Nursing home residents have the right to who they will spend time with and how they will spend it. Specifically, 42 C.F.R. § 483.10(f)(1) – (3), (8) provides that residents have the right to and the facility must promote and facilitate resident self-determination through support of resident choice, including but not limited to the rights specified in paragraphs (f)(1) through (11) of this section.
(1) The resident has a right to choose activities, schedules (including sleeping and waking times), health care and providers of health care services consistent with his or her interests, assessments, plan of care and other applicable provisions of this part.
(2) The resident has the right to make choices about aspects of his or her life in the facility that are significant to the resident.
(3) The resident has a right to interact with members of the community and participate in community activities both inside and outside the facility.
(8) The resident has a right to participate in other activities, including social, religious, and community activities that do not interfere with the rights of other residents in the facility.
The intent of the requirements in Subsections (1) – (3) and (8) is to ensure that each resident has the opportunity to exercise his or her autonomy regarding those things that are important in his or her life. This includes the residents’ interests and preferences.
Guidance
It is important for residents to have a choice about which activities they participate in, whether they are part of the formal activities program or self-directed. Additionally, a resident’s needs and choices for how he or she spends time, both inside and outside the facility, should also be supported and accommodated, to the extent possible, including making transportation arrangements.
Residents have the right to choose their schedules, consistent with their interests, assessments, and care plans. This includes but is not limited to, choices about the schedules that are important to the resident, such as waking, eating, bathing, and going to bed at night. Choices about schedules and ensuring that residents are able to get enough sleep is an important contributor to overall health and well-being. Residents also have the right to choose healthcare schedules consistent with their interests and preferences, and information should be gathered to proactively assist residents with the fulfillment of their choices. Facilities must not develop a schedule for care, such as waking or bathing schedules, for staff convenience and without the input of the residents.
Examples that demonstrate the support and accommodation of resident goals, preferences, and choices include, but are not limited to:
If a facility changes its policy to prohibit smoking (including electronic cigarettes), it should allow current residents who smoke to continue smoking in an area that maintains the quality of life for these residents and takes into account non-smoking residents. The smoking area may be an outside area provided that residents remain safe. Residents admitted after the facility changes its policy must be informed of this policy at admission. (See §483.10(g)(1) and §483.10(g)(16)) For further explanation of safety concerns, refer to §483.25(d), F689. For information on smoking policies, refer to §483.90(i)(5), F926.
Procedures
During interviews with residents or their family and/or representative(s), determine if they are given the opportunity to choose and whether facility staff accommodates his or her preferences for:
Interview facility staff about what the resident’s goals, preferences, and choices are and the location of that information. Interview facility staff to determine how they sought information from the resident’s family and/or representative(s) regarding a resident’s preferences and choices for residents who are unable to express their choices. Additionally, the resident’s preferences should be accommodated by facility staff and reflected through adjustments in the care plan. Ask the social worker or other appropriate staff how they help residents pursue activities outside the facility.
Examples of noncompliance may include, but are not limited to:
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