Alabama Administrative Code
Title 420 - ALABAMA STATE BOARD OF HEALTH
Chapter 420-5-10 - NURSING FACILITIES
Section 420-5-10-.05 - Resident Right
Universal Citation: AL Admin Code R 420-5-10-.05
Current through Register Vol. 42, No. 11, August 30, 2024
(1) Resident rights. The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility. A facility must protect and promote the rights of each resident, including each of the following rights
(2) Exercise of rights.
(a) The resident has the right to exercise
his or her rights as a resident of the facility and as a citizen or resident of
the United States
(b) The resident
has the right to be free of interference, coercion, discrimination, and
reprisal from the facility in exercising his or her rights
(c) In the case of a resident adjudged
incompetent under the laws of a State by a court of competent jurisdiction, the
rights of the resident are exercised by the person appointed under State law to
act on the resident's behalf.
(d)
In the case of a resident who has not been judged incompetent by the State
court, any legal-surrogate designated in accordance with State law may exercise
the resident's right to the extent provided by State law.
(3) Notice of rights and services
(a) The facility must inform the resident
both orally and in writing in a language that the resident understands of his
or her rights and all rules and regulations governing resident conduct and
responsibilities during the stay in the facility. Such notification must be
made prior to or upon admission and during the resident's stay. Receipt of such
information, and many amendments to it, must be acknowledged in
writing.
(b) The resident or his or
her legal representative has the right:
1.
Upon an oral or written request, to access all records pertaining to himself or
herself including current clinical records within 24 hours(excluding weekends
and holidays); and
2. After receipt
of his or her records for inspection, to purchase at a cost not to exceed the
community standard photocopies of the records or any portions of them upon
request and two working days advance notice of the facility.
(c) The resident has the right to
be fully informed in language that he or she can understand of his or her total
health status, including but not limited to, his or her medical
condition.
(d) The resident has the
right to refuse treatment, to refuse to participate in experimental research,
and to formulate an advance directive as specified in paragraph (h) of this
section; and
(e) The facility must:
1. Inform each resident who is entitled to
Medicaid benefits, in writing, at the time of admission to the nursing facility
or, when the resident becomes eligible for Medicaid of:
(i) The items and services that are included
in nursing facility services under the State plan for which the resident may
not be charged.
(ii) Those other
items and services that the facility offers and for which the resident may be
charged, and the amount of charges for those services; and
2. Inform each resident when changes are made
to the items and services specified in paragraphs (e)1(i) & (ii)
above.
(f) The facility
must inform each resident before, or at the time of admission, and periodically
during the resident's stay, of services available in the facility and of
charges for those services, including any charges for services not covered
under Medicare or by the facility's per diem rate.
(g) The facility must furnish a written
description of legal rights which includes:
1. A description of the manner of protecting
personal funds.
2. A description of
the requirements and procedures for establishing eligibility for Medicaid,
including the right to request an assessment by the State Medicaid Agency to
determine the extent of a couple's non-exempt resources at the time of
institutionalization and attributes to the community spouse an equitable share
of resources which cannot be considered available for payment toward the cost
of the institutionalized spouse's medical care in his or her process of
spending down to Medicaid eligibility levels;
3. A posting of names, addresses, and
telephone numbers of all pertinent State client advocacy groups such as the
State survey and certification agency, the State licensure office, the State
ombudsman program, the protection and advocacy network, and the Medicaid fraud
control unit; and
4. A statement
that the resident may file a complaint with the State survey and certification
agency concerning resident abuse, neglect, and misappropriation of resident
property in the facility.
(h) The facility must maintain written
policies and procedures regarding advance directives. These requirements
include provisions to inform and provide written information to all adult
residents concerning the right to accept or refuse medical or surgical
treatment and, at the individual's option, formulate an advance directive. This
includes a written description of the facility's policies to implement advance
directives.
(i) The facility must
inform each resident of the name, specialty, and a way of contacting the
physician responsible for his or her care.
(j) The facility must prominently display in
the facility written information, and provide to residents and applicants for
admission oral and written information about how to apply for and use Medicare
and Medicaid benefits, and how to receive refunds for previous payments covered
by such benefits.
(k) Notification
of changes. A facility must immediately inform the resident; consult with the
resident's physician; and if known, notify the resident's legal representative
or an interested family member when there is:
1. An accident involving the resident which
results in injury and has the potential for requiring physician
intervention;
2. A significant
change in the resident's physical, mental, or psychosocial status (i.e., a
deterioration in health, mental, or psychosocial status in either
life-threatening conditions or clinical complications);
3. A need to alter treatment significantly
(i.e., a need to discontinue an existing form of treatment due to adverse
consequences, or to commence a new form of treatment); or
4. A decision to transfer or discharge the
resident from the facility as specified in Section
420-5-10-.06.
(l) The facility must also
promptly notify the resident and, if known, the resident's legal representative
or interested family member where there is:
1. A change in room or roommate assignment;
or
2. A change in resident rights
under Federal or State law or regulations.
(m) The facility must record and periodically
update the address and phone number of the resident's legal representative or
interested family member.
(n)
Protection of Resident Funds. The resident has the right to manage his or her
financial affairs, and the facility may not require residents to deposit their
personal funds with the facility.
(o) Management of personal funds. Upon
written authorization of a resident, the facility must hold, safeguard, manage,
and account for the personal funds of the resident deposited with the
facility.
(p) Deposit of funds.
1. Funds in excess of $50. The facility must
deposit any resident's personal funds in excess of $50 in an interest bearing
account (or accounts) that is separate from any of the facility's operating
accounts, and that credits all interest earned on residents funds to that
account. (In pooled accounts, there must be a separate accounting for each
resident's share).
2. Funds less
than $50. The facility must maintain a residents personal funds that do not
exceed $50 in a non-interest bearing account, interest-bearing account, or
petty cash fund.
(q)
Accounting and records. The facility must establish and maintain a system that
assures a full and complete and separate accounting, according to generally
accepted accounting principles, of each resident's personal funds entrusted to
the facility on the resident's behalf.
1. The
system must preclude any co-mingling of resident funds with facility funds or
with the funds of any person other than another resident.
2. The individual financial records must be
available through quarterly statements and on request to the resident or his or
her legal representative.
(r) Notice of certain balances. The facility
must notify each resident that receives Medicaid benefits:
1. When the amount in the resident's account
reaches $200 less than the SSI resource limit for one person; and
2. That, if the amount in the account, in
addition to the value of the resident's other nonexempt resources, reaches the
SSI resource limit for one person, the resident may lose eligibility for
Medicaid or SSI.
(s)
Conveyance upon death. Upon the death of a resident with a personal fund
deposited with the facility, the facility must convey within 30 days the
resident's funds, and a final accounting of those funds, to the individual or
probate jurisdiction administering the resident's estate.
(t) Assurance of financial security. The
facility must purchase a surety bond, or otherwise provide assurance
satisfactory to the Secretary, to assure the security of all personal funds of
residents deposited with the facility.
(u) Limitation on charges to personal funds.
The facility may not impose a charge against the personal funds of a resident
for any item or service for which payment is made under Medicaid and
Medicare.
(v) Free choice. The
resident has the right to:
1. Choose a
personal attending physician;
2. Be
fully informed in advance about care and treatment and of any changes in that
care or treatment that may affect the resident's well-being; and
3. Unless adjudged incompetent or otherwise
found to be incapacitated under the laws of the State, participate in planning
care and treatment or changes in care and treatment.
(w) Privacy and confidentiality. The resident
has the right to personal privacy and confidentiality of his or her personal
and clinical records.
1. Personal privacy
includes accommodations, medical treatment, written and telephone
communications, personal care, visits, and meetings of family and resident
groups, but this does not require the facility to provide a private room for
each resident;
2. Except as
provided in paragraph (i)(ii) below, the resident may approve or refuse the
release of personal and clinical records to any individual outside the
facility;
3. The resident's right
to refuse release of personal and clinical records does not apply when:
(i) The resident is transferred to another
health care institution; or
(ii)
Record release is required by law.
(x) Grievances. A resident has the right to:
1. Voice grievances without discrimination or
reprisal. Such grievances include those with respect to treatment which has
been furnished as well as that which has not been furnished; and
2. Prompt efforts by the facility to resolve
grievances the resident may have, including those with respect to the behavior
of other residents.
(y)
Examination of survey results. A resident has the right to:
1. Examine the results of the most recent
survey of the facility conducted by Federal or State surveyors and any plan of
correction in effect with respect to the facility.
2. In a place readily accessible to
residents, the facility must make the results available for examination and
must post either the results themselves or a notice of their availability;
and
3. Receive information from
agencies acting as client advocates, and be afforded the opportunity to contact
these agencies.
(z)
Work. The resident has the right to:
1.
Refuse to perform services for the facility;
2. Perform services for the facility, if he
or she chooses, when:
(i) The facility has
documented the need or desire for work in the plan of care;
(ii) The plan specifies the nature of the
services performed and whether the services are voluntary or paid;
(iii) Compensation for paid services is at or
above prevailing rates; and
(iv)
The resident agrees to the work arrangement described in the plan of
care.
(aa)
Mail. The resident has the right to privacy in written communications,
including the right to:
1. Send and promptly
receive mail that is unopened; and
2. Have access to stationery, postage, and
writing implements at the resident's own expense.
(bb) Access and visitation reports. The
resident has the right and the facility must provide immediate access to any
resident by the following:
1. Any
representative of the Secretary;
2.
Any representative of the State;
3.
The resident's individual physician;
4. The State long term care ombudsman
(established under Section 712 of the Older Americans Act of 1965 as amended);
5, The Alabama Developmental
Disabilities Advocacy Program (ADDAP) at the University of Alabama School of
Law.
6. Subject to the resident's
right to deny or withdraw consent at any time, immediate family or other
relatives of the resident; and
7.
Subject to reasonable restrictions and the resident's right to deny or withdraw
consent at any time, others who are visiting with the consent of the
resident.
(cc) The
facility must provide reasonable access to any resident by any entity or
individual that provides health, social, legal, or other services to the
resident, subject to the resident's right to deny or withdraw consent at any
time.
(dd) The facility must allow
representatives of the State Ombudsman, described in paragraph (bb)4 above of
this section, to examine a resident's clinical records with the permission of
the resident or the resident's legal representative, and consistent with State
law.
(ee) Telephone. The resident
has the right to have reasonable access to the use of a telephone where calls
can be made without being overheard.
(ff) Personal property. The resident has the
right to retain and use personal possessions, including some furnishings, and
appropriate clothing, as space permits, unless to do so would infringe upon the
rights or health and safety of other residents.
(gg) Married couples. The resident has the
right to share a room with his or her spouse when married residents live in the
same facility and both spouses consent to the arrangement.
(hh) Self-Administration of Drugs. An
individual resident may self-administer drugs if the interdisciplinary team,
has determined that this practice is safe.
(ii) Refusal of Certain Transfers. An
individual has the right to refuse a transfer to another room within the
facility, if the purpose of the transfer is to relocate.
Author: Patricia E. Ivie
Statutory Authority: Code of Ala. 1975, §§ 22-21-20, et seq.
Disclaimer: These regulations may not be the most recent version. Alabama may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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