12/11/2025

You Asked... We Answered

You Asked: What is meant by a “negative psychosocial outcome”?

We Answered: According to the CMS Psychosocial Outcome Severity Guide, a negative psychosocial outcome refers to changes in a resident’s mood, behavior, emotional well-being, or social engagement that occur as a result of facility noncompliance with a regulatory requirement. Psychosocial outcomes such as sadness, fear, withdrawal, anxiety, humiliation, or depressed mood must be evaluated with the same importance as physical outcomes. Psychosocial outcomes may arise from noncompliance in any regulatory area, and a resident may experience either a negative physical outcome, a negative psychosocial outcome, or both.

Although often associated with situations involving abuse, negative psychosocial outcomes can occur in many other circumstances. For example, surveyors assess for psychosocial harm when reviewing unnecessary medications. Interviews with the resident, family, representative(s), and IDT help determine whether medication side effects contributed to psychosocial decline. Side effects such as sedation, lethargy, agitation, mental status changes, or behavior changes may indicate a negative psychosocial outcome if they:

• affect the resident’s ability to perform activities of daily living or interact with others,
• cause withdrawal or decline from usual social patterns,
• result in decreased engagement in activities, or
• diminish the resident’s ability to think or concentrate.

Additional guidance can be found in the SOM Appendix PP and in the Psychosocial Severity Guide. These documents can be found in the Survey Resources zip file on the CMS Nursing Home webpage and under the downloads section on this CMS webpage.