Saturday, September 22, 2012

Life in Assisted Living - Terry Gross interviews Martin Bayne

On my walk this Saturday morning I listened to a Terry Gross interview of Martin Bayne on the National Public Radio program Fresh Air.

Mr. Bayne, a former journalist and monk was forced to move to an assisted living facility as age 52 due to young onset Parkinson’s disease. He was a generation younger than most other residents and on a different plane cognitively. So, he has been able to report on life in such a facility in a more articulate way than most residents. He calls himself an “observer-advocate.”

Mr. Bayne says residents suffer from what he calls “ambient despair. ” The despair results from the loneliness and isolation, and burying feelings and emotions that come from being surrounded by dementia, disability, and frequent death.

In  related articles published in Health Affairs and The Washington Post, Mr. Bayne notes that residents "arrive in this, our new society, suddenly disconnected from our past life, possibly ill, often without the comfort and support of a spouse we’d been married to for decades. We eat meals in a dining room filled with strangers and, for perhaps the first time in a half-century, sleep alone in an unfamiliar bed."

In addition to the high levels of disability, depression, dementia and frequency of death, residents experience a profound loss of control and identity. There is a tremendous loss of humanity as residents become what Mr. Bayne calls “elder-zombies.” Death is handled very poorly and hidden away. 

Mr. Bayne does not have much love for the owners and management of most assisted living facilities. But he does appreciate the "staff members — the personal care assistants, the certified nursing assistants and so on — are the heroes for those of us living in a facility. Underpaid, overworked and highly susceptible to work-related injuries, they are the glue that holds together most of this country’s facilities for the aging."

Mr. Bayne also talks about his philosophy of the importance of turning your stream of compassion within – the love and affection you have for other people is only as much as you can afford for yourself.

If you are interested, the Terry Gross interview is 20 minutes long. I thought it was special. Here is a link:

Here is a link to the related article in the Washington Post:

Wednesday, September 19, 2012

Now is a best time to plan your estate

People find lots of excuses to avoid getting a Will and other helpful estate planning documents. Some people worry that seeing a lawyer will be expensive; others think that their assets are not substantial enough to warrant the preparation of a will; and some of us just want to avoid the unpleasant thought of our deaths. 

It is our experience at Marshall, Parker & Associates that the estate planning process is a lot less painful than many folks have led themselves to believe. All of us like the ability to make choices and preparing your estate plan is exercising your right to choose!  The law gives you lots of options. Why waste them.

One of the cornerstones of estate planning is the Will, which is a blueprint of how you want your assets distributed and your family protected after you are gone. Your Will also allows you to select someone you trust (your Executor) to carry our your wishes.

Some important reasons to prepare or update your Will include:
  • You can make sure that the right people will get the right things at the right time.
  • You can decide who will be in charge of your estate.
  • You can choose a guardian of your choosing for minors.
  • You can create a trust to protect your loved ones.
  • You can minimize family issues and disagreements.
  • You can reduce taxes and estate administration expenses.
  • You can ensure that your plan is updated to take maximum advantage of current laws.
Pennsylvania residents can have an initial appointment with one of the estate planning lawyers at Marshall, Parker & Associates at no charge. So, worry about expense should be no reason to delay. And even if your estate is not large, that is actually all the more reason you need to protect it, both for you during your lifetime and for your loved ones after your death. That's what estate planning is all about.   

It is true that estate planning does require you to recognize that the world will continue even after you have departed it. But estate planning is nothing to fear. Appointments are often filled with laughter and relief. Clients frequently say things like "I feel so relieved to know that I have a plan in place, I shouldn't have waited so long!"

Don't procrastinate. Take advantage of a free initial appointment at Marshall, Parker & Associates to get your estate planning started.  Just call 1-800-401-4552.

Monday, September 17, 2012

What to Do when Dad shouldn't be Driving

Do you remember when you first got a driver’s license? For me it was over 50 years ago, but I remember it vividly. It was both scary and exhilarating: the adulthood it implied, the freedom it offered, the awesome responsibility. Wow, that was a memorable moment of my life. 

Now that I am over 65, I realize that someday I may need to give up that precious license. Someday, my senses and/or mental acuity may decline to a point where I should no longer be driving. I dread the loss that I will suffer when that day comes. 

Over the years I have met with many children of aging parents who expressed concerns that Mom or Dad was still driving. (For some reason, my recollection is that it was usually Dad who was the problem). This can be a big issue for both the kids and the parent. Children don’t know how to convince their parent that it is time to stop driving. They surely want to avoid a confrontation with their parent. And they understand that losing your license to drive is a big deal.

No one who drives wants that right taken away. Yes, it does seem like both a right and "rite" of adulthood. Losing it will be like returning to those pre-age 16 days, but without having the youthful ability to run and ride a bike. For the senior, giving up the car keys involves certain loss of freedom, and increased social isolation and dependency. We don’t want to burden relatives and friends every time we need to run an errand. And if we live in a rural area, we may have no other realistic transportation options. It’s no wonder that the thought of not being able to drive creates anxiety and depression.

I have been thinking about this a lot lately. How will I know when the time has come to restrict my driving, or maybe even give up my license entirely? And what can children do to help their parent through this transition? 

I’ve found that there is actually quite a bit of guidance available online. For example, the AAA website has tool that can help seniors assess their skills and get advice on how to maximize their safety on the road. And the AARP website has advice and a free online seminar for family members. More resources are listed at the end of this article.

How to Assess Driving Ability

If you need to assess a senior's driving ability, Consumer Reports suggests you watch for these red flags:
·      Slow response times.
·      Inability to fully turn to check blind spots.
·      Running stop signs.
·      Motorists honking at them frequently.
·      A hesitation or reluctance to drive.
·      Cognitive dysfunction, such as getting lost or calling for help.
·      Repeat fender benders, dings, or paint scrapes on the car.

The Pennsylvania Department of Transportation offers the following list of questions a child can ask their parent:
  • ·       Do you feel less comfortable driving now than you did five years ago?
  • ·      Have you had more near-accidents in the last year or so?
  • ·      Do intersections bother you because of all the cars and activity in several directions?
  • ·      Is it harder to judge the distance and speed of cars when you merge into traffic?
  • ·      Is night driving more difficult because of glare and blurred vision?

A “yes” response to any of these questions suggests that a driver refresher course or a discussion with the older driver’s physician may be in order.

Information is available online that can help older drivers and their children assess driving ability. Especially helpful is an American Automobile Association booklet that allows older drivers to test their performance by answering a number of simple questions. Drivers 65 Plus: Check Your Own Performance, A Self-Rating Form of Questions, Facts and Suggestions for Safe Driving.

The Hartford Insurance Company has a booklet that offers guidance to children about how to initiate a caring conversation with their parent about driving:  

What you can do if the Older Driver ignores your legitimate concerns

What can a child do if Dad won’t respond to your concerns about his driving? 

Discuss the problem with the older driver’s health care provider. You can turn to your parent’s physician for help. Of course, this can be messy issue for doctors who typically have no training in assessing driving safety. This is not something that can be treated with standard medical advice or a prescription. And physicians are appropriately concerned about not violating patient privacy and maintaining the doctor-patient relationship. 

But, a doctor can provide patient counseling that can carry a level of influence with the older patient that may far exceed that of the children. And a physician can check for medical problems like vision or medication issues. So seeking the help of Dad’s doctor is probably wise. 

Be prepared for the older driver to be reluctant to discuss driving with his physician. He may fear that the doctor may report him to the licensing authority. (In Pennsylvania, doctors are supposed to report persons diagnosed as having a condition that could impair the ability to drive. Ultimately, it is the Department of Transportation, not the doctor, which makes the ultimate decision on whether to impose license restrictions.) 

Here are some additional ideas for children who are struggling with this issue:

Schedule a driving evaluation. Some communities offer Driver Evaluation & Training programs for older or disabled drivers. Check with your local health system or your state licensing agency to find one near you. You can also check on the Insurance Institute for Highway Safety web site to find out about testing options in your state.

Avoid tricks. Experts tend to recommend against using tricks - like hiding keys or disabling Dad’s car. Here is what The Pennsylvania Department of Transportation (PennDot) says on this subject: “It is better to maintain a sense of trust in your relationship, being honest and persistent. Encourage the person to make a decision to reduce or stop driving as appropriate. Be aware that persons who lose the privilege of driving often feel lonely or anxious because they have fewer opportunities to be with friends or involved in activities.”

Write your state licensing agency. As a last resort, family members and others can notify their state licensing agency (e.g. PennDot) of their concerns. Drivers identified through these letters may be asked to submit medical information. Write a detailed letter regarding your observations and the driver's specific medical impairment(s). The letter must also include your name and contact information. For Pennsylvania drivers this letter can be mailed to: Pennsylvania Department of Transportation, P.O. Box 68682, Harrisburg, PA 17106-8682. Reports submitted to PennDOT are confidential.

It may help reassure the older driver to know that may be possible to obtain a restricted license rather than completely lose their driving privilege. In Pennsylvania a “graduated license” can be obtained that allows the senior to continue driving subject to certain limitations. PennDot describes a graduated license as a type of license somewhere between full privilege and no privilege. For example, PennDOT offers a low vision restricted license to drivers with vision between 20/70 and 20/100. These drivers are limited to driving during daylight hours on roads other than freeways. PennDOT may also limit these drivers to driving within a certain geographic area as determined on a case-by-case basis.


The Pennsylvania Department of Transportation offers a free booklet 

The Pennsylvania Department of Transportation also has an Older Driver Information Center

Roadwise RX  (This is a free online tool from the American Automobile Association designed to allow you to record your list of medications in one central location, and to receive personalized feedback about how drug side effects and interactions between medications may impact your safety behind the wheel).

Consumer Reports has a list of Best Cars for Older Drivers.


The following agencies conduct state approved classroom training courses for mature drivers. There are no written or practical driving tests required. The course fees are moderate, but vary with each agency:

✔ The American Association of Retired Persons (AARP) Contact the AARP state office at 225 Market Street, Harrisburg, PA 17101; (717) 238-2277 or via the Web site at

✔ American Automobile Association. Contact your local AAA office for availability or via the Web site at

✔ Seniors for Safe Driving. Call 1-800-559-4880 or via the Web site at for availability.

Wednesday, September 5, 2012

Protecting the Rights of Nursing Home Residents

It’s a tough time financially for Pennsylvania nursing homes. They recently suffered a reduction in payments from Medicare and then barely survived a cut back in Medicaid payments that Governor Corbett included in his budget proposal.  

If elected, the Romney/Ryan team proposes to change Medicaid funding to a block grant, which would likely further restrict funding for nursing home care. The head of Pennsylvania’s Department of Public Welfare, Gary Alexander, has announced his support for moving Medicaid to a block grant.  
So, it looks like the next few years will be tough on nursing homes, and probably even tougher on their residents. Further reductions in funding will almost surely impact staffing levels and quality of care. 

Many nursing home residents are unable to act effectively to protect themselves from poor care and abuse and to assert their basic human rights. Funding cut-backs make it increasingly important that nursing home residents, their families, and advocates understand the laws that exist to protect the rights of those who have become dependent on nursing home care.

Federal Law has long imposed the obligation to protect patient rights on any long term care facility that participates in Medicare or Medicaid. The law (The Nursing Home Reform Law of 1987) is set out in Title 42, Section 483.10 of the Code of Federal Regulations.  These protections apply to any resident of a Medicare or Medicaid  certified facility regardless of their payment source. 

    § 483.10

    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:

    (a) Exercise of rights. 
   (1) 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.
    (2) The resident has the right to be free of interference, coercion, discrimination, and reprisal from the facility in exercising his or her rights.
    (3) 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.
    (4) In the case of a resident who has not been adjudged incompetent by the State court, any legal-surrogate designated in accordance with State law may exercise the resident's rights to the extent provided by State law.
    (b) Notice of rights and services
    (1) 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. The facility must also provide the resident with the notice (if any) of the State developed under section 1919(e)(6) of the Act. Such notification must be made prior to or upon admission and during the resident's stay. Receipt of such information, and any amendments to it, must be acknowledged in writing;
    (2) The resident or his or her legal representative has the right—
    (i) 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
    (ii) 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 2 working days advance notice to the facility.
    (3) 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;
    (4) 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 (8) of this section; and
    (5) The facility must—
    (i) 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—
    (A) The items and services that are included in nursing facility services under the State plan and for which the resident may not be charged;
    (B) 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
    (ii) Inform each resident when changes are made to the items and services specified in paragraphs (5)(i) (A) and (B) of this section.
    (6) 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.
    (7) The facility must furnish a written description of legal rights which includes—
    (i) A description of the manner of protecting personal funds, under paragraph (c) of this section;
    (ii) A description of the requirements and procedures for establishing eligibility for Medicaid, including the right to request an assessment under section 1924(c) which determines 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;
    (iii) 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
    (iv) A statement that the resident may file a complaint with the State survey and certification agency concerning resident abuse, neglect, misappropriation of resident property in the facility, and non-compliance with the advance directives requirements.
    (8) The facility must comply with the requirements specified in subpart I of part 489 of this chapter relating to maintaining 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 and applicable State law. Facilities are permitted to contract with other entities to furnish this information but are still legally responsible for ensuring that the requirements of this section are met. If an adult individual is incapacitated at the time of admission and is unable to receive information (due to the incapacitating condition or a mental disorder) or articulate whether or not he or she has executed an advance directive, the facility may give advance directive information to the individual's family or surrogate in the same manner that it issues other materials about policies and procedures to the family of the incapacitated individual or to a surrogate or other concerned persons in accordance with State law. The facility is not relieved of its obligation to provide this information to the individual once he or she is no longer incapacitated or unable to receive such information. Follow-up procedures must be in place to provide the information to the individual directly at the appropriate time.
    (9) The facility must inform each resident of the name, specialty, and way of contacting the physician responsible for his or her care.
    (10) 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.
    (11) Notification of changes. (i) A facility must immediately inform the resident; consult with the resident's physician; and if known, notify the resident's legal respresentative or an interested family member when there is—
    (A) An accident involving the resident which results in injury and has the potential for requiring physician intervention;
    (B) 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);
    (C) 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
    (D) A decision to transfer or discharge the resident from the facility as specified in § 483.12(a).
    (ii) The facility must also promptly notify the resident and, if known, the resident's legal representative or interested family member when there is—
    (A) A change in room or roommate assignment as specified in § 483.15(e)(2); or
    (B) A change in resident rights under Federal or State law or regulations as specified in paragraph (b)(1) of this section.
    (iii) The facility must record and periodically update the address and phone number of the resident's legal representative or interested family member.
    (12) Admission to a composite distinct part. A facility that is a composite distinct part (as defined in § 483.5(c) of this subpart) must disclose in its admission agreement its physical configuration, including the various locations that comprise the composite distinct part, and must specify the policies that apply to room changes between its different locations under § 483.12(a)(8).

    (c) Protection of resident funds
   (1) 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.
    (2) 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, as specified in paragraphs (c)(3)-(8) of this section.
    (3) Deposit of funds. (i) Funds in excess of $50. The facility must deposit any residents' 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 resident's funds to that account. (In pooled accounts, there must be a separate accounting for each resident's share.)
    (ii) Funds less than $50. The facility must maintain a resident's personal funds that do not exceed $50 in a non-interest bearing account, interest-bearing account, or petty cash fund.
    (4) 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.
    (i) The system must preclude any commingling of resident funds with facility funds or with the funds of any person other than another resident.
    (ii) The individual financial record must be available through quarterly statements and on request to the resident or his or her legal representative.
    (5) Notice of certain balances. The facility must notify each resident that receives Medicaid benefits—
    (i) When the amount in the resident's account reaches $200 less than the SSI resource limit for one person, specified in section 1611(a)(3)(B) of the Act; and
    (ii) 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.
    (6) 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.
    (7) 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.
    (8) 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 or Medicare (except for applicable deductible and coinsurance amounts). The facility may charge the resident for requested services that are more expensive than or in excess of covered services in accordance with § 489.32 of this chapter. (This does not affect the prohibition on facility charges for items and services for which Medicaid has paid. See § 447.15, which limits participation in the Medicaid program to providers who accept, as payment in full, Medicaid payment plus any deductible, coinsurance, or copayment required by the plan to be paid by the individual.)
    (i) Services included in Medicare or Medicaid payment. During the course of a covered Medicare or Medicaid stay, facilities may not charge a resident for the following categories of items and services:
    (A) Nursing services as required at § 483.30 of this subpart.
    (B) Dietary services as required at § 483.35 of this subpart.
    (C) An activities program as required at § 483.15(f) of this subpart.
    (D) Room/bed maintenance services.
    (E) Routine personal hygiene items and services as required to meet the needs of residents, including, but not limited to, hair hygiene supplies, comb, brush, bath soap, disinfecting soaps or specialized cleansing agents when indicated to treat special skin problems or to fight infection, razor, shaving cream, toothbrush, toothpaste, denture adhesive, denture cleaner, dental floss, moisturizing lotion, tissues, cotton balls, cotton swabs, deodorant, incontinence care and supplies, sanitary napkins and related supplies, towels, washcloths, hospital gowns, over the counter drugs, hair and nail hygiene services, bathing, and basic personal laundry.
    (F) Medically-related social services as required at § 483.15(g) of this subpart.
    (ii) Items and services that may be charged to residents' funds. Listed below are general categories and examples of items and services that the facility may charge to residents' funds if they are requested by a resident, if the facility informs the resident that there will be a charge, and if payment is not made by Medicare or Medicaid:
    (A) Telephone.
    (B) Television/radio for personal use.
    (C) Personal comfort items, including smoking materials, notions and novelties, and confections.
    (D) Cosmetic and grooming items and services in excess of those for which payment is made under Medicaid or Medicare.
    (E) Personal clothing.
    (F) Personal reading matter.
    (G) Gifts purchased on behalf of a resident.
    (H) Flowers and plants.   
    (I) Social events and entertainment offered outside the scope of the activities program, provided under § 483.15(f) of this subpart.
    (J) Noncovered special care services such as privately hired nurses or aides.
    (K) Private room, except when therapeutically required (for example, isolation for infection control).
    (L) Specially prepared or alternative food requested instead of the food generally prepared by the facility, as required by § 483.35 of this subpart.
    (iii) Requests for items and services. (A) The facility must not charge a resident (or his or her representative) for any item or service not requested by the resident.
    (B) The facility must not require a resident (or his or her representative) to request any item or service as a condition of admission or continued stay.
    (C) The facility must inform the resident (or his or her representative) requesting an item or service for which a charge will be made that there will be a charge for the item or service and what the charge will be.

    (d) 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.

    (e) 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 (e)(3) of this section, 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.

    (f) 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.

    (g) 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. The facility must make the results available for examination in a place readily accessible to residents, and must post a notice of their availability; and
    (2) Receive information from agencies acting as client advocates, and be afforded the opportunity to contact these agencies.

    (h) 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.

    (i) 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.
    (j) Access and visitation rights
   (1) The resident has the right and the facility must provide immediate access to any resident by the following:
    (i) Any representative of the Secretary;
    (ii) Any representative of the State:
    (iii) The resident's individual physician;
    (iv) The State long term care ombudsman (established under section 307(a)(12) of the Older Americans Act of 1965);
    (v) The agency responsible for the protection and advocacy system for developmentally disabled individuals (established under part C of the Developmental Disabilities Assistance and Bill of Rights Act);
    (vi) The agency responsible for the protection and advocacy system for mentally ill individuals (established under the Protection and Advocacy for Mentally Ill Individuals Act);
    (vii) Subject to the resident's right to deny or withdraw consent at any time, immediate family or other relatives of the resident; and
    (viii) 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.
    (2) 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.
    (3) The facility must allow representatives of the State Ombudsman, described in paragraph (j)(1)(iv) 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.

    (k) Telephone. The resident has the right to have reasonable access to the use of a telephone where calls can be made without being overheard.

    (l) 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.

    (m) 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.

    (n) Self-Administration of Drugs. An individual resident may self-administer drugs if the interdisciplinary team, as defined by § 483.20(d)(2)(ii), has determined that this practice is safe.

    (o) Refusal of certain transfers
   (1) An individual has the right to refuse a transfer to another room within the institution, if the purpose of the transfer is to relocate—
    (i) A resident of a SNF from the distinct part of the institution that is a SNF to a part of the institution that is not a SNF, or
    (ii) A resident of a NF from the distinct part of the institution that is a NF to a distinct part of the institution that is a SNF.
    (2) A resident's exercise of the right to refuse transfer under paragraph (o)(1) of this section does not affect the individual's eligibility or entitlement to Medicare or Medicaid benefits.

For further information and clarification of the above rules see Centers for Medicare and Medicaid Services, State Operations Manual Appendix PP - Guidance to Surveyors for Long Term Care Facilities

Pennsylvania has its own separate regulations governing the rights of residents of long-term care nursing facilities which provide either skilled nursing care or intermediate nursing care, or both. The Pennsylvania regulations can be found at 28 Pa Code Section 201.29.

Pennsylvania also has a regulatory list of patient’s rights that applies to hospital patients. See Patient’s Bill of Rights at 28 Pa Code Section 103.22

Marshall Elder and Estate Planning Blog: Are we Abandoning our Nursing Home Residents?

Marshall Elder and Estate Planning Blog: Making Sense of Medicaid Block Grant Proposals