In compliance with federal requirements at 42 CFR § 483.10, residents of a state veterans home have the right to a dignified existence, self-determination and communication with and access to persons and services inside and outside the state veterans home. The state veterans homes shall protect and promote the rights of each resident, including those with limited cognition or other barriers that limit the exercise of rights:
(1) Exercise of rights.
(a) The resident has the right to exercise his or her rights as a resident of the state veterans home and as a citizen or resident of the United States.
(b) The resident has the right to be free of interference, coercion, discrimination, and reprisal from the state veterans home in exercising his or her rights.
(c) In the case of a resident adjudged incompetent under the laws of the state by a court of competent jurisdiction, the rights of the resident are exercised by the person appointed under state law to act on the resident's behalf.
(d) In the case of a resident who has not been adjudged incompetent by the state court, any legal-surrogate designated in accordance with state law may exercise the resident's rights to the extent provided by state law.
(e) The state veterans home shall not require the resident to sign any contract or agreement that purports to waive any right of the resident.
(2) Notice of rights and services.
(a) The state veterans home shall inform the resident both orally and in writing in a language that the resident understands of his or her rights and all rules and regulations governing resident conduct and responsibilities during the stay in the state veterans home. Such notification must be made prior to or upon admission and during the resident's stay. Receipt of such information, and any amendments to it shall be acknowledged in writing.
(b) The resident or his or her surrogate decision maker has the right:
(i) Upon an oral or written request, to access all records pertaining to the resident including clinical records within twenty-four hours for medicaid certified nursing facility residents and according to chapter
70.129 RCW, for other facility residents; and
(ii) After receipt of his or her records for inspection, to purchase at a cost not to exceed the community standard, photocopies of the records or any portions of them upon request and two working days advance notice to the state veterans home.
(c) The resident has the right to be fully informed in language that he or she can understand of his or her total health status, including but not limited to, his or her medical condition.
(d) The resident has the right to refuse treatment, and to refuse to participate in experimental research; and
(e) The state veterans home shall according to federal regulations at 42 CFR § 483.10 (c)(8):
(i) Inform each resident who is entitled to medicaid benefits, in writing, at the time of admission to the medicaid certified nursing facility or, when the resident becomes eligible for medicaid of:
(A) The items and services that are included in medicaid certified nursing facility services under the state plan and for which the resident may not be charged;
(B) Those other items and services that the state veterans home offers and for which the resident may be charged, and the amount of charges for those services; and
(ii) Inform each resident when changes are made to the items and services specified in (e)(i)(A) and (B) of this subsection.
(f) The state veterans home shall inform each resident before, or at the time of admission, and periodically during the resident's stay, of services available in the state veterans home and of charges for those services, including any charges for services not covered under medicaid or the medicaid certified nursing facility daily rate.
(g) Disclosure of fees. Prior to admission, the state veterans home shall provide the applicant information on the amount which will be due upon admission.
(h) The state veterans home shall furnish a written description of legal rights which includes:
(i) A description of the manner of protecting personal funds, under subsection (3) of this section;
(ii) In the case of a medicaid certified nursing facility resident, a description of the requirements and procedures for establishing eligibility for medicaid, including the right to request an assessment which determines the extent of a couple's nonexempt resources at the time of admission and attributes to the community spouse an equitable share of resources which cannot be considered available for payment toward the cost of the resident's medical care in his or her process of spending down to medicaid eligibility levels;
(iii) A posting of names, addresses, and telephone numbers of all pertinent state client advocacy groups such as the state survey and certification agency and the state ombudsman program, the protection and advocacy network, and the medicaid fraud control unit; and
(iv) A statement that the resident may file a complaint with the state survey and certification agency concerning resident abuse, neglect, and misappropriation of resident property in the state veterans home.
(i) The state veterans home shall inform each resident of the name, specialty, and way of contacting the physician responsible for his or her care.
(j) The medicaid certified nursing facility shall prominently display in the medicaid certified nursing facility written information and provide to residents and applicants for admission oral and written information about how to apply for and use of medicare and medicaid benefits, and how to receive refunds for previous payments covered by such benefits.
(k) Notification of changes.
(i) The state veterans home must immediately inform the resident; consult with the resident's physician; and if known, notify the resident's surrogate decision maker and when appropriate, with the resident's consent, an interested family member when there is:
(A) An accident involving the resident which results in injury and has the potential for requiring physician intervention;
(B) A significant change in the resident's physical, mental, or psychosocial status (i.e., a deterioration in health, mental, or psychosocial status in either life-threatening conditions or clinical complications);
(C) A need to alter treatment significantly (i.e., a need to discontinue an existing form of treatment due to adverse consequences, or to commence a new form of treatment); or
(D) A decision to transfer or discharge the resident from the state veterans home.
(ii) The state veterans home shall also promptly notify the resident and, if known, the resident's surrogate decision maker and when appropriate, with the resident's consent an interested family member when there is:
(A) A change in room or roommate assignment; or
(B) A change in resident rights under federal or state law or regulations.
(iii) The facility must record and periodically update the address and phone number of the resident's surrogate decision maker and interested family member.
(3) Protection of resident funds.
(a) The resident has the right to manage his or her financial affairs, and the state veterans home may not require residents to deposit their personal funds with the state veterans home.
(b) Management of personal funds. Upon written authorization of a resident, the state veterans home shall hold, safeguard, manage, and account for the personal funds of the resident deposited with the state veterans home.
(c) Accounting and records. The state veterans home must establish and maintain a system that assures a full and complete and separate accounting, according to generally accepted accounting principles, of each resident's personal funds entrusted to the facility on the resident's behalf.
(i) The system must preclude any commingling of resident funds with state veterans home funds or with the funds of any person other than another resident.
(ii) The individual financial records must be available through quarterly statements on request to the resident or his or her legal representative.
(d) Notice of certain balances. The state veterans home shall notify each resident that receives medicaid benefits:
(i) When the amount in the resident's account reaches two hundred dollars less than the SSI limit for one person; and
(ii) That, if the amount in the account, in addition to the value of the resident's other nonexempt resources, reaches the SSI limit for one person, the resident may lose eligibility for medicaid or SSI.
(e) Conveyance upon death. Upon the death of a resident with a personal fund deposited with the state veterans home, the state veterans home must convey within thirty days the resident's funds, and a final accounting of those funds, to the individual or probate jurisdiction administering the resident's estate.
(f) Assurance of financial security. The state veterans homes are self-insured and assure the security of personal funds of residents deposited with the state veterans home.
(g) Limitation on charges to personal funds. The state veterans home may not impose a charge against the personal funds of a resident for any item or service for which payment is made under medicaid, medicare or the U.S. Department of Veterans Affairs.
(h) The state veterans home shall:
(i) Not charge a resident (or the resident's representative) for any item or service not requested by the resident;
(ii) Not require a resident (or the resident's representative) to request any item or service as a condition of admission or continued stay; and
(iii) Inform the resident (or the resident's representative) requesting an item or services for which a charge will be made that there will be a charge for the item or service and what the charge will be.
(4) Free choice. The resident has the right to:
(a) Choose a personal attending physician;
(b) Be fully informed in advance about care and treatment and of any changes in that care or treatment that may affect the resident's well-being; and
(c) Unless adjudged incompetent or otherwise found to be incapacitated under the laws of the state, participate in planning care and treatment or changes in care and treatment.
(5) Privacy and confidentiality. The resident has the right to personal privacy and confidentiality of his or her personal and clinical records.
(a) Personal privacy includes accommodations, medical treatment, written and telephone communications, personal care, visits, and meetings of family and resident groups, but this does not require the state veterans home to provide a private room for each resident;
(b) Except as provided in (c) of this subsection, the resident may approve or refuse the release of personal and clinical records to any individual outside the state veterans home;
(c) The resident's right to refuse release of personal and clinical records does not apply when:
(i) The resident is transferred to another health care institution; or
(ii) Record release is required by law.
(6) Grievances. A resident has the right to:
(a) Voice grievance without discrimination or reprisal. Such grievances include those with respect to treatment which has been furnished as well as that which has not been furnished; and
(b) Prompt efforts by the state veterans home to resolve grievances the resident may have, including those with respect to the behavior of other residents.
(7) Examination of survey results. A resident has the right to:
(a) Examine the results of the most recent survey or complaint investigation of the medicaid certified nursing facility conducted by federal or state surveyors or inspectors and any plan of correction in effect with respect to the medicaid certified nursing facility. The medicaid certified nursing facility shall:
(i) Publicly post a copy of the most recent survey and complaint investigation until the violation is corrected to the satisfaction of the department of social and health services, up to a maximum of one hundred twenty days;
(ii) Make a copy of the survey results available for examination in a place readily accessible to residents;
(iii) Post a notice that the results of the survey or investigation are available and the location of the surveys when not posted; and
(iv) Post surveys and notices in a place or places in plain view of the residents in the medicaid certified nursing facility, persons visiting those residents, and persons who inquire about placement in the medicaid certified nursing facility; and
(b) Receive information from agencies acting as client advocates, and be afforded the opportunity to contact these agencies.
(8) Work. The resident has the right to:
(a) Refuse to perform services for the state veterans home;
(b) Perform services for the state veterans home, if he or she chooses, when:
(i) The state veterans home has documented the need or desire for work in the plan of care;
(ii) The plan specifies the nature of the services performed and whether the services are voluntary or paid; and
(iii) The resident agrees to the work arrangement described in the plan of care.
(9) Mail. The resident has the right to privacy in written communications, including the right to:
(a) Send and promptly receive mail that is unopened; and
(b) Have access to stationery, postage, and writing implements at the resident's own expense.
(10) Access and visitation rights.
(a) The resident has the right and the state veterans home shall provide immediate access to any resident by the following:
(i) Any representative from the federal or state agency administering medicaid or U.S. Department of Veterans Affairs health care programs;
(ii) The resident's individual physician;
(iii) Any representative of the state long term care ombudsman (established under section 307 (a)(12) of the Older American's Act of 1965);
(iv) Subject to the resident's right to deny or withdraw consent at any time, immediate family or other relatives of the resident; and
(v) Subject to reasonable restrictions and the resident's right to deny or withdraw consent at any time, others who are visiting with consent of the resident.
(b) The state veterans home shall provide reasonable access to any resident by any entity or individual that provides health, social, legal, or other services to the resident, subject to the resident's right to deny or withdraw consent at any time.
(c) The state veterans home shall allow representatives of the state ombudsman, described in (a)(iii) of this subsection, to examine a resident's clinical records with the written permission of the resident or the resident's surrogate decision maker, and consistent with state law.
(11) Telephone. The resident has the right to have twenty-four-hour access to a telephone which:
(a) Provides auditory privacy; and
(b) Is accessible to a person with a disability and accommodates a person with sensory impairment.
(12) Personal property. The resident has the right to retain and use personal possessions, including some furnishings, and appropriate clothing, as space permits, unless to do so would infringe upon the rights or health and safety of other residents.
(a) No medicaid certified nursing facility shall require residents to sign waivers of potential liability for losses of personal property.
(b) The state veterans home shall have a system in place to safeguard personal property within the state veterans home.
(13) Roommates rooms.
(a) A resident shall have the right to share a room with his or her spouse when married residents live in the same state veterans home and both spouses consent to the arrangement.
(b) A resident shall have the right to receive three days notice of change in room or roommate except where the move is at the resident's request, a longer or shorter notice is required to protect the health or safety of the person or other resident, or an admission is necessary.
(c) The medicaid certified nursing facility shall make reasonable efforts to accommodate residents wanting to share the same room.
(14) Self-administration of drugs. An individual resident may self-administer drugs if the interdisciplinary care team has determined that this practice is safe.
(15) Refusal of certain transfers.
(a) An individual has the right to refuse a transfer to another room within the state veterans home, if the purpose of the transfer is to relocate a resident from a distinct part of the state veterans home that is a medicaid certified nursing facility to a part of the state veterans home that is not a medicaid certified nursing facility.
(b) A resident's exercise of the right to refuse transfer under (a) of this subsection does not affect the individual's eligibility or entitlement to medicare or medicaid benefits.
[Statutory Authority: RCW 43.60A.070 and chapter 72.36 RCW. 04-19-026, § 484-20-087, filed 9/9/04, effective 10/10/04; 94-22-050, § 484-20-087, filed 10/31/94, effective 12/1/94. Statutory Authority: RCW 43.60A.070. 92-17-046, § 484-20-087, filed 8/14/92, effective 9/14/92.]