The Estates of Perryville imposed a two-week restriction on Resident #1's ability to leave alone after the person returned to the facility intoxicated. But federal inspectors found the facility failed to follow proper procedures for residents who may lack the capacity to make safe decisions about their care.
During a November interview, the resident told inspectors that a physician had ordered the restriction "due to being unsafe." The resident said he was his own responsible party and "had the right to leave when he wanted."
"The facility and the physician were infringing on his rights by not allowing him to leave and it made him mad," the resident told inspectors.
The Social Services Director confirmed that the physician had sent an order for the two-week restriction after the resident returned intoxicated. Staff had educated the resident about safety during leaves of absence, but the facility "kept hearing from community and staff members unsafe things Resident #1 was seen doing while LOA."
No law enforcement had been involved in any incidents.
The facility's leave of absence policy, signed by the resident in August, warned that if "alcohol or chemical consumption/intoxication is suspected at the time of the resident's return to the facility, we reserve the right to send the resident to the hospital for evaluation and testing." The policy also stated the facility would call the attending physician and responsible party if a resident returned under the influence.
But the policy document failed to address restrictions on leaves of absence entirely.
The Director of Operations told inspectors that only the resident's "independent LOA privilege had been restricted for two weeks." The resident "showed poor insight and judgement" and while generally having the right to leave, "due to poor decisions the physician only prohibited the portion of the non-supervised LOA, or independent LOA."
Federal regulations require nursing homes to ensure residents have the right to leave the facility unless they have been determined to lack capacity through proper legal procedures. When facilities believe a resident cannot make safe decisions, they must follow specific steps including discussions about guardianship, power of attorney, or discharge to appropriate care settings.
The Social Services Director acknowledged there had been "no discussion with the resident regarding enacting a Power of Attorney, getting a guardian or discharging to a lower level of care."
The restriction meant Resident #1 could not leave the facility alone for any purpose during the two-week period, despite being considered competent enough to serve as his own responsible party for all other decisions about his care and treatment.
The case illustrates the complex balance nursing homes must strike between resident safety and individual rights. While facilities have obligations to protect residents from harm, they cannot arbitrarily restrict fundamental freedoms without following due process requirements.
The inspection found the facility violated federal tag F550, which governs resident rights and facility practices. The violation was classified as causing minimal harm or potential for actual harm, affecting few residents.
Federal inspectors noted that community members and staff had reported seeing the resident engage in unsafe behaviors while away from the facility, but these concerns alone do not justify restricting a competent adult's freedom of movement without proper legal procedures.
The resident's anger about the restriction reflected a common tension in long-term care settings, where the desire to protect vulnerable adults sometimes conflicts with their constitutional rights to make their own choices, even poor ones.
Nursing homes that serve as residents' homes, not hospitals, must respect the fundamental liberty interests of people who live there. When safety concerns arise, facilities must work within legal frameworks rather than imposing unilateral restrictions.
The Estates of Perryville's approach of restricting independent leaves while allowing supervised ones showed staff recognized the resident retained some decision-making capacity. But this partial restriction without proper assessment or legal authorization still violated federal requirements.
The case demonstrates how even well-intentioned safety measures can become rights violations when facilities fail to follow established procedures for addressing residents' diminished capacity or poor judgment.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Estates of Perryville, LLC, The from 2025-11-06 including all violations, facility responses, and corrective action plans.
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