Failure to Provide Assistive Device for Bed Mobility
Penalty
Summary
The facility failed to reasonably accommodate the needs and preferences of a resident who required assistive devices for bed mobility. The resident, who had diagnoses including type 2 diabetes mellitus, chronic wounds, and a lumbar vertebra fracture, reported having previously used a bed rail at another facility to assist with repositioning. Despite multiple requests to CNAs, nurses, and therapy staff for a similar device, the resident was informed that such devices were not allowed due to facility policy. The resident expressed that having a positioning bar would help with bed mobility and make him feel more secure, especially when staff were not always available in pairs to assist with changing his brief. Observations and interviews revealed that the resident attempted to use alternative objects, such as the nightstand drawer and his walker, to aid in repositioning, but these were unstable and potentially unsafe. Staff interviews confirmed that the resident required moderate to extensive assistance with bed mobility and that he often held onto the nightstand drawer or walker for support. Some staff acknowledged that a positioning device might be helpful, but none had notified therapy or nursing about the resident's use of these makeshift supports. The care plan indicated a goal to increase the resident's strength and independence, with approaches to encourage participation in ADLs, but did not address the specific need for an assistive device for bed mobility. Facility leadership, including the DON and Director of Rehab, stated that the facility was restraint-free per corporate policy and that devices such as bed canes or side rails were considered restraints and therefore not permitted. While a trapeze was available for some residents, it was not deemed helpful for side-to-side movement, and the resident had declined its use. The facility's policy and lack of individualized assessment for the requested device resulted in the resident not receiving reasonable accommodation for his bed mobility needs.