SMQT Resident Rights and Dignity 4 — Questions and Answers
Question 1: Under 42 CFR §483.10, a resident's right to refuse treatment means the facility must:
- Discharge the resident if they refuse necessary treatment
- Honor the refusal and document it, with staff explaining consequences and exploring alternatives (Correct answer)
- Require a physician to override the refusal if the treatment is deemed necessary
- Contact the family to make the decision on the resident's behalf
Correct answer: Honor the refusal and document it, with staff explaining consequences and exploring alternatives
A competent resident's refusal of treatment must be honored, documented, and the facility must explain consequences and offer alternatives.
Question 2: A resident files a grievance alleging that a staff member was disrespectful. Under the 2016 Final Rule, which of the following is required?
- The facility may resolve the grievance verbally without documentation
- The facility must provide a written decision to the resident that includes the steps taken and the outcome (Correct answer)
- Grievances about staff conduct are handled exclusively by the HR department without resident notification
- The resident must submit the grievance in writing for it to be valid
Correct answer: The facility must provide a written decision to the resident that includes the steps taken and the outcome
The 2016 Final Rule requires facilities to provide written grievance decisions including the steps taken to investigate and the outcome.
Question 3: A facility proposes to transfer a resident to another room within the facility. What does the resident rights regulation require?
- Room transfers within the facility require no advance notice
- The facility must give advance notice and explain the reason for the transfer (Correct answer)
- Room transfers require written consent from the resident's legal representative only
- The facility may transfer the resident immediately if a clinical rationale exists
Correct answer: The facility must give advance notice and explain the reason for the transfer
Residents must receive advance notice of room transfers and an explanation of the reason, as room changes affect the resident's home environment.
Question 4: Which of the following is NOT a permissible reason for an involuntary discharge or transfer under federal nursing home regulations?
- The resident's health has improved and nursing home care is no longer needed
- The resident's presence endangers the health or safety of others
- The facility is closing
- The resident filed a complaint with the State Survey Agency (Correct answer)
Correct answer: The resident filed a complaint with the State Survey Agency
Filing a complaint with a regulatory agency is protected activity; discharging a resident for this reason is retaliatory and prohibited.
Question 5: When evaluating a facility's use of physical restraints, a surveyor should look for evidence that:
- A physician order alone is sufficient to justify ongoing restraint use
- The least restrictive alternative was used, with informed consent and ongoing reassessment (Correct answer)
- Restraints are acceptable if family members provide written authorization
- Restraints applied for staff convenience are permissible if reviewed monthly
Correct answer: The least restrictive alternative was used, with informed consent and ongoing reassessment
Restraint use requires that the least restrictive alternative is attempted, informed consent is obtained, and the need is regularly reassessed.
Question 6: A resident with a court-appointed legal guardian refuses a procedure that the guardian has consented to. How should the facility proceed?
- Proceed with the procedure based solely on the guardian's consent
- Attempt to understand the resident's objection, involve the care team, and seek ethics consultation if needed (Correct answer)
- Override the resident's objection since the guardian holds legal authority
- Discharge the resident for non-compliance
Correct answer: Attempt to understand the resident's objection, involve the care team, and seek ethics consultation if needed
Even when a legal guardian holds decision-making authority, the facility should attempt to understand and honor the resident's expressed preferences and involve the care team.
Question 7: A facility posts a notice on the dining room bulletin board listing which residents have been assessed as a fall risk. This practice:
- Is acceptable as a safety measure to alert all staff
- Violates residents' right to confidentiality of their health information (Correct answer)
- Is required under CMS fall prevention guidelines
- Is permissible only if residents consent at the care plan meeting
Correct answer: Violates residents' right to confidentiality of their health information
Publicly posting residents' health assessment status violates their right to confidentiality and privacy under both HIPAA and CMS resident rights regulations.
SMQT Resident Rights and Dignity 4
Under 42 CFR §483.10, a resident's right to refuse treatment means the facility must: