Advance Directive Signed by Incompetent Resident
Penalty
Summary
The facility failed to ensure that advance directive forms were properly completed by a designated responsible party for a resident who was deemed incompetent to make medical decisions. The resident, who had diagnoses including dementia and a history of falls, was assessed as severely cognitively impaired and required substantial to maximum assistance. Documentation in the medical record indicated that the resident was admitted to hospice services and had been formally evaluated as incompetent to make healthcare decisions by both a physician and a clinical psychologist. Despite this determination of incompetency, the most recent advance directive form specifying code status (MI-POST) was signed by the resident, rather than by the designated patient advocate or responsible party. Interviews with facility staff confirmed that the resident should not have signed the form due to their incompetency, and the error was attributed to a likely mistake by nursing staff. The facility's policy requires periodic evaluation of residents' decision-making capacity and proper completion of advance directives, which was not followed in this instance.