The Foundational Requirement: Mutual Consent and Federal Law
Federal regulations, specifically those from the Centers for Medicare & Medicaid Services (CMS) under 42 CFR § 483.10(e)(4), stipulate that nursing facilities must allow married couples to share a room if both spouses live in the facility and agree to the arrangement. This is a fundamental resident right aimed at preserving marital relationships in long-term care settings. The primary requirement for spouses wishing to live together is their mutual consent.
Room Availability and Its Impact
While consent is key, the practical ability for spouses to share a room also depends on the availability of a suitable room. Facilities are required to make reasonable efforts to provide a shared room. If a shared room is unavailable, the facility should offer alternative arrangements to ensure the couple can maintain close contact, such as providing adjacent rooms. Facilities cannot refuse this right arbitrarily.
Potential Exceptions: Medical and Safety Concerns
Nursing facilities can separate a married couple under limited circumstances, primarily when a medical or safety risk to one or both spouses, or other residents, is determined by a physician or care team. Examples include one spouse needing a specialized unit or a documented history of abuse. Any such decision must be documented and communicated to the couple and their family, and the facility must still try to facilitate interaction.
The Application and Request Process
Couples should inform the nursing facility of their desire to share a room during the application process. Both spouses' consent will typically be confirmed. It is advisable to review the residency agreement to ensure it reflects this request. If a shared room is not immediately available, follow up with the administration to be notified when one becomes available.
Financial Implications: The Impact of Medicaid and Other Payers
Financial considerations, especially regarding Medicaid, are important. Spousal impoverishment rules protect assets and income for the non-institutionalized spouse. While the right to share a room is not tied to the payment source, facility policies may differ based on whether one or both spouses use Medicaid or are private pay.
Comparison of Spousal Rooming in Nursing Homes vs. Assisted Living
| Feature | Nursing Facility (Skilled Nursing) | Assisted Living Facility |
|---|---|---|
| Governing Authority | Primarily federal law (CMS) and state regulations. | State-specific licensing and regulations. |
| Right to Share | Federal law guarantees the right to share a room if both consent and space is available. | Policies are more variable and facility-dependent; less federal oversight. |
| Required Care Level | Both spouses must meet the criteria for skilled nursing care to be residents. | Typically, both must meet the criteria for assisted living services, which is a lower level of care. |
| Exceptions | Strictly limited to documented medical or safety concerns. | Can vary widely; facilities may have more leeway to enforce policies related to care needs or occupancy. |
| Privacy | Federal law mandates privacy for spousal visits, including potential shared rooms. | Varies by facility policy; often dependent on apartment-style units designed for couples. |
| Roommate Displacements | Cannot displace an existing roommate to accommodate a couple's request. | Policies vary; a facility's decision would be governed by its specific occupancy and resident-transfer policies. |
The Importance of Advocacy
Advocacy is crucial for families. Understanding federal rights helps ensure fair treatment. If a facility denies a reasonable request without valid cause, residents and families can use the facility's grievance process, contact the State's Long-Term Care Ombudsman Program, or file a complaint with the state's health department. The National Long-Term Care Ombudsman Program offers support for residents' rights. For more information, you can visit the National Long-Term Care Ombudsman Program website.
Conclusion: Your Right to Stay Together
The primary requirement for spouses to live in the same room in a nursing facility is their mutual consent, as protected by federal law. While factors like room availability and medical necessity can influence the outcome, facilities are obligated to accommodate this right when feasible. By being informed about their rights, families can navigate the process and help ensure couples can remain together in their long-term care setting.
