The Tennessee Nursing Home Care Act, set out mainly in Title 68, Chapter 11 of the Tennessee Code, licenses nursing homes, spells out the rights every resident holds, limits when a facility can force a resident to leave, sets minimum staffing, and gives residents and families concrete ways to push back when something goes wrong. Most of what families need from the law lives in a handful of sections, and knowing them before admission day is the difference between signing whatever is put in front of you and signing only what you have to.
Rights Every Resident Holds
Tenn. Code Ann. 68-11-901 lists the rights that attach the moment a person is admitted, and the facility must give written notice of those rights at admission.1Justia Law. Tennessee Code 68-11-901 – Rights of Nursing Home Residents The list is long. A few pieces of it carry most of the weight in day-to-day life.
Privacy, Communication, and Care Decisions
Residents have the right to privacy during treatment and personal care, including visual privacy in shared rooms and bathrooms. Married residents may visit privately with a spouse and, where medically appropriate and space allows, share a room. Every resident may communicate freely by telephone, and the facility must make at least one phone accessible to wheelchair users with sound amplification. Mail must be delivered unopened on the business day it arrives, and residents may send mail to anyone without facility interference.
On the medical side, residents may choose their own physician, must be fully informed of their condition, and have the right to participate in planning their care. A mentally competent resident may refuse treatment, though the facility must explain the consequences and document the refusal.1Justia Law. Tennessee Code 68-11-901 – Rights of Nursing Home Residents
Restraints and Personal Belongings
Physical and chemical restraints cannot be used for discipline or staff convenience. Any restraint requires a physician’s order with documented medical justification. Residents may keep and use personal clothing and possessions as space permits, and the facility must prepare a written inventory on the day of admission and update it as items change. Facilities must have a written policy for investigating any loss of a resident’s property.1Justia Law. Tennessee Code 68-11-901 – Rights of Nursing Home Residents
Grievances Without Retaliation
Residents may voice grievances and recommend policy changes to staff or outside parties without retaliation, coercion, or discrimination. The facility must provide space for resident council meetings and, if asked, help residents organize them. Using this right creates a documented record, which matters if a complaint later becomes a formal proceeding.
Handling of Personal Funds
Federal rules add a layer of financial protection. A facility cannot require a resident to deposit personal funds with it. When a resident does so voluntarily, the facility acts as a fiduciary and must keep those funds in a separate, interest-bearing account if the balance exceeds $100, or $50 for Medicaid-funded residents. Quarterly financial statements are required, and all funds must be returned within 30 days of discharge or death.2eCFR. 42 CFR 483.10 – Resident Rights The facility must also carry a surety bond covering deposited funds and must notify Medicaid recipients when the account balance nears the SSI resource limit, because crossing it can jeopardize Medicaid eligibility.
What You Should Not Have To Sign at Admission
Admission is the point of maximum pressure, and it is also where two federal protections do the most work.
No Personal Payment Guarantees From Family
Any nursing home that participates in Medicare or Medicaid is prohibited from requiring a family member or other third party to personally guarantee payment as a condition of admission.3Office of the Law Revision Counsel. 42 USC 1396r – Requirements for Nursing Facilities Facilities commonly ask family members to sign as a “responsible party,” and that language can quietly shift financial liability onto the signer. If an admission packet includes wording that makes you personally responsible for the bill, you may cross it out or refuse to sign that provision, and the facility cannot deny admission on that basis.
Arbitration Clauses Are Voluntary
Federal regulations bar facilities from requiring a resident or representative to sign a binding arbitration agreement as a condition of admission or continued care. The facility must state clearly that signing is voluntary, explain the agreement in plain language the resident understands, and ensure it provides for a neutral arbitrator and a convenient venue.4eCFR. 42 CFR 483.70 – Administration5Centers for Medicare and Medicaid Services. Medicare and Medicaid Programs – Revision of Requirements for Long-Term Care Facilities Arbitration Agreements An arbitration clause you didn’t realize you signed can eliminate the right to a jury trial if something later goes wrong.
Tennessee courts have held that an agent acting under a general durable power of attorney may sign such an agreement during admission, and that wrongful death beneficiaries can be bound by it. If you hold power of attorney for a loved one and want to preserve their right to a court proceeding, decline the arbitration clause at admission.
Staffing Requirements
Tennessee’s staffing rules, in Tenn. Comp. R. & Regs. 1200-08-06-.06, require 24-hour nursing services supervised by a registered nurse. A licensed practical nurse or registered nurse must be on duty at all times, and each shift must have at least two nursing personnel. Beyond that, the regulations require a minimum of two hours of direct care per resident per day, with at least 0.4 of those hours provided by licensed nursing personnel rather than aides.6Tennessee Department of Health Board for Licensing Health Care Facilities. Standards for Nursing Homes Chapter 1200-08-06
Each facility must employ a full-time director of nursing who holds a valid Tennessee nursing license. Certified nursing assistants must complete a state-approved training program of at least 75 hours and pass a competency exam.7PubMed. The Omnibus Budget Reconciliation Act of 1987 – A Policy Analysis Staff must also take continuing education covering current healthcare practices, dementia care, and abuse prevention.
One boundary worth flagging: a federal rule that would have imposed higher minimum staffing across nursing homes was repealed effective February 2, 2026. The repealed rule would have required 0.55 RN hours per resident day, 2.45 nurse aide hours per resident day, and 3.48 total nursing hours per resident day. The reinstated federal baseline now requires only that a facility use the services of a registered nurse for at least eight consecutive hours a day, seven days a week, except when waived; the earlier 24-hour, 7-day RN coverage requirement was also removed.8Federal Register. Medicare and Medicaid Programs – Repeal of Minimum Staffing Standards for Long-Term Care Facilities Tennessee’s state staffing rules now carry more relative weight, and families should ask any facility for its actual staffing levels rather than relying on the regulatory floor.
When a Facility Can Transfer or Discharge a Resident
Tennessee law tightly restricts involuntary discharge. A facility may transfer or discharge a resident against their wishes only for limited reasons: the resident needs a higher level of care the facility cannot provide, the resident’s presence endangers the health or safety of others, the resident has failed to pay after adequate notice, the facility is closing, or the resident no longer requires nursing home care.9Justia Law. Tennessee Code 68-11-902 – Transfer or Discharge of Residents
Before any involuntary transfer, a physician must personally examine the resident within seven days of the proposed move, confirm familiarity with the discharge plan, and certify in writing that the transfer will not threaten the resident’s health or safety. The only exception is when a physician determines that failing to transfer would itself threaten the resident or others, and that determination must be documented in the medical record.10Justia Law. Tennessee Code 68-11-907 – Involuntary Transfer or Discharge
Federal rules require at least 30 days’ written notice before a non-emergency transfer. The notice must state the reason, the effective date, and the resident’s right to appeal, and the facility must help secure alternative placement.11eCFR. 42 CFR 483.15 – Admission, Transfer, and Discharge Rights A resident who disputes the decision can request a hearing.
What Happens to the Bed During a Hospital Stay
When a resident is temporarily transferred to a hospital or takes therapeutic leave, federal law requires the facility to give written notice of the state’s bed-hold policy, the facility’s own bed-hold rules, and the resident’s right to return.11eCFR. 42 CFR 483.15 – Admission, Transfer, and Discharge Rights Tennessee’s Medicaid program, however, stopped reimbursing facilities for bed-hold days on July 1, 2018.12Cornell Law Institute. Tennessee Comp R and Regs 1200-13-02-.16 – Bed Holds For a Medicaid-funded resident, that creates a real risk of losing the bed during a hospital stay unless the family pays privately to hold it. Ask about the bed-hold policy before any planned hospitalization.
Paying for Care and TennCare Eligibility
Nursing home care in Tennessee is expensive. Semi-private rooms average roughly $8,600 to $9,200 per month, and private rooms run higher. Few families can absorb a long-term stay without Medicaid or long-term care insurance.
TennCare covers nursing home care for individuals who meet both income and asset limits. As of 2026, the monthly income limit for institutional Medicaid is $2,982.13TN.gov. TennCare Eligibility Reference Guide The countable asset limit is $2,000 for an individual, though certain property is generally exempt, including a primary residence up to state equity limits, one vehicle, and personal belongings.14TN.gov. TennCare Eligibility Reference Guide
TennCare applies a five-year look-back to asset transfers before the application date. Transfers made to family to qualify faster can trigger a penalty period during which Medicaid will not pay for care. Allowable spend-down measures include paying off debts, prepaying funeral expenses, and covering nursing home costs out of pocket. Because the rules interact in ways that are easy to get wrong, consulting an elder law attorney before applying is usually worth the cost.
After death, federal law requires every state Medicaid program to seek recovery of nursing facility payments from the estate of a recipient who was 55 or older.15Medicaid.gov. Estate Recovery In Tennessee, TennCare can recover from the probate estate. Assets that pass outside probate, such as life insurance proceeds or certain trust assets, are generally not subject to recovery. Recovery is deferred when the recipient is survived by a spouse, a child under 21, or a blind or disabled child of any age, and Tennessee recognizes additional hardship exceptions.
Reporting Problems and Enforcing the Law
Tennessee imposes a broad mandatory reporting duty. Any person with reasonable cause to suspect that an adult has suffered abuse, neglect, or exploitation must report it. The statute names physicians, nurses, social workers, facility employees, and caretakers as examples, but the duty reaches anyone with that suspicion.16TN.gov. Tennessee Code Annotated Title 71, Chapter 6, Part 1 – Adult Protection Reports go to Adult Protective Services or the Tennessee Department of Health. Failing to make reasonable efforts to report is a Class A misdemeanor.17Justia Law. Tennessee Code 71-6-110 – Violation of Duty to Report
Complaints about regulatory violations can also be filed directly with the Division of Health Care Facilities, which investigates and enforces compliance. Reports may be made anonymously, and state and federal law protect employees from retaliation for reporting misconduct.
The Long-Term Care Ombudsman
Tennessee’s Long-Term Care Ombudsman Program, established under the federal Older Americans Act, advocates for nursing home residents and helps mediate disputes with facilities. The ombudsman can investigate complaints, push for policy changes, and help residents understand their rights. The statewide toll-free number is 877-236-0013.18TN.gov. District Long-Term Care Ombudsman If you are not sure whether a concern rises to a formal complaint, the ombudsman is a good first call.
Penalties and Private Lawsuits
The state can impose civil monetary penalties on facilities that violate licensing standards, with severity tied to the nature and persistence of the violation.19Justia Law. Tennessee Code 68-11-804 – Type C Civil Monetary Penalties Other state-level tools include suspension of new admissions, mandatory corrective action plans, and license revocation in severe cases. CMS can impose additional penalties on facilities that receive Medicare or Medicaid funding, including payment suspensions, exclusion from federal healthcare programs, or temporary management. Residents and families may also sue facilities directly for negligence, abuse, or violations of resident rights, and Tennessee courts have recognized that claims tied to privacy violations and other rights breaches can survive the resident’s death.
Whistleblower Protection for Staff
Nursing home employees who witness Medicare or Medicaid fraud have added protection under the federal False Claims Act. Its qui tam provision lets employees report fraud that causes financial loss to the federal government on a confidential basis. If the report leads to a successful recovery, the whistleblower receives a mandatory award of 15 to 30 percent of the proceeds. Because the Act imposes treble damages on the wrongdoer, those awards can be substantial. These protections sit alongside Tennessee’s own anti-retaliation rules for facility employees who report regulatory violations.
Facility Licensing in Brief
No person, company, or government entity may operate a nursing home in Tennessee without a license from the state’s Health Facilities Commission, formerly overseen by the Department of Health.20Justia Law. Tennessee Code 68-11-204 – Health Care Facilities The licensing framework sits under the Health Care Facilities Act at Tenn. Code Ann. 68-11-201.21Justia Law. Tennessee Code 68-11-201 – Health Care Facilities Licenses can be denied, suspended, or revoked for failures in areas such as infection control and emergency preparedness, and operating without a valid license is itself a violation. Inspection results for every Medicare- and Medicaid-certified nursing home are publicly available through CMS’s Care Compare tool, and checking those results is one of the most useful steps a family can take before choosing a facility.