Page 27 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHO OWNS THE CARE PLAN
the clinical record...
F280
483.20(k)(2) Comprehensive Care Plans
Interpretive guidelines
The resident’s right to participate in choosing treatment options, decisions in care planning and the right to refuse treatment are addressed at 483.20(k)(2)(ii) and 483.10(b)(4), respectively, and include the right to accept or refuse treatment...
The resident has the right to refuse specific treatments and to select among treatment options before the care plan is instituted...
While Federal regulations affirm the residents’ right to participate in care planning and to refuse treatment, the regulations do not create the right for a resident, legal surrogate or representative to demand that the facility use specific medical intervention or treatment that the facility deems inappropriate. Statutory requirements hold the facility ultimately
accountable for the resident’s care and safety, including clinical decisions.
F281
483.20(k)(3) Professional Standards of Quality
Intent
The intent of this regulation is to assure that services being provided meet professional standards of quality (in accordance with the definition provided below) and are provided by appropriate qualified persons (e.g., licensed, certified).
Interpretive Guidelines
“Professional standards of quality” means services that are provided according to accepted standards of clinical practice. Standards may apply to care provided by a particular clinical discipline or in a specific clinical situation or setting. Standards regarding quality practices may be published by a professional organization, licensing board, accrediting body or other regulatory agency. Recommended practices to achieve
desired resident outcomes may also be found in clinical literature...
The following CMS interpretive guideline seems to stop short of granting full residents’ rights as it relates to the final responsibility of the facility for the resident’s care.
F280: Interpretive guidelines - While Federal regulations affirm the residents’ right to participate in care planning and to refuse treatment, the regulations do not create the right for a resident, legal surrogate or representative to demand that the facility use specific medical intervention or treatment that the facility deems inappropriate. Statutory requirements hold the facility ultimately accountable for the resident’s care and safety, including clinical decisions.
Is this interpretive guideline the base of that unanswered question of how to balance quality of care with resident choice? We need to accept the premise that all involved want to get it right –
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