The new CMS regulations which were implemented in November 2017 included the addition of regulation F559 which sometimes leads to a deficiency due to the lack of documented pre-planning or lack of documentation of conversations with the resident. While this regulation has not yet been widely identified as deficient, some pre-planning will assist in avoidance of deficiency in the future.
We all know there are times when a resident requires a room move due to circumstances involving facility improvements or maintenance issues. In the case of improvements or renovations, a well laid plan is always best. Well in advance of planned renovations, discussions at resident council meetings, or other resident group meetings should occur. There should be documented notes on the agenda and discussion on agenda topics. A project map including estimated dates and length of the project should also be provided. Spring boarding from that format, the social worker should follow up with each resident individually to assure their understanding of the plan, time frame and ultimate resolution. Additionally, each member of the facility staff should also have a clear understanding of the project. If possible, develop a construction progress web page where progress can be tracked. The web page should be accessible by all residents or information can broadcasted as a loop on TV screens in or near the affected location.
Of course, there are other times when a resident move needs to occur such as an environmental emergency or systems emergency. These emergent moves may include but not limited to plumbing issues, water leakage, electrical issues, storm damage, etc. When instances like these occur, resident safety is paramount, but conversation from the social worker is critical as well. The social worker and the maintenance representative should meet with the resident to explain the situation and the plan for repair, including how much time is needed before the resident can return to the location. If this move will be a permanent or semi-permanent situation, further conversation with the resident and documentation in the resident record is essential.
When a resident is scheduled to receive a new roommate, the social worker must meet with the resident to discuss the pending arrival and document the discussion. Follow up conversations with both residents is required to document adjustment by each individual. Keep in mind that according to the regulation, a resident, “cannot demand that a current roommate is displaced in order to accommodate a specifically requested resident to move in.” Additionally, if a resident has lost a roommate due to death or discharge, the remaining resident needs time to grieve that loss. The social worker’s connection to the resident at this time is critical. Discussion with and documentation of meetings with the resident is required in order to meet the intent of the regulation. Each person grieves differently, so placement of a new roommate with the existing resident may take some time. Also keep in mind that the death of a roommate may require additional outside resources for the remaining resident such as counseling or an opportunity to speak with a clergy person.
If not completed properly, room moves may receive an additional citation for social services through tag F745 which indicates the requirement of medically-related social services. Utilization of social work services are identified to “maintain the highest practicable physical, mental and psychosocial well-being of each resident” according to the regulation. Not all social work services are required to be performed through in-house social work staff, but this varies from state to state.
The main guidelines to remember when it comes to room moves is
- there needs to be a well laid out plan,
- afford the resident the time and opportunity to talk about their concerns,
- provide counseling if needed when the move is traumatic,
- follow up with the resident, and
- document the process as it is happening.
In our continued monitoring of this F-Tag, there have not been any significant identification of deficiencies of this regulation. However, know that if a citation is identified here, there could also be deficiencies identified in F585–Grievences.
