Resident Refusal of Diet Recommendations

Resident Refusal of Diet Recommendations

Effective Date: [Original NPP Date]
Revised Date: [Current Date]

Goal

To monitor and document a resident’s refusal of diet recommendations made by the Speech-Language Pathologist and/or Physician. Additionally, to minimize unnecessary dietary restrictions to the extent possible and to provide the highest quality of care in a dignified atmosphere where each resident’s right of self-determination is respected.

Policy

It is a resident’s right to refuse recommendations for diet restrictions made by the Speech-Language Pathologist and/or Physician, i.e., modified diets, altered textures, withholding oral nutrition and/or hydration.

In the event of such refusal, the resident must be informed by appropriate Interdisciplinary Team Members (e.g., Speech-Language Pathologist, Nurse, Physician, Registered Dietitian, Social Worker, etc.) of the health and safety consequences of such refusals, and the availability of any therapeutic alternatives that might exist. In addition to providing and documenting this education, the Interdisciplinary Team must also develop a Care Plan with pertinent approaches for minimizing risks of future complications and facilitating adequate nutritional support. The appropriate procedure to effect this policy will be followed.

Procedure

I. Notification and Documentation:

I. Physician Notification: - The Physician will be notified of all such refusals. Notification time and date must be documented in the medical record by the Nurse. - The legal representative of the incapable resident will be notified, and of the capable resident with their consent.

II. Interdisciplinary Team Meeting: - A meeting should be held with the resident (and/or their legal representative) and family members actively interested in the resident’s care. They will be informed by the Interdisciplinary Team of the health and safety consequences of such refusal. - If a meeting cannot occur, a discussion by teleconference should be conducted.

III. Documentation of Discussion: - All Interdisciplinary Team members participating in this meeting/discussion should document a summary of the discussion and outcome in their respective sections of the resident’s medical record. - A “Refusal of Treatment or Services/Informed Consent” form is required for all refusals. The form follows this policy and procedure.

II. Completion of Refusal Form:

• The form includes:

  • Resident’s name.
  • Alternate decision maker, if the resident is not capable.
  • Recommendations refused.
  • Risks of refusing recommendations.
  • Benefits (if any) of refusing recommendations.
  • Resident informed of risks and benefits, evidenced by signature and date.
  • Statement of refusal.
  • Signature of resident and/or legal representative and date.
  • Witness signature and date.
  • Signatures and dates of all Interdisciplinary Team members present for the meeting/discussion.

• If the resident refuses to sign the form, document the reason and have two witnesses sign.

• This form, once completed, is part of the permanent medical record and should be kept with other important medical consent/declination forms within the medical record. It must not be removed from the resident’s chart.

III. Modification of Physician’s Order and Care Plan:

• The physician’s order specifying diet consistency must be changed, if needed, to reflect the resident’s informed choice.
• The Interdisciplinary Team must develop or modify the existing care plan for the resident to address the refusal of recommendations. The care plan should address pertinent approaches for minimizing risks and facilitating adequate nutritional support. The care plan should reflect resident goals and choices and should be modified as needed as the resident’s conditions or needs change.

References:

• Centers for Medicare & Medicaid Services. State Operations Manual, Appendix PP - Guidance to Surveyors for Long Term Care Facilities. [Link to current CMS SOM]
• CMS Requirements of Participation for Long-Term Care Facilities. [Link to current guidelines]