What steps should be taken when a resident chooses not to comply with diet or fluid restrictions?




According to the State Operations Manual (SOM), under F553 ‘The Right to Participate in Planning Care,’ a resident has the right to select or refuse specific treatment options before the care plan is instituted, based on the information provided as required under §483.10(c)(1), (4)-(5), F552. While Federal regulations affirm a resident’s right to participate in care planning and to refuse treatment, the regulations do not require the facility to provide specific medical interventions or treatments requested by the resident, family, and/or resident representative that the resident’s physician deems inappropriate for the resident’s medical condition.

Steps to Take When a Resident Refuses Dietary Restrictions:

  1. Offer Approved Diet Choices:

The interdisciplinary team should provide diet options that are approved by the attending physician based on the resident’s medical condition.

  1. Inform the Resident:

The resident must be given comprehensive information about the risks and benefits associated with each choice and the consequences of non-compliance. This information should be communicated in an understandable manner. Potential risks include malnutrition, dehydration, aspiration, choking, hospitalization, and even death.

  1. Respect the Resident’s Choice:

Allow the resident to make an informed decision. If the resident decides not to comply with the dietary restrictions, the risks and benefits of compliance versus non-compliance should be documented.

Documentation: Document the resident’s decision in an ‘Informed Consent and Care Planning for Resident Choice’ form, which should include:

      • The diet choices provided.
      • The information about risks and benefits.
      • The resident’s final decision.

Facility Compliance: The facility should adhere strictly to serving meals and snacks permitted by the prescribed diet. The resident has the right to receive food brought in by family or friends and to obtain drinks or snacks from vending machines.

Legal Review: In certain cases, the facility may need to consult with their attorney to review decisions regarding resident non-compliance.

Additional Considerations: Recognize that not all residents are capable of making informed decisions about dietary restrictions. In such cases, communication may need to occur with a resident representative who holds the authority to make treatment decisions on behalf of the resident.

Angie Hamer RN, RAC-CT
Clinical Consultant

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