Strengthen Resident Councils
Nursing homes are not just sites of care, they are people’s homes. To truly honor that, older adults and individuals with disabilities need to direct their own care and also to have a meaningful voice in their community. The Moving Forward Coalition strengthens resident councils as an important way to advance resident‑informed decision-making, ensuring that resident priorities shape both daily practice and policy. In partnership with the Connecticut Long‑Term Care Ombudsman Program, the Coalition provides training, resources, and structured support to help resident councils thrive.
Why Resident Councils Matter
More than 1.2 million people live in U.S. nursing homes, yet the people most affected by nursing home policy are often excluded from decisions shaping their daily lives. Resident councils provide a resident‑led pathway for people to meaningfully shape their experience by raising concerns and opportunities, and by influencing how nursing homes respond. When resident councils are well supported, nursing homes report higher resident satisfaction and fewer complaints, which may reflect stronger communication, accountability, and trust.
Strengthening resident councils creates the conditions for residents to shape decisions, surface issues early, and drive continuous improvement. When councils lack structure, issues might not be detected, which may lead to avoidable harm and a diminished quality of life.
“As resident leader Richard McCann, a participant in one of the Coalition’s resident council pilot sites, explains: “The way I always look at it, the resident council is really a union for the resident… You don’t work for the company—you work for yourself. And it’s our job to make sure that people get the best…they get the best treatment and they get treated the best.”
Why Action is Needed Now
Resident councils are federally required in Medicare‑ and Medicaid‑certified nursing homes, established under the Nursing Home Reform Act (OBRA ’87). Federal regulations affirm residents’ rights, including their right to organize, meet privately, and raise concerns about care, with an expectation that nursing home leaders will respond.
However, in reality, most resident councils do not have sufficient training, resources, or support to make a significant impact on care and quality. This gap runs counter to the 2022 National Academies of Sciences, Engineering, and Medicine (NASEM) report, which calls for systems that center residents’ values, preferences, and voice as a foundation for quality improvement.
From Consensus to Action
In direct response to the NASEM report’s call to strengthen systems that honor residents’ voice and rights, the Coalition convened a committee composed of Ombudsman, nursing home leaders, and residents, focused on strengthening resident councils. Through the committee process, members aligned on the core elements needed for effective resident-led councils and developed the Strengthening Resident Councils Guide.
The Guide offers practical tools and structures that help councils elevate concerns, organize priorities, and strengthen follow-through to action. Residents from around the country provided feedback to help create this Guide. The stories, tips, and quotes throughout the document are from residents who wanted to share their experiences.
With this Guide, nursing home communities can:
Strengthen resident leadership and effective council operations
Create reliable mechanisms for resident feedback to shape organizational decisions
Support shared problem-solving that improves daily life, care, and culture
From Guide to Practice
The Strengthening Resident Councils Guide centers resident leadership in the life of the nursing home, with support from Ombudsmen, administrators, and staff members through practical tools and simple, structured approaches that make resident voices visible, organized, and actionable in everyday practice. Practice‑based experience generates ongoing learning about what helps resident councils thrive. Those learnings continue to inform refinements to the Guide, process, and related supports.
Initial Pilot Implementation (New Jersey):
Four nursing homes in New Jersey initially piloted early versions of the Guide in 2024, testing how the tools support resident‑led councils in real‑world settings and generating early learning about implementation.
Connecticut Leadership and Ongoing Implementation:
The Connecticut Long‑Term Care Ombudsman Program leads implementation by providing training, coordination, and ongoing support to strengthen resident councils and embed the resident voice as a core component of nursing home life,
Practice and Ongoing Learning
How practice-based experience is generating learnings for a stronger resident voice
Practice‑based experience continues to shape and strengthen the Strengthening Resident Councils Guide. Early learnings from the initial pilot homes in New Jersey, combined with ongoing work in Connecticut, are helping identify what supports effective, resident‑led councils in real‑world settings.
This ongoing learning is informing refinements to the Guide and related supports as we seek to strengthen their usability, relevance, and ability to help nursing homes embed resident voice into everyday practice, decision‑making, and community life across diverse settings.
From Ongoing Learning and Practice to Policy
How implementation insights inform system-level change
Early implementation of the Strengthening Resident Councils Guide demonstrates what nursing homes need to reliably support active resident engagement. Practice based insights from New Jersey and Connecticut have surfaced common barriers, effective supports, and the structural conditions that enable resident councils to function as meaningful mechanisms for shared decision-making and accountability. This work also highlights the critical role Long-Term Care Ombudsman play in advocating for residents’ rights and ensuring access to pathways of support such as resident councils.
These insights are informing broader policy and system level discussions, including opportunities to strengthen guidance, training, and expectations related to resident engagement and support for Long-Term Care Ombudsman Programs. By embedding on-the-ground learning into actionable recommendations, this work reinforces resident councils as a core component of nursing home quality, governance, and responsiveness.