Continuing on with resident’s rights regulations in  Appendix PP F551 includes the requirement that if a resident is unable to exercise their resident’s rights that the resident’s representative can do so on their behalf. However, there are some caveats in this regulation that I want to point out.

The regulation states that unless the resident has been adjudged incompetent by the state court, they have the right to designate a representative who may exercise the resident’s rights to the extent provided by the state law. Nursing homes must treat decisions by the resident’s representative as the decision of the resident. If the resident has a court appointed representative, the paperwork completed by the court should outline what powers the representative has compared to the powers the resident retains. In the case of a court appointed legal guardian, the nursing home must carefully review this information and include it in the plan of care as the surveyors will review documentation to ensure that the resident is able to make all decisions except those appropriated to the representative.

Regardless of a resident being judged incompetent, if it is determined the resident understands the risks, benefits, and alternatives to proposed health care and expresses a preference, then the resident’s wishes should be considered. However, just because the resident has a representative doesn’t relieve the nursing home of their duty to protect the resident’s best interests. Each nursing home should have a procedure for reporting concerns of representatives making decisions that may not be in the resident’s best interests.

To ensure compliance, nursing homes should review resident’s records to verify that paperwork is maintained for each resident on representatives. If a resident has a representative who is court appointed, the care plan should clearly define what decisions the representative is able to make and what decisions remain with the resident. Review the resident’s nurses notes to determine whether staff are following the requirements of this regulation.