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F578: Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive

F578 is one of the federal requirements every Medicare and Medicaid certified nursing home must meet. CMS describes it as: Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. It sits in CMS's resident rights category.

4,306citations in the CMS files
3,609homes cited at least once
819in the 12 months to September 2026
2.6%rated actual harm or immediate jeopardy

CMS Health Deficiencies file, data as of September 1, 2026. The files hold each home's last three standard inspections and three years of complaint visits.

How seriously inspectors rate it

Every citation gets a letter for how much harm inspectors found and how many residents it touched (how to read the letters). 10.0% of F578 citations came from a complaint visit rather than a routine inspection.

  • Immediate jeopardy (J, K, L)94 (2.2%)
  • Actual harm (G, H, I)16 (0.4%)
  • Potential for more than minimal harm (D, E, F)4,170 (96.8%)
  • Potential for minimal harm (A, B, C)26 (0.6%)

By letter: B 26, D 3,276, E 860, F 34, G 16, J 81, K 10, L 3.

What inspectors wrote

Three recent F578 citations from different states, quoted from the inspectors' statements of deficiencies (CMS form 2567). Names are removed by CMS.

Inspectors wrote, August 6, 2026, scope and severity DBased on interview and record review, the facility failed to ensure all residents had the right to formulate an advance directive for 2 of 8 residents (Resident #74 and Resident #84) reviewed for advanced directives, in that: The facility failed to ensure Resident #74 and Resident #84 had an Out-of-Hospital Do Not Resuscitate (OOH-DNR) form that did not have missed required information. These failures could place residents at risk for not having their end-of-life wishes honored and incomplete records.

Parkview Skilled Care and Rehabilitation, Big Spring, TX

Inspectors wrote, August 6, 2026, scope and severity DBased on interview, record review, and policy review, the provider failed to ensure that a resident's advance directive (a legal document that expresses a person's health care wishes if they become unable to speak for themselves) and code status (specifies the type of emergent treatment a person wishes to receive if their heart or breathing would stop) were accurately documented to reflect the resident's chosen wishes for one of one sampled resident (16) with documented code status discrepancies.

Custer Care and Rehab Center, Custer, SD

Inspectors wrote, July 31, 2026, scope and severity DBased on interview and document review the facility failed to ensure 1 of 1 resident's (R5) Provider Orders for Life Sustaining Treatment (POLST) was completed timely.

Heritage Manor, Chisholm, MN

Most recent F578 citations at the harm or jeopardy level

Newest first, the latest 40 in the current files. Each home's page shows the citation in full context, with its correction status.

InspectionHomeTownLetterVisit
July 30, 2026Aviata at Arbor SpringsOcala, FL JComplaint
July 24, 2026Autumn Lake Healthcare at BeloitBeloit, WI LComplaint
July 1, 2026Lexington Health Care CenterLexington, NC GStandard
June 17, 2026Goldwater Care Peoria HeightsPeoria Heights, IL GComplaint
June 10, 2026Palm Garden of ClearwaterClearwater, FL JComplaint
May 20, 2026Villa at Beecher PlaceFlint, MI JComplaint
May 1, 2026Viera Del Mar Health and Rehabilitation CenterViera, FL JStandard
April 28, 2026Paradigm at Woodwind LakesHouston, TX KComplaint
April 9, 2026Aztec HealthcareAztec, NM JComplaint
April 6, 2026Jewish Home and Care CenterMilwaukee, WI LComplaint
April 6, 2026Southside Care CenterMinneapolis, MN JStandard
March 27, 2026Vivo Healthcare GandyTampa, FL JComplaint
March 20, 2026Meridian Care Monte VistaSan Antonio, TX JComplaint
March 5, 2026Vivo Healthcare West OrangeOcoee, FL JComplaint
February 25, 2026Rosewood Rehabilitation and Nursing CenterRensselaer, NY KComplaint
January 29, 2026Medilodge of Grand RapidsGrand Rapids, MI GComplaint
January 28, 2026Eagle Crest Rapid RecoveryHouston, TX JComplaint
January 23, 2026Hampshire Memorial HospitalRomney, WV JStandard
January 23, 2026Springs at Boca Ciega BaySouth Pasadena, FL JComplaint
December 22, 2025Center at Centerplace, LLC, theGreeley, CO JComplaint
December 17, 2025Dade City Health and Rehabilitation CenterDade City, FL JComplaint
December 8, 2025The Terrace at Crystal LLCCrystal, MN JStandard
December 4, 2025Cranbury CenterMonroe Township, NJ JStandard
October 29, 2025Birmingham Nursing and Rehabilitation Ctr LLCBirmingham, AL JComplaint
October 24, 2025Aviata at Bryan DairyLargo, FL JComplaint
September 26, 2025Solaris Healthcare Bayonet PointHudson, FL JComplaint
September 22, 2025Mn Veterans Home-MplsMinneapolis, MN JComplaint
September 11, 2025Villas at Bryn Mawr LLCMinneapolis, MN JComplaint
September 11, 2025Casa Mora Rehabilitation and Extended CareBradenton, FL KComplaint
September 2, 2025Tolstoy Foundation Rehabilitation and Nrsg CenterValley Cottage, NY LStandard
September 2, 2025Falkville Rehabilitation and Healthcare CenterFalkville, AL KComplaint
August 14, 2025Morningstar Residential Care CenterOswego, NY JComplaint
August 1, 2025Sterling Park Health Care CenterWaite Park, MN JStandard
July 24, 2025Evercare of SwanseaSwansea, IL JComplaint
June 27, 2025The Rehabilitation Center of AlbuquerqueAlbuquerque, NM JComplaint
June 26, 2025Hayes ResidenceSaint Paul, MN JStandard
June 13, 2025Pruitthealth - Fleming IslandFleming Island, FL JComplaint
June 12, 2025Martin Luther Care CenterBloomington, MN JStandard
June 10, 2025La Bella of CahokiaCahokia, IL JComplaint
May 15, 2025Sonterra Health CenterSan Antonio, TX GStandard

Most recent F578 citations

InspectionHomeTownLetter
August 6, 2026Parkview Skilled Care and RehabilitationBig Spring, TX D
August 6, 2026Custer Care and Rehab CenterCuster, SD D
July 31, 2026Heritage ManorChisholm, MN D
July 31, 2026South Coast Post AcuteSanta Ana, CA E
July 30, 2026Montgomeryville Skilled Nursing and RehabilitatiMontgomeryville, PA E
July 30, 2026Aventura at Carriage InnDayton, OH D
July 30, 2026Azalea Health & Rehab CenterWilmington, NC E
July 30, 2026Wilson Pines Nursing and Rehabilitation CenterWilson, NC D
July 30, 2026Hertford Rehabilitation and Healthcare CenterHertford, NC B
July 30, 2026Laurel Health & Rehabilitation CenterLaurel, MT D
July 30, 2026Aviata at Arbor SpringsOcala, FL J
July 29, 2026Magnolia Place Health CareLiberty, TX E
July 24, 2026Autumn Lake Healthcare at BeloitBeloit, WI L
July 24, 2026Splendido at Rancho VistosoTucson, AZ D
July 23, 2026Mountain City Nursing & Rehabilitation CenterHazleton, PA D
July 23, 2026La Grande Post Acute RehabLa Grande, OR D
July 23, 2026Riverside Landing Nursing and RehabilitationMcConnelsville, OH D
July 23, 2026Nora Springs Care CenterNora Springs, IA D
July 22, 2026The HighlandsDecorah, IA D
July 20, 2026Westmoreland PlaceChillicothe, OH D
July 20, 2026Sanctuary WadsworthWadsworth, OH D
July 20, 2026Tower Nursing and Rehabilitation CenterRaleigh, NC E
July 17, 2026Parklane West Healthcare CenterSan Antonio, TX D
July 17, 2026Dreier's Nursing Care CenterGlendale, CA D
July 17, 2026August Healthcare at WilmingtonWilmington, NC E

F578 citations by state

Counts depend on how many homes a state has and how often its inspectors visit, so a larger number is not by itself a worse record.

StateCitations
California778
Ohio329
Texas241
Illinois194
Michigan186
Maryland164
Pennsylvania150
Missouri139
Washington135
Oklahoma132
Connecticut130
North Carolina126
Virginia120
Florida107
Massachusetts81
Iowa79
Indiana79
New York78
Georgia70
Minnesota66
Louisiana64
Wisconsin64
Oregon63
Idaho55
New Jersey54
West Virginia51
Mississippi48
Tennessee46
Maine42
New Mexico39
Arizona36
Colorado31
Kentucky31
Arkansas30
Kansas28
South Carolina25
South Dakota24
Hawaii23
Montana23
Utah21
District of Columbia17
Delaware16
North Dakota13
Nevada13
Alabama11
Nebraska10
Vermont10
Wyoming10
New Hampshire8
Rhode Island8
Puerto Rico6
Alaska1
Guam1

By inspection year: 2018 22, 2019 138, 2020 56, 2021 148, 2022 369, 2023 782, 2024 1,187, 2025 1,026, 2026 578.

Common questions

What is F578 in a nursing home inspection?
F578 is the federal requirement to "honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive". CMS files it under resident rights. A home cited under F578 did not meet that requirement at the inspection.
How often is F578 cited?
The CMS files as of September 1, 2026 list 4,306 F578 citations at 3,609 nursing homes, 819 of them in the 12 months to that date. 2.6% were rated as actual harm or immediate jeopardy.
Is a F578 citation serious?
It depends on the letter. Most F578 citations (96.8%) were rated as potential for more than minimal harm, D to F. 94 were immediate jeopardy, the most serious level.

The interpretive guidance inspectors use for each F-tag is CMS's State Operations Manual, Appendix PP. NursingHomeClear reports the citations as CMS records them and is not affiliated with CMS. All F-tags · Methodology

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