Long-Term Care Substitution Requests: Federal, State & Facility Regulations

Residents’ requests for care substitutions (food, activities, treatments) are governed by layered regulations:

Federal (CMS)

• Residents’ Rights (42 CFR §483.10): Right to choose care.
• Comprehensive Care Plans (42 CFR §483.20): Must reflect preferences, including substitutions.
• Resident Assessment: Must document preferences.
• Food & Nutrition Services (42 CFR §483.35): Alternatives required when requested.

State Regulations

Each state has nursing home rules; some exceed federal minimums. Consult your State Department of Health.

Facility Policies

• Written procedures for substitution requests.
• Resident consent central—exceptions only for incapacity or safety risk.

Individual needs, preferences, and rights must guide every decision.