The Fundamentals of Quality for Long Term Care
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Residents Rights – 483.10
Summary Highlights
Federal and State laws mandate that all residents residing in Skilled Nursing Facility/Nursing Facility have rights guaranteed to them. It is the responsibility of the facility (Administrator & Staff) to promote and ensure that the resident exercise his/her rights, even if the resident has communication barriers or cognition limits. It is important for all staff to recognize and be aware that the resident has choice to the extent possible, about quality of life and quality of care. Furthermore facilities must also be aware that the facility policies and procedures cannot violate the intent of the regulatory requirement. In the event a resident cannot legally exercise his/her rights, the resident’s representative can exercise his/her rights for him/her.
This section of regulations also place the responsibility on the facility to verify that the surrogate or representative have the authority to act on behalf of the resident. Staff must also be aware that, although a resident may have a legal surrogate or representative; this does not automatically relieve a facility from its duty to protect and promote the resident’s interest.
Another element of Residents Rights is the presence of advance directive. Does the facility have policies and procedures to implement advance directives? Is the staff aware of the policies and procedures? During medical records review, the surveyor will determine compliance with the extent at which the facility provides education to residents and their families regarding advance directives.
Residents finances not only covers accounting of residents personal allowances, but it also covers information given to residents and their families about services covered by Medicare and Medicaid. Does the Business Office or the Social Worker communicate to the residents about Medicaid limitations? Does the Business Office secure authorization from the resident or family in order to handle their funds, and do they do quarterly accounting of those funds to the residents?
Residents’ privacy, dignity, self respect – very important component of residents rights. “Knock and ask for permission before entering resident’s room. Only authorized staff directly involved in treatment should be present when treatments are given. People not involved in the care of the individual should not be present without the individual’s consent while he/she is being examined or treated.
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About the Book
For all Administrators, Directors of Nursing, and Quality Assurance (QA)/Quality Improvement (QI) Directors or Coordinators, this is not only required reading for your facilities, but more important, it is a practical tool to guide you as you prepare for your survey. As the saying goes, “Your facility must be survey-ready 365 days a year.” So use this book to help you get ready—and stay ready.
The Fundamentals of Quality for LTC, Part I gives you the F-Tags, as well as the Centers for Medicare and Medicaid (CMS) Interpretive Guidelines and Guidance to Surveyors. This is a comprehensive monitoring tool for all disciplines to use in an interdisciplinary format. It covers the Federal Long Term Care Regulations 42 CFR §483.10 Resident Rights through §483.20 Resident Assessment. Because this is such a practical tool, it is a book that staff will keep handy at their desks to use for monitoring purposes and for quick reference. It will help the Interdisciplinary Team (IDT)—including one of the most important and busiest groups, the Certified Nursing Assistants (CNAs)— maintain awareness of the expectations of the Federal and State Surveyors. It will also keep the staff’s focus on Quality of Care and Quality of Life.
About the Author
As an administrator who routinely spent part of her day with the front-line staff when she operated her nursing centers, Nora Wellington appreciates the hard work of the front- line staff, as well as the importance of the IDT. Alicia Creighton-Allen brought her clinical skills as an Intensive Care Nurse into her Long Term Care (LTC) nursing experience, to co-author the Fundamentals of Quality series (Part I, Part II, Part III). Parts of these tools have been used by staff in some of the nursing centers where Wellington was an administrator, and those staff members have encouraged her to share her hands-on practical monitoring tools with the LTC community. These tools will help you be ready for annual surveys, and also to make you “survey-ready 365 days a year.”
Visit www.nwellingtonassociates.com for more information about workshops, training, and other related LTC resources.
This is the first book in a three-part series.