DepartmentLegal ColumnDoes resident or family preference always control? Resident-centered care versus regulatory compliance
Section snippets
Self-administering medications
This is an example of a right, under 42 CFR, Section 483.10(n), that can be limited by a determination by an interdisciplinary team meeting the requirements of 483.20(d)(2)(ii), that the resident lacks the capacity to self-administer such medications. A resident in a Medicare and Medicaid certified SNF/NF may not simply assume this risk.
Restraints
The SOM, interpreting 42 CFR, Section 483.13(a), contains extensive guidance on physical and chemical restraints, including when a particular intervention may or may or may not constitute a restraint. There is a part of this guidance that addresses the decision making process for a restraint. Key for the purpose of this article is the point that CMS advises that resident or health care decision maker choice or preference may not justify a restraint. The SOM states:
“In the case of a resident who
Food choice
Simple food preferences can trigger regulatory analysis. For example, CMS issued S&C 14-34-NH devoted to the topic of egg preparation in SNFs and NFs, following a dispute on this issue that went up through the federal court where an SNF was cited for “immediate jeopardy” based on egg preparation. Elgin Nursing and Rehabilitation Center was cited for immediate jeopardy, and was the subject of a $5000 civil money penalty and the loss of any ability to offer a nurse aide training program for two