A Resident’s Right to Refuse: Best Practices for Managing Risks

​When caring for a resident who is refusing treatment—even if that refusal results in a decline in condition—detailed documentation is key for mitigating risks against possible legal action. One expert explains how in an article published in the July 2017 issue of Caring for the Ages. By law, skilled-nursing facility (SNF) residents with decision-making capacity have the right to refuse treatment, but at the same time, SNFs have a duty to ensure each resident can "attain or maintain the highest practicable physical, mental, and psychosocial well-being" unless medically unavoidable. The author of the article suggests that facilities conduct timely interdisciplinary team meetings, hold care conferences with resident family members, encourage compliance, and offer alternatives if treatment is refused. All efforts made by the facility and care team to render care should be documented. The author uses an example of a resident who was admitted to an SNF with sacrococcygeal discoloration, but intermittently refused care. The resident's condition declined to a stage 2 pressure injury, and three weeks after admission, the resident was discharged to an acute care hospital for respiratory distress and died three days later.