Impact of Health & Hospital Corporation of Marion County v. Talevski on Government-Owned Nursing Homes

Footnotes for this article are available at the end of this page.

Does legislation enacted pursuant to Congress’s Spending Clause power give rise to rights privately enforceable via 42 U.S.C. § 1983? If so, do provisions regarding medication and transfer in the Federal Nursing Home Reform Act of 1987 (“FNHRA” or the “Act”) give rise to rights enforceable by § 1983? In a 7-2 decision penned by Justice Ketanji Brown Jackson, the Supreme Court of the United States answered “yes” to both questions.

In Health & Hospital Corporation of Marion County v. Talevski,1 the family of Gorgi Talevski could no longer care for him as his dementia progressed, so they placed him in Valparaiso Care and Rehabilitation’s (“VCR”) nursing home in 2016. Though he could feed himself and communicate in English on arrival, he suddenly lost those abilities during his first year at VCR. An investigation revealed that VCR was chemically restraining Talevski with psychotropic drugs. After weaning, Talevski began to regain the ability to self-feed. Toward the end of 2016, VCR asserted that Talevski harassed female residents and staff and transferred him multiple times, ultimately sending him to live at another facility 90 minutes away from his family.

In 2019, Talevski sued the nursing home under § 1983, alleging that the use of chemical restraints and persistent transfer attempts had violated rights that the FNHRA guaranteed him as a nursing home resident. The district court dismissed Talevski’s claims as unenforceable under § 1983. The appellate court reversed, holding that the relevant FNHRA provisions unambiguously confer individually enforceable rights on nursing home residents that were presumptively enforceable under § 1983, and, further, the presumption was not rebutted by anything in the FNHRA indicating congressional intent to foreclose § 1983 enforcement of those rights.

The Supreme Court affirmed. It explained that § 1983 provides a cause of action against any person acting under color of state law who deprives a person of “rights, privileges, or immunities secured by the Constitution and laws” of the United States. The plain language of § 1983 does not modify “and laws,” and the Court had previously declined to read “laws” to mean only civil rights or equal protection laws. Accordingly, the Court rejected the nursing home’s argument that the FNHRA’s enactment under Congress’s spending power authority barred Talevski’s invocation of § 1983 to vindicate rights under the Act.

After confirming that the FNHRA can create § 1983 enforceable rights, the Court analyzed whether the provisions at issue actually did so. Talevski’s complaint invoked two provisions in the FNHRA’s requirements relating to residents’ rights. The first requires nursing homes to protect residents’ right to be free from chemical restraints not required to treat the resident’s medical symptoms. And the second concerns “transfer and discharge rights” under the Act, prohibiting nursing homes’ transfer or discharge of a resident without fulfilling certain preconditions, including advance notice of such a transfer or discharge. The Court found that the unnecessary-restraint and predischarge-notice provisions unambiguously confer individual rights on the class of beneficiaries to which Talevski belonged and are thus presumptively enforceable under § 1983. And the Court did not find any intent in the FNHRA showing Congress intended the Act’s remedial scheme to be the exclusive avenue through which a plaintiff may assert his claims, as would be necessary to rebut the presumption.

In sum, the majority concluded that § 1983 is available to enforce every right that Congress validly and unambiguously creates, and that the FNHRA secures the particular rights that Talevski invokes without otherwise signaling that enforcement of those rights via § 1983 is precluded as incompatible with the FNHRA’s remedial scheme. Accordingly, the Court affirmed the judgment of the appellate court.

Justice Amy Coney Barret and Chief Justice John Roberts concurred in the opinion. They acknowledged that the FNHRA cleared the high bar set by the Court’s precedent for analyzing whether Spending Clause statutes give rise to individual rights, though they cautioned that courts must “tread carefully” before concluding that other such statutes may be enforced through § 1983. Justice Neil Gorsuch also concurred, but advised of undeveloped issues of whether legal rights in spending clause enactments are “secured” as against states and whether Congress can do so consistent with the Constitution’s anti-commandeering principle.

Justices Samuel Alito and Clarence Thomas dissented in the ruling. In a solo dissent, Justice Thomas opined that legislation enacted under Congress’s spending authority does not secure rights by law, rendering the FNHRA unenforceable under § 1983. “The Court must, at some point, revisit its understanding of the spending power and its relation to § 1983,” he said. Justice Alito, joined by Justice Thomas, wrote that even though FNHRA created substantive private rights, the Act’s enforcement scheme foreclosed a private cause of action via § 1983. “By specifying limited remedies for federal authorities and tasking States with otherwise determining the consequences for violations, the Act creates a clear division of authority that ensures States retain their historical control over nursing-home regulation,” Justice Alito wrote. “Allowing § 1983 suits will upset this balance by allowing any plaintiff to demand damages regardless of the remedial regime that States establish pursuant to their explicit authority under the Act.”

AGG Takeaways

The effect of the Supreme Court’s ruling in this case is limited in that it is only applicable to government-owned or -operated nursing homes — § 1983 is inapplicable to private facilities. But government-owned or -operated facilities have great cause for concern. Nursing home residents previously could sue these facilities for negligence or malpractice. This decision adds an additional mechanism for suit under § 1983 for violations of FNHRA provisions. Victors in § 1983 litigation may be awarded attorneys’ fees, and the ability to pursue this federal claim may allow a plaintiff to evade damages caps enacted by some states. The increased avenues for liability enabled by this ruling may prompt local governments to reconsider whether they wish to own and operate nursing homes.


[1] No. 21-806, 2023 WL 3872515 (U.S. June 8, 2023).