This week’s “Ftag of the Week” on the CMSCG Blog, F743 No Pattern of Behavioral Difficulties Unless Avoidable, is part of the Behavioral Health Services Regulatory Group. In Phase 3 (effective November 28, 2019), there is a strong emphasis on Behavioral Health, so providers need to ensure that they are familiar with the requirements of this regulatory group. F743 focuses on the behavioral health of residents who were not assessed as having a diagnosis of a mental or psychosocial adjustment difficulty and do not have documented histories of trauma or post-traumatic stress disorder (PTSD). For these residents, it is important to ensure that they receive the necessary psychosocial support to prevent them from experiencing “a pattern of decreased social interaction” and/or becoming increasingly withdrawn or exhibiting angry or depressive behaviors by ensuring that a person-centered plan of care is in place.
For example, a facility was cited under F743 when a resident verbally expressed to a staff member that she was depressed and did not want to stay at the facility, but the staff member did not report the resident’s comments to nursing or the resident’s physician. The resident had been identified as at risk for social isolation since she was a new admission. The facility was unable to provide evidence to surveyors that it had identified in the care plan that the resident was expressing verbalizations of depression, nor were any individualized approaches put in place to address her needs. The regulation at F743 requires that care plans include an individualized approach that is reviewed and revised as necessary to support the needs of the residents. Facility staff are expected to have the skills to monitor and assess residents to ensure they do not experience this kind of decline unless it is unavoidable based on the resident’s clinical condition. If the pattern was unavoidable, it needs to be well-documented in the medical record as to why it was not identified by the IDT, resident and/or resident representative.
Just remember that you have a responsibility to those that you choose to admit to your facility to meet their needs and recognize that these needs may change, including the “intangible” ones which are sometimes more difficult to identify.