[Code of Federal Regulations] [Title 38, Volume 2] [Revised as of July 1, 2003] From the U.S. Government Printing Office via GPO Access [CITE: 38CFR52.70] [Page 847-850] TITLE 38--PENSIONS, BONUSES, AND VETERANS' RELIEF CHAPTER I--DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PART 52--PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES-- Table of Contents Subpart D--Standards Sec. 52.70 Participant rights. The participant has a right to a dignified existence, self- determination, and communication with and access to persons and services inside and outside the facility. The program management must protect and promote the rights of each participant, including each of the following rights: (a) Exercise of rights. (1) The participant has the right to exercise his or her rights as a participant of the program and as a citizen or resident of the United States. (2) The participant has the right to be free of interference, coercion, discrimination, and reprisal from the program management in exercising his or her rights. (3) The participant has the right to freedom from chemical or physical restraint. [[Page 848]] (4) In the case of a participant determined incompetent under the laws of a State by a court of jurisdiction, the rights of the participant are exercised by the person appointed under State law to act on the participant's behalf. (b) Notice of rights and services. (1) The program management must inform the participant both orally and in writing in a language that the participant understands of his or her rights and all rules and regulations governing participant conduct and responsibilities during enrollment in the program. Such notification must be made prior to or upon enrollment and periodically during the participant's enrollment. (2) Participants or their legal representatives have the right-- (i) Upon an oral or written request, to access all records pertaining to them including current participant records within 24 hours (excluding weekends and holidays); and (ii) After receipt of their records for review, to purchase, at a cost not to exceed the community standard, photocopies of the records or any portions of them upon request and with two working days advance notice to the facility management. (3) Participants have the right to be fully informed in language that they can understand of their total health status. (4) Participants have the right to refuse treatment, to refuse to participate in patient activities, to refuse to participate in experimental research, and to formulate an advance directive as specified in paragraph (a)(7) of this section. (5) The program management must inform each participant before, or at the time of enrollment, and periodically during the participant's stay, of services available in the facility and of charges for those services to be billed to the participant. (6) The program management must furnish a written description of legal rights which includes a statement that the participant may file a complaint with the State (agency) concerning participant abuse and neglect. (7) The program management must have written policies and procedures regarding advance directives (e.g., living wills). These requirements include provisions to inform and provide written information to all participants concerning the right to accept or refuse medical or surgical treatment and, at the individual's option, formulate an advance directive. This includes a written description of the facility's policies to implement advance directives and applicable State law. (8) Notification of changes. (i) Program management must immediately inform the participant; consult with the primary physician; and notify the participant's legal representative or an interested family member when there is-- (A) An accident involving the participant which results in injury and has the potential for requiring physician intervention; (B) A significant change in the participant's physical, mental, or psychosocial status (e.g., 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 participant from the program. (ii) The program management must also promptly notify the participant and the participant's legal representative or interested family member when there is a change in resident rights under Federal or State law or regulations as specified in paragraph (b)(1) of this section. (iii) The program management must record and periodically update the address and phone number of the participant's legal representative, or interested family member, and the primary physician. (c) Free choice. (1) The participant has the right to-- (i) Be fully informed in advance about care and treatment and of any changes in that care or treatment that may affect the participant's well-being; and (ii) Unless determined incompetent or otherwise determined to be incapacitated under the laws of the State, [[Page 849]] participate in planning care and treatment or changes in care and treatment. (2) If the participant is determined incompetent or otherwise determined to be incapacitated under the laws of the State, the participant's legal representative or interested family member(s) has the right to participate in planning care and treatment or changes in care and treatment. (d) Privacy and confidentiality. Participants have the right to privacy and confidentiality of their personal and clinical records. (1) Participants have a right to privacy in their medical treatment and personal care. (2) Except as provided in paragraph (d)(3) of this section, participants may approve or refuse the release of personal and clinical records to any individual outside the facility. (3) The participant's right to refuse release of personal and clinical records does not apply when-- (i) The participant is transferred to another health care institution; or (ii) The release is required by law. (e) Grievances. A participant has the right to-- (1) Voice grievances without discrimination or reprisal. Participants may voice grievances with respect to treatment received and not received; and (2) Prompt efforts by facility management to resolve grievances the participant may have, including those with respect to the behavior of other participants. (f) Examination of survey results. A participant has the right to-- (1) Examine the results of the most recent VA survey with respect to the program. The program management must make the results available for examination in a place readily accessible to participants, and must post a notice of their availability; and (2) Receive information from agencies acting as client advocates, and be afforded the opportunity to contact these agencies. (g) Work. The participant has the right to-- (1) Refuse to perform services for the facility; (2) Perform services for the facility, if he or she chooses, when-- (i) The facility has documented the need or desire for work therapy in the plan of care; (ii) The plan specifies the nature of the services performed and whether the services are voluntary or paid; (iii) Compensation for (work therapy) paid services is at or above prevailing rates; and (iv) The participant agrees to the work therapy arrangement described in the plan of care. (h) Access and visitation rights. (1) The program management must provide immediate access to any participant by the following: (i) Any representative of the Under Secretary for Health; (ii) Any representative of the State; (iii) The State long-term care ombudsman; (iv) Immediate family or other relatives of the participant subject to the participant's right to deny or withdraw consent at any time; and (v) Others who are visiting subject to reasonable restrictions and the participant's right to deny or withdraw consent at any time. (2) The program management must provide reasonable access to any participant by any entity or individual that provides health, social, legal, or other services to the participant, subject to the participant's right to deny or withdraw consent at any time. (3) The program management must allow representatives of the State Ombudsman Program to examine a participant's clinical records with the permission of the participant or the participant's legal representative, subject to State law. (i) Telephone. The participant has the right to reasonable access to use a telephone where calls can be made without being overheard. (j) Personal property. The participant has the right to have at least one change of personal clothing. (k) Self-administration of drugs. An individual participant may self-administer drugs if the interdisciplinary team has determined that this practice [[Page 850]] is safe for the individual and is a part of the care plan. (Authority: 38 U.S.C. 101, 501, 1741-1743) (The Office of Management and Budget has approved the information collection requirements in this paragraph under control number 2900- 0160.)