Ftag of the Week – F578 Request/Refuse/Discontinue Treatment; Formulate Advance Directives (Pt. 1)

This week on the CMSCG Blog, we will continue to look at Resident Rights regulations. Our next “Ftag of the Week” is F578 Request/ Refuse/ Discontinue Treatment; Formulate Advance Directives. As the name of the regulation implies, this requirement ensures that residents have the right to request, refuse and/or discontinue treatment, to participate/ refuse participation in experimental research, and to formulate one or more advance directives. Each of these areas has multiple points contained within it, so we will be reviewing this regulation over a couple of posts.

The Right to Request/Refuse Treatment

Under F578, residents have the right to request treatment as well as refuse any treatment or service. However, just because a resident requests treatment does not mean that staff are required to provide the treatment or service if the request is medically unnecessary or inappropriate. Providers should be mindful that while residents retain the right to refuse any treatment or service, staff are expected to provide other care that helps the residents to attain/maintain their highest level of well-being. Refusal of one service does not absolve a facility from providing other care. Facility staff are expected to try to determine the cause of the refusal and address the concern, if possible.

If a treatment or service is declined, the services that would otherwise be provided must be documented in the resident’s comprehensive care plan (CCP).

Here are some key points from the Interpretive Guidance (IG) to note:

  • If a resident declines treatment, the resident may not be treated against his/her wishes.
  • If a resident refuses treatment, he/she cannot be transferred or discharged for refusing treatment unless the criteria for transfer/discharge have been met.
  • If a resident is unable to make a healthcare decision, the resident’s legal representative, subject to State requirements, may make this decision and it would be binding on the facility.

Experimental Research

F578 requires that residents have the right to participate in, or refuse to participate in, experimental research. If a resident is considering participating, he/she must be provided with full information regarding the nature of the research, including if there will be medications or other treatments utilized, and any potential consequences of participation.

Here are some key points to understand:

  • If a resident plans to participate in experimental research, he/she must provide informed consent prior to participation and the initiation of the research.
  • If the resident is incapable of consenting, but his/her representative provides consent, the facility is required to ensure that the consent has been properly obtained and that essential measures are taken to protect the resident from harm/mistreatment.
  • The resident/representative must be given the opportunity to refuse to participate during the experimental research activity as well, even if he/she provided consent prior to participating.

In our next post, we will look at the regulatory requirements for advance care planning and look at the regulatory expectations for all the policies and procedures a facility needs to have in place for compliance at F578.

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