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Strengthening Family Involvement in Nursing Homes

Sam Perlin

Strengthening Family Involvement in Nursing Homes



After nursing home placement, families continue to play an important role in the lives of their elderly relatives.  One way families can work with nursing facility administration and staff to ensure residents receive the best possible care is through a family council.  A family council is a self-led and self-determining group of relatives and friends working to improve the residents’ quality of life and provide families with a voice in decision-making.  Family councils are a powerful force for improvement in nursing homes.  They encourage families to play active roles in the operation of the nursing facility.  In addition, facility staff is given the opportunity to find out about and address problems in the facility rather than having families turn to outside agencies, and families benefit from a forum to constructively channel their concerns.


Federal and State Regulations authorize the formation of family councils in nursing homes.  The regulations (Federal 42 CFE 483.15(c); State TAC 19.701) state:


  • A resident’s family has the right to meet in the facility with the families of other residents in the facility.
  • The facility must provide a family group, if one exists, with private space.
  • Staff or visitors may attend meetings at the group’s invitation.
  • The facility must provide a designated staff person responsible for providing assistance and responding to written requests that result from group meetings.
  • When a family group exists, the facility must listen to the views and act upon the grievances and recommendations of residents and families concerning proposed policy and operational decisions affecting resident care and life in the facility.


Of the more than 1100 nursing homes in Texas, less than half have family councils.  In 1997, 45.5 % of nursing facilities in the national reported having a family council; in 2003 this had decreased slightly to 43.2 %.


In the past few years States have begun to pass family council legislation.  California’s Family Council bill, effective Jan. 1, 2000, added significant new rights for family councils and new obligations for facilities with regard to family councils.  Massachusetts, in Jan 2000, passed similar legislation, as did Maryland in Oct. 2004.  New York in 2004 signed a family council law, and that same year Minnesota required state surveyors to include family councils in the survey process.


Texas needs legislation that strengthens the rights of family members of nursing home residents.




It is the collective responsibility of family members, residents, advocates, nursing home providers, governmental regulatory systems, and the community in general to promote family involvement through the strengthening of family councils.




That the oversight of nursing facilities in Texas be revisited, and the following points be included in an updated regulatory system:


  1. That no nursing facility may prohibit the formation of a family council, and when requested by a member of the resident’s family or the resident’s representative, the family council shall be allowed to meet in a common meeting room of the facility, in private without facility staff, at least once a month during mutually agreed upon hours.
  2. That family councils shall be provided with adequate space on a prominent bulletin board or other posting area for the display of meeting notices, minutes, newsletters, or other information pertaining to the operation or interest of the family council.
  3. That facility shall provide a designated staff person who shall be responsible for providing assistance and responding to written requests that result from family council meetings.
  4. That the facility shall respond in writing to written requests or concerns of the family council within ten working days.
  5. That staff or visitors may attend family councils meetings at the group’s invitation.
  6. That the facility shall consider the views and act upon the grievances and recommendations of a family council concerning proposed policy and operational decisions affecting resident care and life in the facility.
  7. That when a family council exists, the facility shall include notice of the meetings in quarterly mailings and shall inform family members, friends and representatives of new residents of the time, place, and date of the meetings.
  8. That state surveyors include family members in the survey process.


This background summary was drafted by Diane Persson ( and reflects comments from other Texas managing local ombudsmen.  It was prepared for circulation and discussion.                        March 21, 2006


All material copyrighted 2010 - Sam Perlin