Regulatory Requirements
Per Appendix PP, If a resident chooses to perform services for the facility, then there are several requirements to be aware of. First, the resident’s care plan must include documentation regarding the resident’s wish or need to work in the facility. That way, it is evident from the plan of care that the resident is interested in performing the services, not being required to do so by the facility. If a resident requests to work in the facility, the expectation is that the interdisciplinary team will review the request and ensure that the work would be clinically and psychologically appropriate for the resident, and care plan accordingly.
The resident or the resident representative must agree to the work arrangement that is laid out in the plan. The resident retains the right to refuse to participate in any of the services at any time, even if they were initially agreed upon.
The care plan must also include information on the types of services to be performed and whether the services are voluntary or paid. If the services are to be paid for, then the resident must be compensated at or above prevailing rates.
A prevailing rate, per the Interpretive Guidance, is defined as “the wage paid to the majority of workers in the community surrounding the facility for the same type, quality and quantity of work requiring comparable skills.”
On Survey
When surveyors are making observations on survey, they will be looking to see if residents are engaging in facility services, such as meal set up, housekeeping or laundry. If residents are identified, they will interview the residents/representatives and staff to determine whether the residents chose to participate in the services or not. The surveyor will also review the resident record to ensure there is a care plan in place that includes the type of services to be provided, documentation that the resident wishes to perform the services, and whether the services are voluntary or paid.
This regulation is not frequently cited, but this actual survey citation paints a great picture of why a regulation for this topic even exists:
Complaint Survey – F566 S/S: D
A facility was cited for failure to allow residents to refuse to perform facility services at his/her discretion when an aide insisted that a resident mend a bag of clothes that the staff member brought from home.
The resident was interviewed and stated that the aide had given her a bag of clothes from her home and asked the resident when they would be ready. The resident responded by saying she would do it later, and then the aide poked the resident in the chest multiple times and kissed the resident on her neck, causing the resident to cry. Another aide attempted to intervene and ended up in a verbal altercation with the first aide. The resident stated that the aide was aggressive, and she tried to get away from her, but she would not let her pass, and that this was not the first time the aide had been kissing her, which made her uncomfortable.
The aide was interviewed and told the surveyor that she and the resident were having a conversation in the hallway about some sewing projects that the resident was working on, and it was between the resident and her only.
The surveyor reviewed the activities calendar, which did not show any sewing or mending activities scheduled for the month. The Activities Manager confirmed that sewing was not on the facility’s activities schedule and that it was not acceptable for a staff member to bring clothes from home to have a private activity with a resident.
The resident’s care plans were reviewed, and there was no evidence of a care plan that described the resident’s need/desire to work for the facility, nor was there a care plan specific to sewing staff clothing.
It certainly is clear why such a citation would be given, but if you look at the citation as a whole there are so many more issues that should be addressed with the aide who requested the mending be done – not withstanding his/her abusive behavior and exploitation of the resident.
