Participation in Planning and Treatment Right to Be Informed [§483.10 (b)(3),(4), and (11)] Residents are to be fully informed in advance about care and treatment and of any changes in care or treatment that may affect the resident’s well-being. This means that a resident receives the information necessary to make a health care decision. To determine whether this right is being upheld, surveyors might ask residents questions like:
How are you involved in planning your care?
If your care plan is changed, how do you find out about it?
Does staff explain how these changes will affect you?
These three questions might also be appropriate for you to routinely ask residents when helping them identify strategies for good care. Residents are to participate in planning and making any changes in their care and treatment. [§483.10 (d)(3)] According to the Guidance to Surveyors, this means that the resident has an opportunity to select from alternative treatments. Even if a resident’s ability to make decisions about care and treatment is impaired or if the resident has been adjudicated incompetent, the resident should be kept informed and be consulted on personal preferences. A handout for you to use in helping residents and families understand and use this process, “Assessment And Care Planning: The Key To Good Care,” is in Appendix B. The comprehensive care plan is to include measurable objectives and timetables to meet a resident’s medical, nursing, mental, and psychosocial needs that are identified in the comprehensive assessment. [§483.20(d)(1)] In practice, many residents and family members do not play an active role in the care planning process. Often the conference is short and pre-emptive; selected staff report on the resident and their anticipated treatment objectives. Staff members are usually too busy to really involve the resident (and/or family) in advance to work together toward goals and choices. Yet the resident has the right to “choose activities, schedules, and health care consistent with his or her interests, assessments, and plans of care,” and to “make choices about aspects of his or her life in the facility that are significant to the resident.” [§483.15(b)] The assessment and care planning process are often the keys to good care and, typically, are areas where improvement is needed.