Failure to Honor Resident's Shower Preferences on Dialysis Days
Penalty
Summary
The facility failed to honor a resident's preferences regarding personal hygiene care, specifically related to shower scheduling. The resident, who had diagnoses including metabolic encephalopathy, urinary tract infection, and end stage renal disease, was cognitively intact and received dialysis three times a week on Mondays, Wednesdays, and Fridays. Documentation showed that the resident frequently refused showers on Wednesdays, which coincided with her dialysis days, and expressed concerns about going to dialysis with wet hair and the risk of developing pneumonia. Despite the resident communicating her preferences to multiple staff members, her shower schedule was not adjusted to accommodate her wishes. Review of the care plan indicated interventions to support resident choice and provide opportunities for decision-making during care. However, records from February to early May showed repeated refusals of showers on dialysis days, with staff documenting refusals but not consistently exploring or addressing the underlying reasons. Progress notes and psychiatric notes confirmed that the resident occasionally refused showers, but there was no evidence that staff had asked the resident about her reasons for refusal or attempted to modify the schedule based on her expressed preferences. Interviews with staff, including a CNA, LPN, and the DON, revealed that while staff were aware of the resident's refusals and her concerns about showering before dialysis, there was no indication that her preferences were formally considered or that her shower schedule was changed. The facility's policy required involving residents in decision-making related to ADLs, but in this case, the resident's choice regarding shower timing was not honored, leading to the deficiency.