A nursing home cannot override a valid power of attorney that is being used within its scope. Federal regulations require Medicare- and Medicaid-certified facilities to treat a properly designated agent’s decisions the same as the resident’s own. But that obligation has real limits, and in a handful of situations a facility is not just permitted to refuse an agent’s directive but legally required to.
What the Facility Is Required to Honor
The governing rule is 42 CFR § 483.10. A facility “must treat the decisions of a resident representative as the decisions of the resident to the extent required by the court or delegated by the resident.”1eCFR. 42 CFR 483.10 – Resident Rights The obligation tracks what the resident actually delegated. Whatever authority the document grants, the facility has to respect. Nothing more.
The same regulation draws the opposite line just as clearly. A facility “shall not extend the resident representative the right to make decisions on behalf of the resident beyond the extent required by the court or delegated by the resident.”1eCFR. 42 CFR 483.10 – Resident Rights Ignoring a valid POA and treating one as broader than it is are both violations of the resident’s rights.
Two document types come up most often. A durable power of attorney for healthcare (also called a medical POA or healthcare proxy) covers medical decisions: consenting to or refusing treatment, choosing physicians, admission and discharge decisions, access to medical records, and end-of-life care. A durable power of attorney for finances covers money and property: paying bills, managing accounts, handling insurance, applying for benefits like Medicaid. The scope of each depends on what the principal wrote into the document. A financial agent has no authority to make medical calls, and a healthcare agent has no authority over the bank account. The facility is right to enforce that line.
When a Nursing Home Can Refuse to Follow the Agent
Several circumstances give a facility legitimate grounds to push back on an agent’s instructions. If you are the agent, recognizing these helps you tell the difference between an improper refusal and a required one.
- The document is invalid or incomplete. A POA that was not executed under state law, that has expired, or that lacks language granting the specific authority being claimed is not enforceable. Execution rules vary by state and usually involve signatures, witnesses, and sometimes notarization. The facility is entitled to review the document before relying on it.
- The agent is acting outside the document’s scope. A financial agent making medical decisions, or a healthcare agent trying to manage accounts, is exceeding their authority. The facility should refuse those requests, and federal regulation actually forbids them from doing otherwise.
- A springing POA’s trigger has not been met. Some documents only activate once a physician certifies the principal is incapacitated. If the triggering condition described in the document has not been documented, the facility has reason to wait.
- The resident still has capacity and disagrees. If the resident is capable of making the decision themselves and their choice contradicts the agent’s, the resident wins. This is not the facility overriding the POA. It is the facility following the law.
- The facility suspects abuse, neglect, or financial exploitation by the agent. This is the most consequential exception, and the one where agents most often feel their authority has been ignored.
Suspected Abuse or Exploitation by the Agent
When staff have reason to believe an agent is harming the resident or misusing the resident’s funds, the response is not discretionary. Federal regulations require the facility to report suspected abuse, neglect, or exploitation to the facility administrator, the State Survey Agency, and adult protective services, on strict timelines that depend on the severity of the allegation. The facility must also take steps to prevent further harm while an investigation is ongoing.2eCFR. 42 CFR 483.12 – Admission, Transfer, and Discharge Rights Individual staff members who form a reasonable suspicion of a crime against a resident have their own duty to report to the State Agency and law enforcement.
These obligations apply regardless of whether the suspected wrongdoer holds a valid POA. In practice, a facility that has flagged concerns may effectively pause compliance with an agent’s directives while things get sorted out. If you are the agent and this happens to you, it may feel adversarial, but the facility’s caution usually reflects legal exposure rather than overreach. Facilities that fail to report suspected exploitation face serious regulatory consequences.
The Resident Still Comes First
A power of attorney does not replace the resident. If the resident has the capacity to decide, their choice controls, even when a valid POA exists and even when the agent disagrees. Federal law protects the resident’s right to choose their own physician, be informed about care and treatment in advance, and participate in planning changes to that care.3Office of the Law Revision Counsel. 42 US Code 1396r – Requirements for Nursing Facilities
The resident also keeps the right to revoke the POA, as long as they have capacity to do so. Under 42 CFR § 483.10, the resident retains “the right to exercise those rights not delegated to a resident representative, including the right to revoke a delegation of rights.”1eCFR. 42 CFR 483.10 – Resident Rights Even when a court-appointed representative is involved, the resident’s “wishes and preferences must be considered” and the resident must be given opportunities to participate in care planning “to the extent practicable.”
When a Guardianship Actually Displaces the POA
The one arrangement that definitively supersedes a power of attorney is a court-appointed guardianship. If a family member, the facility, or another concerned party believes the agent is failing to protect the resident, they can petition a court to appoint a guardian. If the court grants the petition, the guardian’s authority takes over.
Under 42 CFR § 483.10, when a resident has been “adjudged incompetent under the laws of a State by a court of competent jurisdiction, the rights of the resident devolve to and are exercised by the resident representative appointed under State law.”1eCFR. 42 CFR 483.10 – Resident Rights The guardian exercises those rights to the extent the court finds necessary.
A guardianship petition is a court finding, in effect, that the current arrangement is not working. The best way to avoid one is transparency: keep records of every decision made on the principal’s behalf, communicate regularly with the facility and other family members, and stay within the four corners of the document.
Medical Records and HIPAA
Access to medical records is one of the most common flashpoints. Under HIPAA’s privacy rule, a person who holds authority under state law to make healthcare decisions for an adult must be treated as that individual’s “personal representative” for purposes of accessing protected health information.4eCFR. 45 CFR 164.502 – Uses and Disclosures of Protected Health Information General Rules A properly documented healthcare POA agent should have the same access to the resident’s records as the resident would have. A facility that refuses is likely violating HIPAA, not protecting privacy.
The facility does have every right to verify the document first. Bring a copy with you and expect compliance staff to take some time to review it. And keep the scope point in mind: an agent holding only a financial POA does not automatically gain access to medical records. The authority claimed has to match the authority in the document.
What to Do If You Think the Facility Is Wrong
Start direct. Request a meeting with the facility administrator or director of nursing. Bring the original POA or a certified copy, and walk through the specific authority the document grants and the specific decision being disputed. Many refusals come from staff unfamiliarity with the document or genuine confusion about its scope, and a face-to-face review often settles things.
If the facility’s position does not change, contact your state’s Long-Term Care Ombudsman Program. Every state operates one under the Older Americans Act to investigate complaints made by or on behalf of nursing home residents.5Office of the Law Revision Counsel. 42 US Code 3058g – State Long-Term Care Ombudsman Program Ombudsmen investigate, mediate between families and facilities, and advocate for residents’ rights before government agencies.6National Long-Term Care Ombudsman Resource Center. About the Ombudsman Program They cannot issue binding orders, but their involvement often prompts a facility to comply. You can find your local ombudsman through the Eldercare Locator at 1-800-677-1116.
When informal steps fail, consult an elder law attorney. An attorney can send a formal demand letter, file a complaint with the state health department or survey agency, or bring a court action to enforce the POA. If the dispute has escalated to a guardianship petition aimed at replacing you, representation is not optional. You need someone who can respond to that petition and defend your role.