Page 77 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
APPENDIX D
APPENDIX D
Recommendations for Regulatory Guidance Changes to Support Resident Rights, including the Right of Self-Determination
F151
483.10
Interpretive Guidelines:
Expand the examples with the inclusion of “right to refuse treatment” and “right to make choices about all aspects of his or her life in the facility that are significant to the resident.”
F152
Interpretive Guidelines:
Procedures 483.10(a)(3) and (4)
Add a procedure to determine if the “resident can understand the situation and express a preference, the resident has been informed and his/her wishes respected to the degree practicable.”
F154
483.10(d)(2)
Interpretive Guidelines
Add a protocol to clarify the best practice process risk benefit education and determination of reasonable available alternatives.
F155
483.10(b)(4)
Interpretive Guidelines
Strengthen the guidance on honoring advanced directives to assist care team members in advocacy for resident expressed choice.
Consider wording to reflect the positive nature of choice instead of the negative of refusal.
Expand the guidelines and add a procedure and protocol to clarify the best practice process regarding a resident choice of treatment option, positioning the right to choose no treatment as a viable option. Include best practice guidance on assessing the reasons for the resident’s refusal, clarifying and educating the resident as to the consequences of refusal, offering of alternative treatments.
F156
483.10(b)(8)
Interpretive Guidelines
Expand the guidelines and add a procedure and protocol to clarify the best practice process regarding providing care that conflicts with a resident’s living will and/or advanced directive, including the guidance of an established ethics committee, ombudsman, or other specified resident advocate.
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