and receive the resident’s personal mail unopened.

  (L) May meet with, and participate in activities of, social, religious, and community groups at the resident’s discretion.

  (M) May retain and use the resident’s personal clothing and possessions as space permits, unless to do so would infringe upon rights of other residents.

  (N) If married, is assured privacy for visits by the resident’s spouse; if both are residents of the facility, they are permitted to share a room.

  (O) Shall have the right to choose the resident’s own personal physician and the right to request a second opinion from a physician of the resident’s choice if significant alternatives for care or treatment exist. If the resident requests information concerning care or treatment alternatives, the resident has the right to receive such information from the resident’s doctor or the administrators as appropriate.

  (P) To the extent permitted by law, has the right to refuse care or treatment, including the right to discharge himself or herself from the facility, and to be informed of the consequences of that action, and the nursing home shall be relieved of any further responsibility for that refusal.

  (Q) Is assured reasonable access to a telephone located in a quiet area where the resident can conduct a private conversation.

  (R) Has the right to return to the first available bed in the nursing home the resident came from after hospitalization if the patient has not retained the resident’s bed under subdivision (S) of this subdivision (2), provided the facility is able to meet the resident’s medical needs and that the resident’s welfare or that of other residents will not be adversely affected.

  (S) Has the right upon payment of the resident’s usual rate or, in the case of Medicaid residents, the resident’s certified per diem compensation, to retain the resident’s bed in the nursing home while absent from the facility due to hospitalization, provided such absence does not exceed 10 successive days.

  (T) Is provided with professional assessment of pain and its management.

  (3) The staff of the facility shall ensure that the residents and their families:

  (A) Shall have the right to organize, maintain, and participate in either resident or family councils, or both. The facility shall provide space and, if requested, assistance for meetings. Council meetings shall be afforded privacy, with staff or visitors attending only at the council’s invitation. The facility shall respond in writing to written requests from council meetings. Resident councils and family councils shall be encouraged to make recommendations regarding facility policies.

  (B) Shall have the right to review current and past State and federal survey and inspection reports of the facility and, upon request, to receive a copy of any report from the facility. Copies of reports shall be available for review at any time at one station in the facility. The facility may charge a reasonable amount for more than one copy per resident. (Added 1985, No. 153 (Adj. Sess.); amended 1989, No. 71, § 1; 1999, No. 91 (Adj. Sess.), § 36; 2003, No. 162 (Adj. Sess.), § 14; 2015, No. 23, § 49; 2021, No. 20, § 364; 2021, No. 105 (Adj. Sess.), § 627, eff. July 1, 2022.)

• § 7302. Adoption of grievance procedure

  (a) [Repealed.]

  (b) A resident grievance mechanism plan shall include a method by which each resident filing a grievance will be made aware of the State Long-Term Care Ombudsman and that the Ombudsman may be contacted as an alternative or in addition to the home’s grievance mechanism. As used in this section, “Ombudsman” means the State Long-Term Care Ombudsman established in chapter 75 of this title pursuant to the Older Americans Act of 1965, as amended.

  (c) The grievance mechanism within the facility will provide, at a minimum:

  (1) designation of employees responsible for handling and assessing the validity of a grievance or recommendation;

  (2) a method of investigating and assessing the validity of a grievance or recommendation;

  (3) methods of resolving grievances; and

  (4) methods of recording grievances and actions taken.

  (d) Complaints that cannot be resolved by the grievance procedure within the facility shall be referred to the Ombudsman within seven working days.

  (e) Within seven days of receipt of the complaint, the Ombudsman shall notify the complainant and the nursing home that an investigation has been initiated and that a written report will be made to the complainant and the nursing home within 14 days. (Added 1985, No. 153 (Adj. Sess.); amended 1989, No. 71, § 2; 1989, No. 219 (Adj. Sess.), § 9(a); 2005, No. 174 (Adj. Sess.), § 135; 2021, No. 20, § 365; 2023, No. 53, § 130, eff. June 8, 2023.)

• § 7303. Notice to residents; posting

  (a) A summary of the obligations of the nursing home to residents using its facilities shall be written in clear language, in easily readable print, and posted conspicuously in a public place on each floor of the home. This notice shall also summarize the facility’s grievance procedure and directions for contacting the Office of the State Long-Term Care Ombudsman. The directions for contacting the Office of the State Long-Term Care Ombudsman shall be written by the Department of Disabilities, Aging, and Independent Living; shall include a description of the Ombudsman program; and shall be underscored.

  (b) A readable copy of this same notice shall be presented to each resident on admission together with an oral explanation of the rights, grievance procedure, and directions for contacting the Office of the State Long-Term Care Ombudsman. (Added 1985, No. 153 (Adj. Sess.); amended 1989, No. 71, § 3; 1989, No. 219 (Adj. Sess.), § 5; 2005, No. 174 (Adj. Sess.), § 136; 2013, No. 131 (Adj. Sess.), § 92, eff. May 20, 2014; 2021, No. 20, § 366.)

• § 7304. Administrative penalty

  The Commissioner of Disabilities, Aging, and Independent Living may, after a hearing, impose an administrative penalty of not more than $1,000.00 against any facility or employee of a facility who violates a provision of this chapter. (Added 1985, No 153 (Adj. Sess.); amended 1989, No. 219 (Adj. Sess.), § 6; 2005, No. 174 (Adj. Sess.), § 137.)

• § 7305. Readmission

  Notwithstanding any provision of this chapter to the contrary, a facility may petition the Commissioner of Disabilities, Aging, and Independent Living to deny readmission to the facility of any former resident returning from a period of hospitalization. A petition shall be made as soon as possible after the hospitalization of the resident and only shall be granted if in the judgment of the Commissioner, upon consultation with the State Long-Term Care Ombudsman, the resident has exhibited a nonremedial pattern of violent behavior that poses a danger to others. (Added 1985, No. 153 (Adj. Sess.); amended 1989, No. 71, § 4; 1989, No. 219 (Adj. Sess.), § 7; 2005, No. 174 (Adj. Sess.), § 138; 2021, No. 20, § 367.)

• § 7306. Resident’s representative

  (a) Except as provided in subsection (b) of this section, the rights and obligations established under this chapter shall devolve to a resident’s guardian, next of kin, sponsoring agency, or representative payee (except when the facility itself is a representative payee) if the resident:

  (1) has been adjudicated incompetent;

  (2) has been found by his or her physician to be medically incapable of understanding or exercising the rights granted under this chapter; or

  (3) exhibits a communication barrier.

  (b) Notwithstanding the provisions of subsection (a) of this section, consent for a do-not-resuscitate order or a clinician order for life-sustaining treatment shall be provided or withheld only by the resident, by the resident’s guardian or agent, or by a surrogate designated pursuant to 18 V.S.A. chapter 231, subchapter 2.

  (c)(1) A resident’s representative identified in subsections (a) and (b) of this section shall make decisions for the resident by attempting to determine what the resident would have wanted under the circumstances. In making the determination, the resident’s representative shall consider the following:

  (A) the resident’s specific instructions or wishes as expressed to a spouse, adult child, parent, adult sibling, adult grandchild, clergy person, health care provider, or any other adult who has exhibited specific care or concern for the resident; and

  (B) the representative’s knowledge of the resident’s personal preferences, values, or religious or moral beliefs.

  (2) If the resident’s representative cannot determine what the resident would have wanted under the circumstances, the representative shall make a determination through an assessment of the resident’s best interests. When making a decision for the resident on this basis, the representative shall not authorize the provision or withholding of health care on the basis of the resident’s economic status or a preexisting, long-term mental or physical disability.

  (3) When making a determination under this section, representatives shall not consider their own interests, wishes, values, or beliefs.

  (d) Notwithstanding the provisions of subsection (a) of this section, the facility shall make every reasonable effort to communicate the rights and obligations established under this chapter directly to the resident. (Added 1985, No. 153 (Adj. Sess.); amended 1989, No. 71, § 5; 1999, No. 91 (Adj. Sess.), § 37; 2013, No. 131 (Adj. Sess.), § 93, eff. May 20, 2014; 2015, No. 23, § 50; 2015, No. 136 (Adj. Sess.), § 2, eff. Jan. 1, 2018.)