Failure to Assist Residents with Mobility and Getting Out of Bed
Penalty
Summary
The facility failed to provide necessary assistance with activities of daily living (ADLs), specifically mobility and getting out of bed, for two residents. One resident, who had diagnoses including traumatic subdural hemorrhage, pneumonia, and epilepsy, was assessed as cognitively moderately impaired and fully dependent on staff for mobility and other ADLs. Observations throughout the day showed this resident remained in bed with the call light within reach, and the gastrostomy tube feeding was alternately on and off. The assigned CNA admitted not offering to get the resident out of bed, citing forgetfulness and the presence of a g-tube, despite acknowledging the importance of mobility for preventing bed sores and maintaining function. The Director of Staff Development confirmed that getting residents out of bed is part of morning care and does not require a physician's order, but stated the facility preferred to keep the resident in bed during feeding times. Another resident, with diagnoses including pneumonia, COPD, and low back pain, was cognitively intact and required partial or moderate assistance for mobility. Observations showed this resident remained in bed throughout the morning and early afternoon, with staff assisting only with lunch. The resident reported that only the physical therapist, not nursing staff, assisted her with getting out of bed, and that nursing staff had not offered to help her transfer to a chair. The Director of Staff Development stated that CNAs are expected to offer and assist all residents with getting out of bed and to report refusals to the charge nurse, emphasizing that this is a standard part of daily responsibilities. A review of facility policies confirmed that staff are required to monitor, assist with, and provide ADLs, including transferring from bed to chair, to ensure residents attain or maintain their highest practicable well-being. Despite these policies, the facility did not ensure that the two residents were offered or provided necessary assistance with mobility and getting out of bed, resulting in prolonged periods spent in bed and potential compromise of dignity, preferences, and functional well-being.