CMS SOM App. J, Tag W209

client's legal guardian is required unless the participation is unobtainable or inappropriate.

Guidance §483.440(c)(2)

The facility should make every effort to schedule team meetings at a time that enables the client

parent or legal guardian, to attend without having to forfeit work time or pay.

The facility should make every effort to schedule team meetings at a time that enables the client

parent or legal guardian, to attend without having to forfeit work time or pay.

It is expected that the client will routinely attend team meetings unless their participation is

unobtainable. Examples of when client participation is not available include, but are not limited

to: 1) the client is away from the facility for medical reasons or hospitalization; or 2) although

the facility has documented repeated attempts to engage the client, the client refuses to

participate.

If families/legal guardians are unable to attend a program planning meeting, the facility provides

them information regarding the meeting outcome and gives them an opportunity to discuss the

plan with the facility staff.

"Unobtainable", for the purposes of this guideline, means that the facility has made a good faith

effort to seek parental or legal guardian participation in the process, even though the effort may

ultimately be unsuccessful (for example, the parent may be impossible to locate or may prove

unwilling or unable to participate).

"Inappropriate", for the purposes of this guideline, means that the parent or legal guardian's

behavior is so disruptive or uncooperative that others cannot effectively participate; the client

does not wish his or her parent to participate, and the client is competent to make this decision;

or there is strong and documented evidence that the parent or legal guardian is not acting on

the client's behalf or in the client's best interest. In the case of the latter, determine what the

facility has done to bring effective resolution to the problem.

Instances when it is not appropriate for the client, parent or legal guardian, to attend the team

discussion are rare. If the client does not attend the meeting, the facility must document the

reason for his/her non-participation.

There may also be instances where a parent or legal guardian is considered unobtainable for a

team meeting, such as being out of the country. In these instances, the parent or legal guardian

should still be notified of the meeting, provided with information concerning the outcome of the

meeting and documentation in the client record should describe why the parent or legal

guardian could not attend and what information was provided to them.

If the client is an adult who is competent to make decisions and who is not adjudicated, parents

may not participate in the process if their participation is opposed by the client.

In the event that a non-adjudicated adult chooses not to have their family involved in the active

treatment process, the surveyor should see evidence in the record of efforts made by the facility

to understand why the client has declined family participation. If the client continues to decline

family involvement after the facility has held discussions with him/her about the importance of

this issue, the facility should honor the wishes of the client.

In general, the more involvement and communication among the team members, the client and

the parent or legal guardian the more likely the plan will be successful. The facility goal should

be to routinely include these parties unless rare circumstances exist.