Can you come and go in a nursing home?

Oct 27, 2025 4 min read •

Resident Rights Nursing Home Policies

According to the federal 1987 Nursing Home Reform Law, residents are guaranteed a right to dignity and self-determination. A resident's ability to come and go in a nursing home depends on several factors, including their health, cognitive abilities, and the facility's specific policies. While most residents can leave for short periods, precautions must be taken to ensure their safety and continued care.

Quick Summary

A resident's freedom to leave a nursing home is protected by law, but is subject to safety protocols and individual health assessments. Short leaves of absence, or "day passes," for outings are generally permitted with proper coordination. Overnight leaves for non-medical reasons, known as "therapeutic leave," are also possible but require advance approval and can impact insurance coverage, potentially incurring bed-hold fees.

Key Points

Resident Rights: Federal law guarantees residents the right to freedom of movement and self-determination, which prevents facilities from restricting their ability to leave without a valid reason.
Day Passes: Most residents can leave for short outings, often called "day passes," to attend family events or run errands, as long as they notify staff and return before the midnight census.
Overnight Leave: Temporary overnight leave, or "therapeutic leave," is possible with doctor approval but may not be covered by Medicare, which could result in a "bed-hold" fee charged to the resident.
Impact on Insurance: The length and reason for a leave affect Medicare and Medicaid coverage. For instance, Medicare does not pay for overnight absences, but Medicaid policy varies by state.
Safety Restrictions: Residents with cognitive impairments like dementia may have their movement restricted to secured areas for their own safety, a practice distinct from illegal restraints.
Leaving Against Advice: Leaving a nursing home without proper planning or against a doctor's advice (AMA) can lead to a formal discharge and potentially jeopardize future care and insurance coverage.
Open Communication: Clear and timely communication with nursing home staff, the resident's doctor, and family is crucial to ensure all necessary protocols for a temporary leave are followed.
Involuntary Discharge: Facilities cannot evict a resident for leaving without permission unless specific, legally defined conditions are met, such as endangering others.

Your Rights and Facility Responsibilities

Under federal law, nursing home residents have significant rights designed to protect their independence and dignity. A nursing home cannot treat residents like prisoners and must respect their autonomy. This includes the right to choose activities, schedules, and communicate with people inside and outside the facility. However, these rights are balanced against the facility's responsibility to ensure the safety and well-being of all residents, leading to structured policies around leaving the premises.

Short Leaves of Absence or "Day Passes"

For short outings that do not involve an overnight stay, residents are typically free to leave with proper notification. These "day passes" are encouraged by advocacy groups to help residents stay connected to their community and maintain social independence. Common outings include:

Family visits and holiday celebrations
Attending religious services or other community events
Running personal errands or shopping
Going for a car ride or to a restaurant

In most cases, if a resident returns by the midnight census, the facility can still bill Medicare for that day. Proper planning is essential, including informing staff of your departure, destination, and expected return time. This is primarily for safety and emergency preparedness, not to restrict movement.

Overnight Leave and Therapeutic Passes

If a resident wishes to be away from the nursing home overnight for non-medical reasons, such as a family event, it is called a "therapeutic leave". This is distinct from a hospital stay. Policies regarding overnight absences can vary significantly based on the resident's insurance coverage and state regulations.

Medicare: Generally does not cover the cost of holding a bed for a resident on an overnight leave. The facility can charge the resident a "bed-hold" fee to reserve their spot.
Medicaid: State Medicaid rules for bed-hold policies on therapeutic leave differ. Some states cover a certain number of days per year, while others may not pay at all. It is crucial to check with the state program and the facility's policy beforehand.

Restrictions on Leaving the Facility

While freedom of movement is a core resident right, it is not absolute. Restrictions can be put in place for safety reasons, particularly for individuals with specific medical or cognitive conditions.

Cognitive Impairment: Residents with advanced dementia or Alzheimer's who are prone to wandering may be housed in a secure memory care unit with monitored exits. This is a safety measure to prevent them from getting lost or injured.
Endangering Health/Safety: A resident whose behavior or medical condition poses a documented threat to themselves or others may face limitations. Facilities must document these risks and attempt alternatives before restricting movement.
Leaving Against Medical Advice (AMA): If a resident leaves without proper notification, especially against a doctor's advice, they risk being discharged from the facility. This could result in a loss of insurance coverage for their current stay and complications with future care.

Comparison of Leave Types

To help clarify the differences, here is a comparison of various types of absences from a nursing home setting:


Feature	Short-Term Outing (Day Pass)	Therapeutic Leave (Overnight)	Leaving Against Medical Advice (AMA)
Purpose	Social engagement, family visits, errands, holidays.	Overnight family visits, vacation, special events.	Resident leaves without proper consent or against medical advice.
Approval	Usually requires advance notification to staff.	Requires doctor's approval and advance planning.	No approval or proper planning involved.
Length	Returns by the midnight census.	Absent overnight or for multiple days.	Abrupt and uncoordinated departure.
Bed Coverage	Medicare/Medicaid typically covers the day.	Depends on insurance and state rules; bed-hold fees may apply.	Likely lose coverage for the current admission and potentially future care.
Impact on Resident	Positive for physical and mental well-being.	Potential for temporary enjoyment but may involve bed-hold fees.	Can result in formal discharge and medical risks.
Facility Billing	Can bill Medicare for the day.	Medicare won't cover; facility can bill resident for bed-hold.	Facility will discharge and potentially bill for services rendered up to departure.

Conclusion

Nursing home residents generally have the right to come and go, provided they follow the established policies designed for their safety and care coordination. Short daytime leaves are common and encouraged, while overnight absences require more formal planning and have implications for insurance coverage and potential bed-hold costs. The freedom of movement for residents is protected by law, and facilities must balance this right with their duty of care. For residents with cognitive impairment, safety precautions are a priority, which may mean restricted access to unsecured exits. Anyone considering a leave should communicate openly with the facility, their doctor, and check their insurance policy to understand all requirements and financial implications. For further assistance or to understand specific rights, contacting a Long-Term Care Ombudsman is highly recommended.

Source for Resident Rights: For more detailed information on federal protections for nursing home residents, review the Nursing Home Resident Bill of Rights based on the Nursing Home Reform Act of 1987.

Frequently Asked Questions

No, a nursing home cannot legally lock you in or restrain you for convenience. Federal law protects a resident's right to freedom from physical or chemical restraints. The only exceptions are when there is a documented and substantial risk to the resident's or others' safety, or in a secure memory care unit designed for residents with dementia who are at risk of wandering.

A "day pass" refers to a short, temporary leave from the nursing home for a few hours, such as for a family outing or holiday meal. Residents are generally permitted to take these leaves as long as they inform staff and return before midnight. This allows the facility to continue billing Medicare for that day.

No, Medicare does not pay the nursing home to hold a bed for a resident who is away overnight (past the midnight census). In such cases, the resident or their family may be responsible for paying a bed-hold fee to reserve their spot until they return.

A day pass is a short absence where the resident returns before midnight. Therapeutic leave, on the other hand, is an authorized absence that includes an overnight stay. Therapeutic leave requires doctor approval and can have implications for how insurance covers the stay and bed-hold charges.

If a resident leaves without notifying staff, especially against medical advice, it can be considered a self-discharge. This may lead to the facility terminating coverage for the current admission. The resident could also be formally discharged and potentially face medical risks if their condition requires supervision.

The facility cannot involuntarily discharge you for leaving often unless it can prove that you pose a safety or health risk to yourself or others. However, frequent, unplanned absences could be seen as non-compliance and potentially lead to a discharge process with proper notice.

For residents with memory impairments, facilities often have secure areas to prevent wandering, which is a key safety measure. The resident's safety must be the priority. While outings are possible, they require staff supervision or accompaniment by a responsible family member or caregiver who signs the resident out.

References

Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider regarding personal health decisions.