CMS SOM App. PP, Tag F566

and the facility must not require a resident to perform services for the facility. The resident

may perform services for the facility, if he or she chooses, when—

(i) The facility has documented the resident’s 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;

(iii) Compensation for paid services is at or above prevailing rates; and

(iv) The resident agrees to the work arrangement described in the plan of care.

DEFINITIONS §483.10(f)(9)

“Prevailing rate” is the wage paid to the majority of workers in the community surrounding the

facility for the same type, quality, and quantity of work requiring comparable skills.

GUIDANCE §483.10(f)(9)

All work or services provided by a resident, whether voluntary or paid, must be part of his/her

care plan. Any work assignment must be agreed to and negotiated by the resident or the

resident’s representative. The resident also has the right to refuse to participate in these services

or assignments at any time.

A resident’s request to work or perform services should be discussed by the interdisciplinary

team and be clinically and psychologically appropriate for the resident.

PROCEDURES §483.10(f)(9)

• Through interviews with residents, resident representatives, and staff, determine if

residents were given a choice as to whether or not they were willing to perform services.

• During observations, note whether residents are engaged in performing these services

(such as housekeeping, laundry, meal set up, etc.).

• Review the resident’s care plan to ensure it includes;

o The nature of the services to be provided, including the resident’s desire to do so, and

the objectives for this arrangement; and,

o Whether they are provided voluntarily or paid.

Examples of noncompliance may include, but are not limited to:

• The resident or his or her representative did not agree to the work arrangements;

• The resident’s care plan does not specify the nature of the services provided by the

resident or whether or not they are voluntary or paid; or

• Compensation for paid services is not at or above prevailing rates.