Ftag of the Week – F560 Right to Refuse Certain Transfers

Happy New Year! Welcome to the first Ftag of the Week post for 2020, F560 Right to Refuse Certain Transfers.

The regulation at F560 states that a resident has the right to refuse transfer to another room within the facility under three general situations. Per the regulation, if a resident exercises the right to refuse a transfer, it does not impact the resident’s eligibility or entitlement to Medicare/Medicaid benefits.

SNF Residents

First, if the intention is to relocate a SNF resident from a distinct part of the facility that is a SNF to a part that is not a SNF, the resident may decline that relocation for the purpose of obtaining Medicare or Medicaid eligibility. The Interpretative Guidance (IG) notes that the facility is responsible for notifying the resident/representative about any changes in eligibility for covered services and if the resident may have a financial responsibility. If the resident cannot pay for the services, and after being given a discharge notice the resident can be transferred or discharged under the provision of F621, Equal Access to Quality Care.

NF Residents

Second, if a resident who is residing in a NF distinct part of a facility (Medicaid only), he/she cannot be forced to move from the NF part of the facility to another part of the overall campus, such as a hospital, just to ensure the resident is eligible for Medicare payments. The IG states that these moves can only be made at the request of the resident.

Transfers for Staff Convenience

Finally, residents have the right to refuse a transfer if it is solely for the convenience of staff. There is a potential for psychosocial harm when residents are moved, so it is important to minimize the potential for negative outcomes when planning room changes. The majority of the issues cited under F560 are related to these types of transfers, as you can see from the following examples:

  • A resident who was admitted to a subacute room was transferred to a long-term care unit. The resident was upset and crying and the transfer continued anyway, resulting in actual harm to the resident due to her psychological distress (S/S: G)
  • A cognitively impaired resident was not informed of her room change from one floor to another until staff started moving her belongings. The resident’s son was made aware of the room change, but was not offered the option to refuse the transfer (S/S: E)
  • Female residents of a facility were moved from the general residential area of the nursing home to the secure female unit because the facility needed their rooms so they could admit male residents to the facility. Residents and their representatives were informed but were not given any choice about the move, and documentation showed the residents were very upset after the move (S/S: E)

It is important to remember that residents need to be offered the option to refuse transfers such as these, and that emotional prep is included as part of the process when a resident is being prepared for a room change. In each of these deficiencies, the residents were visibly upset or crying, but psychosocial services were not provided to alleviate their distress. As with so many situations, documentation is crucial – it needs to be evident that the resident was given an opportunity to refuse a transfer.  Obviously residents not being given the opportunity to refuse a transfer is looked at closely, but remember, when determining compliance with this regulation, a surveyor will also be assessing compliance with such areas as notification of roommate change and Medicare/Medicaid coverage.

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