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Focus on the F-tag: 42 CFR, Part 483 Resident Rights to Make Decisions and Choices

“The resident has the right to a dignified existence, self-determination. . . .A facility must protect and promote the rights of each resident . . . . “(483.10, Tag F150). In taking a close look at the challenges that the current regulations, survey process, and provider concerns pose, in the past the focus has been on doing what is “in the best interest of the person” as defined by the healthcare professional staff, rather than as defined by the person. The RAI process has been based on a historical medical model that assumes the “resident” is the passive and “compliant” recipient of care provided by professionals. But person-centered care comes from a fundamentally different perspective, which puts particular value on an individual's right to make decisions concerning every aspect of her or his life. A person is not required to follow a health care provider's advice, and this right does not change just because care is being delivered in a care community instead of at home. The question is how you identify a resident's preferences outside of the questions that are included in the MDS, and at this point there is no mandated format for assessing resident preference. Residents express preferences in a variety of ways. They say they do not want a shower. They happily go outside. They get up and leave an activity. Residents communicate verbally, behaviorally, and emotionally. Direct care staff in care communities interpret this communication on a daily, if not hourly basis. And of course, the issue is much more complicated when the person is living with dementia and has both decisional and communication challenges. Capturing the staff's interpretations and putting this vital information in to your care plans will drastically improve the effectiveness and compliance of your plans.
 
Staff Contact: Danielle Watford, Director of Quality Improvement & Regulatory Affairs, dwatford@mehca.org