This F-Tag requires nursing facilities to provide medically-related social services aimed at attaining or maintaining each resident's highest practicable physical, mental, and psychosocial well-being. Covered services include advocacy, grievance resolution, mental health counseling referrals, transitions of care assistance, advance care planning, and support for residents experiencing distress, loss, or abuse. Facilities must identify social service needs and ensure they are met, though a qualified social worker need not deliver all services unless required by state law. This regulation governs nursing facility operations and does not license or set standards for any distinct behavioral health level of care.
View official sourceF745 (Rev. 225; Issued: 08-08-24; Effective: 08-08-24; Implementation: 08-08-24) §483.40(d) The facility must provide medically-related social services to attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident. INTENT §483.40(d) To assure that sufficient and appropriate social services are provided to meet the resident’s needs. DEFINITIONS §483.40(d) Definitions are provided to clarify terminology related to behavioral health services and the attainment or maintenance of a resident’s highest practicable well-being. “Medically-related social services” means services provided by the facility’s staff to assist residents in attaining or maintaining their mental and psychosocial health. GUIDANCE §483.40(d) All facilities are required to provide medically-related social services for each resident. Facilities must identify the need for medically-related social services and ensure that these services are provided. It is not required that a qualified social worker necessarily provide all of these services, except as required by State law. If there are concerns about requirements involving qualified social workers, refer to §483.70(o) (F850), Social worker. Examples of medically-related social services include, but are not limited to the following: • Advocating for residents and assisting them in the assertion of their rights within the facility in accordance with §483.10, Resident Rights, §483.12, Freedom from Abuse, Neglect, and Exploitation, §483.15, Transitions of Care, §483.20, Resident Assessments (PASARR), and §483.21, Comprehensive Person-Centered Care Planning; • Assisting residents in voicing and obtaining resolution to grievances about treatment, living conditions, visitation rights, and accommodation of needs; • Assisting or arranging for a resident’s communication of needs through the resident’s primary method of communication or in a language that the resident understands; • Making arrangements for obtaining items, such as clothing and personal items; • Assisting with informing and educating residents, their family, and/or representative(s) about health care options and ramifications; • Making referrals and obtaining needed services from outside entities (e.g., talking books, absentee ballots, community wheelchair transportation); • Assisting residents with financial and legal matters (e.g., applying for pensions, referrals to lawyers, referrals to funeral homes for preplanning arrangements); • Transitions of care services (e.g., assisting the resident with identifying community placement options and completion of the application process, arranging intake for home care services for residents returning home, assisting with transfer arrangements to other facilities); • Providing or arranging for needed mental and psychosocial counseling services; • Identifying and seeking ways to support residents’ individual needs through the assessment and care planning process; • Encouraging staff to maintain or enhance each resident’s dignity in recognition of each resident’s individuality; • Assisting residents with advance care planning, including but not limited to completion of advance directives (For additional information pertaining to advance directives, refer to §483.10(g)(12) (F578)), Advance Directives); • Identifying and promoting individualized, non-pharmacological approaches to care that meet the mental and psychosocial needs of each resident; and • Meeting the needs of residents who are grieving from losses and coping with stressful events. Situations in which the facility should provide social services or obtain needed services from outside entities include, but are not limited to the following: • Lack of an effective family or community support system or legal representative; • Expressions or indications of distress that affect the resident’s mental and psychosocial well-being, resulting from depression, chronic diseases (e.g., Alzheimer’s disease and other dementia related diseases, schizophrenia, multiple sclerosis), difficulty with personal interaction and socialization skills, and resident to resident altercations; • Abuse of any kind (e.g., alcohol or other drugs, physical, psychological, sexual, neglect, exploitation); • Difficulty coping with change or loss (e.g., change in living arrangement, change in condition or functional ability, loss of meaningful employment or activities, loss of a loved one); and • Need for emotional support. NOTE: When needed services are not covered by Medicaid, nursing facilities are still required to attempt to obtain these services on behalf of the resident (e.g., arranging transportation services).