Resident’s Right to Be Informed and Involved in Planning and Implementing Care

F552 in Appendix PP relates to the resident’s right to be informed of their total health status, participate in planning and implementing care. The regulatory language in F552 states that the resident has the right to be fully informed, in a language they understand of their total health status, including their medical condition, the care to be furnished, the type of caregiver or professional providing the care, and to be informed of risks and benefits of proposed care, treatment options and alternatives, and to choose the options they prefer.

F552 shouldn’t be confused with the resident’s right to participate in care planning as that is a different regulation. When reviewing the interpretative guidance for F552 you’ll notice that this regulation is geared towards general care and treatment. For example, if the physician has a concern that the resident may have cancer and would like to complete diagnostic testing, the physician should explain this to the resident (or representative). Nursing home residents vary in physical, functional, and mental capabilities. A resident who is fairly independent and has a good quality of life may decide to complete an array of diagnostic testing and based on the outcome may choose to undergo treatment for various ailments. Whereas a representative of a resident in the end stages of dementia may not want to even undergo diagnostic testing if the resident has to go out of the nursing home and conduct numerous hours of tests.

Each situation must be explained and well-documented to ensure compliance with F552. While the example above was related to a potentially life-altering diagnosis, there may be simpler examples as well. For example, a resident who develops a cough that progressively gets worse, and the physician orders a chest x-ray. One provider may have options for in-house portable x-ray services whereas another would be required to leave the building. If the resident completes the x-ray and the result of the test shows pneumonia, the physician may want the resident to be transferred to the hospital for IV antibiotics. In this situation it would be important to identify whether the nursing home can provide IV antibiotics in house that may prevent a hospitalization, which would be  “alternative options” available.