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Help: The Resident Coded As Impaired At B4 Is Refusing Treatment
Question: What are the implications of situations where the facility honors a resident's request to refuse care (medications mostly or treatments) when the MDS is coded at B4 as impaired in daily decision-making, or the resident has a diagnosis of dementia in Section I? What do we need to document or do in that type of scenario?
Ohio Subscriber
Answer: The intent of Section B4 on the MDS is to determine the resident's actual decision-making about activities of daily living. Examples are noted on page 3-46 of the Resident Assessment Instrument user's manual. With this in mind, scoring anything other than independent on B4 would not necessarily contradict the resident's decision to refuse treatment. However, with a diagnosis of dementia, one might question whether the resident could actually make an informed decision to refuse treatment. If the resident continues to refuse treatment, it would behoove the facility to include documentation that staff has counseled the resident/family with regard to potential negative outcomes of refusing treatment. And they should continue to encourage the resident to accept the treatment.
If the facility no longer attempts to deliver the treatments, it might also be a good idea to get a power of attorney for health care from a family member. The facility attorney should also review the legal issues when the facility complies with the resident's wishes to refuse treatment. Another documentation requirement would be the notification of the attending physician with regard to the resident's refusal of treatment.
- Expert advice provided by nursing consultant Marilyn Mines with FR&R Healthcare Consulting in Deerfield, IL.
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Help: The Resident Coded As Impaired At B4 Is Refusing Treatment
Question: What are the implications [...]