Do Nursing Home Residents Have the Right to Refuse Treatment?

Your mother doesn’t want the medication.

She’s told the staff. She’s told you.

But the nursing home keeps insisting. They say it’s “for her own good.” They imply she doesn’t understand what she’s doing. They hint that if she doesn’t comply, there will be consequences.

Here’s the truth: competent nursing home residents have the legal right to refuse medical treatment—even when staff disagree.

Federal Law Protects the Right to Refuse Treatment

The Patient Self-Determination Act guarantees nursing home residents the right to make their own medical decisions.

Under federal nursing home regulations (42 CFR § 483.10), residents have the right to:

• Accept or refuse treatment
• Be fully informed about treatment options and consequences
• Participate in care planning decisions
• Make advance directives
• Have their decisions respected by staff

This isn’t a privilege nursing homes grant. It’s a federally protected right.

What “Capacity to Consent” Actually Means

The right to refuse treatment depends on having capacity to consent.

In Tennessee, capacity means “the mental ability to make a rational decision, which includes the ability to perceive, appreciate all relevant facts, and to reach a rational judgment upon such facts.”

Capacity is not the same as agreeing with staff recommendations. A resident who chooses differently than what medical professionals suggest isn’t automatically lacking capacity.

You can disagree with medical advice and still be perfectly capable of making your own decisions.

When Can Facilities Override Refusal?

There are limited situations where the right to refuse treatment can be overridden:

• Emergency situations threatening life. If a resident is unconscious or in immediate life-threatening danger, emergency treatment can be provided.
• Court-ordered treatment. If a court determines someone lacks capacity and appoints a healthcare decision-maker, that person can consent to treatment on the resident’s behalf.
• Serious mental health crises. Tennessee’s psychiatric hold laws allow involuntary treatment in specific circumstances where someone poses an immediate danger to themselves or others due to mental illness.
• Highly contagious disease. Public health laws may require treatment for diseases that pose serious risks to others.

Short of these narrow exceptions, residents make their own medical decisions.

How Nursing Homes Violate This Right

Too many nursing homes pressure, manipulate, or outright force treatment on unwilling residents:

• Coercion and intimidation. Staff threaten discharge, withhold privileges, or suggest the resident will be labeled “difficult” if they refuse.
• Misleading information. Facilities downplay side effects, exaggerate benefits, or don’t explain alternatives.
• Ignoring refusals. Staff proceed with treatment despite clear refusal, claiming they “didn’t understand” or “forgot.”
• Questioning capacity unfairly. When a resident disagrees with recommendations, facilities suddenly claim they lack capacity—without proper evaluation.
• Hiding behind family. Staff pressure family members to override the resident’s wishes, creating family conflict.

All of these violate federal regulations.

Informed Consent Requirements

Before any treatment, nursing homes must provide informed consent under 42 CFR § 483.10(c)(5):

Residents must be told:

• What the treatment involves
• Why it’s recommended
• Potential benefits
• Possible risks and side effects
• Alternative options
• What happens if they refuse

This information must be provided in a language the resident understands. If there’s a language barrier, interpreters must be provided.

Staff can’t just hand someone pills and expect compliance. Real informed consent requires real information.

Tennessee’s Adult Protection Act Protections

Tennessee’s Adult Protection Act (TCA § 71-6-107) specifically addresses providing protective services without consent.

The law recognizes that adults—including those in nursing homes—retain decision-making authority unless a court determines they lack capacity. Services can’t be forced on unwilling adults simply because someone else thinks they should accept them.

This protection extends to medical decisions. Just because a resident is elderly or disabled doesn’t mean they surrender autonomy.

Advance Directives and Living Wills

Tennessee residents can document their wishes through advance directives.

Under Tennessee’s Right to Natural Death Act (TCA § 32-11-101), residents can create:

• Living wills – Document wishes about life-sustaining treatment if they become unable to communicate
• Healthcare power of attorney – Designate someone to make medical decisions if they become incapacitated
• Do Not Resuscitate (DNR) orders – Direct medical staff not to perform CPR

Nursing homes must honor these directives. Ignoring them is illegal.

Tennessee provides free advance directive forms residents can use.

What Families Can Do

If your loved one’s right to refuse treatment is being violated:

Document everything. Write down dates, times, who was involved, and what was said. Get copies of medical records.

Talk to the facility administrator. Sometimes direct communication resolves issues. Make your concerns clear and request written confirmation of how they’ll be addressed.

Contact the Long-Term Care Ombudsman. Tennessee’s ombudsman program advocates for nursing home residents’ rights. They can investigate and intervene.

File a complaint with the Tennessee Department of Health. Violating residents’ rights is a serious regulatory violation.

Consider legal action. If the facility won’t respect your loved one’s rights, contact an experienced nursing home attorney.

Special Considerations: Dementia and Mental Health

Dementia doesn’t automatically eliminate decision-making capacity. Many residents with cognitive impairment can still make informed choices about their care.

Capacity should be evaluated for each specific decision. Someone might be able to decide about some treatments but not others. The evaluation should focus on:

• Does the resident understand the information?
• Can they appreciate how it applies to their situation?
• Can they reason about options?
• Can they communicate a choice?

Facilities can’t use dementia as a blanket excuse to ignore residents’ wishes.

Religious and Cultural Rights

Federal regulations protect residents’ right to practice their religion and maintain cultural traditions—including when those affect medical decisions.

If a resident refuses treatment based on religious beliefs, facilities must respect that choice. This includes:

• Jehovah’s Witnesses refusing blood transfusions
• Christian Scientists preferring spiritual healing
• Religious objections to certain medications

Cultural preferences about end-of-life care, pain management, or specific treatments must also be honored.

Protect Your Loved One’s Autonomy

Nursing home residents don’t give up their rights when they move into a facility. The right to make personal medical decisions is fundamental to human dignity.

If your loved one’s rights are being violated, contact The Higgins Firm. Our Tennessee nursing home abuse attorneys understand federal regulations and state law. We’ve successfully held facilities accountable for violating residents’ rights.

The consultation is free. We don’t get paid unless we win.

Your loved one deserves to have their voice heard and their decisions respected. Let us fight to protect their autonomy.