Health and Hospital Corporation of Marion Cty. v. Talevski
The Supreme Court ruled 7–2 that nursing home residents can sue government-owned nursing homes under a federal civil rights law to enforce the Federal Nursing Home Reform Act's protections against improper chemical restraints and unlawful transfers.
The decision preserves a direct path to federal court for one of the country's most vulnerable populations and reaffirms that Congress can create individually enforceable rights through the laws that govern Medicaid-funded facilities.
How it got here: A federal district court dismissed the lawsuit; the Seventh Circuit reversed; the nursing home asked the Supreme Court to step in and the Court agreed to hear the case.
The Case in Depth
What happened
Gorgi Talevski, a man with advancing dementia, was placed in a county-owned Indiana nursing home in 2016. His family discovered that staff were chemically restraining him with six powerful psychotropic medications, and the facility later attempted to transfer him permanently without giving required advance notice. His wife sued the nursing home on his behalf, claiming these actions violated specific rights guaranteed to nursing home residents by federal law.
The question before the Court
Can a nursing home resident use a federal civil rights lawsuit to enforce federal law protecting residents from improper chemical restraints and forced transfers?
The Court's answer
Yes — nursing home residents can use § 1983 (a federal civil rights law dating to the 1870s) to enforce the specific Federal Nursing Home Reform Act protections at issue here.
The Court reached this in two steps. First, it refused to create a blanket exception to § 1983 for laws passed under the Spending Clause — Congress's power to attach conditions to federal funding — reaffirming that the word "laws" in § 1983 covers all federal laws, period. Second, applying its existing test from Gonzaga University v. Doe, the Court found that the two FNHRA provisions at issue — protecting residents from unnecessary chemical restraints and from transfers without proper advance notice — unambiguously focus on individual residents and use rights-creating language, clearing the high bar required to make rights presumptively enforceable through § 1983. Because the FNHRA's administrative enforcement scheme lacks the hallmarks that would make § 1983 enforcement incompatible with it (such as its own private lawsuit mechanism or mandatory pre-suit procedures), the default availability of § 1983 was not rebutted.
Curious how the Court got there? See the step-by-step legal reasoning →
Why it matters
Nursing home residents and their families now have a confirmed right to bring federal lawsuits — with access to damages and attorney's fees — when a government-run nursing home illegally restrains or transfers a resident. Without this ruling, residents would have been limited to slower administrative complaints and government enforcement, which critics say is often insufficient to protect individual residents.
What changes now
The case is sent back for further proceedings: the Seventh Circuit's ruling allowing the lawsuit to proceed stands, meaning Ivanka Talevski can pursue her § 1983 claims against the county-owned nursing home on behalf of her late husband's estate. The broader effect is that nursing home residents in government-run facilities nationwide retain the ability to bring federal civil rights suits for violations of the two FNHRA protections at issue. The decision leaves open whether other FNHRA provisions, or other Spending Clause statutes, similarly create § 1983-enforceable rights.
What this does not decide
The ruling covers only these two specific FNHRA provisions — not all FNHRA rights or all Spending Clause statutes. Justice Gorsuch flagged unresolved questions about whether spending-power rights are truly "secured" against states and whether enforcing them through § 1983 raises anti-commandeering concerns — issues the Court explicitly left for another day.
Concurrences and dissents
Concurrence — Justice Gorsuch
Justice Gorsuch agreed with the outcome and largely tracked Justice Barrett's reasoning. He wrote separately to flag two questions he believed the parties did not fully develop: whether rights created by spending-power legislation are truly 'secured' against states in the sense § 1983 requires, and whether enforcing such rights against states is consistent with the Constitution's prohibition on federal commandeering of state governments. He characterized those as questions for another day.
Concurrence — Justice Barrett
Justice Barrett, joined by Chief Justice Roberts, wrote to underscore three points: that Maine v. Thiboutot remains good law; that the Gonzaga standard is genuinely demanding and most federal statutes will not clear it (only two other Spending Clause statutes have ever been held enforceable through § 1983); and that courts should use ordinary interpretive tools to carefully assess whether a statute's remedial design forecloses § 1983 — with a statute's own private remedy being the clearest signal that § 1983 is unavailable.
Dissent — Justice Thomas
Justice Thomas argued that Spending Clause legislation fundamentally cannot 'secure' rights 'by law' within § 1983's meaning. Because the spending power is only a power to spend — not a regulatory power — conditions on federal funding work like contract terms accepted voluntarily by states, not binding federal law. Treating them as binding federal law would either violate the anti-commandeering doctrine or reveal the spending conditions themselves to be unconstitutional. He called on the Court to revisit Thiboutot and reconsider the relationship between the spending power and § 1983.
Dissent — Justice Alito
Justice Alito agreed that the FNHRA creates individual rights enforceable in principle through § 1983, but argued the Act's detailed remedial scheme — blending federal and state enforcement, civil penalties, mandatory grievance processes, and annual facility inspections — demonstrates that Congress intended those rights to be vindicated through the statute's own mechanisms, not through § 1983. He warned that allowing § 1983 suits would overwhelm the Act's carefully balanced enforcement framework, since § 1983's broader remedies would make the Act's own remedies obsolete.
How the Court got there
The legal reasoning, step by step
- The Court started by reaffirming that § 1983 — a Reconstruction-era civil rights law — allows any person to sue for the violation of 'rights secured by the Constitution and laws.' The nursing home asked the Court to carve out laws passed under the Spending Clause (Congress's power to fund state programs on conditions), arguing that such laws work like contracts, not binding federal law, and that third-party beneficiaries of contracts generally could not sue in the 1870s. The Court rejected this argument on two grounds: the historical premise about third-party beneficiary law was at least contestable, and § 1983 was always understood as a tort remedy, not a contract remedy — making 1870s contract principles beside the point.
- For a federal statute to create rights enforceable through § 1983, the Court applies the test from Gonzaga University v. Doe (2002): the law must 'unambiguously confer' individual rights on a defined class of beneficiaries, with 'rights-creating' language that has an 'unmistakable focus on the benefited class.' A statute that merely sets program standards or directs how government money flows does not clear this bar.
- The Court found both FNHRA provisions at issue satisfy the Gonzaga test. They reside within a section of the statute expressly titled 'Requirements relating to residents' rights,' protect 'the right to be free from' unnecessary chemical restraints, and restrict a nursing home's power to 'transfer or discharge' a 'resident' without meeting enumerated preconditions. The repeated focus on individual residents — including in every exception built into each provision — supplies the unmistakable individual-centric focus the test demands.
- Even when a statute unambiguously creates rights, a defendant can still defeat § 1983 enforcement by showing Congress intended to preclude it — either expressly or by creating a 'comprehensive enforcement scheme that is incompatible with individual enforcement under § 1983.' Incompatibility, not mere comprehensiveness, is the operative word: a detailed administrative scheme does not automatically foreclose § 1983.
- The Court distinguished three prior cases where it had found implicit preclusion — Rancho Palos Verdes, Smith v. Robinson, and Sea Clammers — all of which involved statutes with their own private judicial remedies and mandatory pre-suit procedures that § 1983 would have circumvented, giving plaintiffs access to benefits unavailable under those statutes. The FNHRA has none of those features; it has no private lawsuit mechanism, no presuit exhaustion requirement a § 1983 suit would bypass, and a savings clause that expressly preserves remedies 'otherwise available under State or Federal law.'
Doctrinal impact
Cases affected by this decision
Reaffirms Maine v. Thiboutot (448 U.S. 1)
Confirmed that '§ 1983 laws' covers all federal laws, not just civil rights or constitutional statutes.
Reaffirms Gonzaga Univ. v. Doe (536 U.S. 273)
Reapplied Gonzaga's demanding test for when a statute unambiguously creates individual § 1983-enforceable rights.
Distinguishes Rancho Palos Verdes v. Abrams (544 U.S. 113)
Found FNHRA lacks the statute-specific private remedy and presuit procedures that made § 1983 incompatible in Rancho Palos Verdes.